A major study shows that psychotherapy doesn't work very well at
all. Butbefore you jump to simple conclusions, consider this: When it
comes to matters of the mind, drug therapy isn't any more
effective.
DOES PSYCHOTHERAPY WORK? DOES PROFESSIONAL TRAINING ACTUALLY MAKE
THERAPISTS MORE EFFECTIVE? THESE ARE SOME OF THE QUESTIONS THAT
RESEARCHERS ARE CURRENTLY DEBATING HOTLY ACROSS E-MAIL NETWORKS, AT
CONFERENCES, AND, TO A LESSER EXTENT, IN PSYCHOTHERAPY JOURNALS.
The matter is scarcely insignificant. Some 16 million people a year
use mental-health services such as psychotherapy. And an estimated 24
million more need help, though many of them get it outside the
mental-health system.
Now, two heavyweight psychologists have completed a thorough review
of the literature. Their findings are eye-opening--though you won't find
the mental-health establishment calling a press conference.
The two psychologists report that years of experience, professional
education, or lawful credentials do not determine the success of
psychotherapy. Never mind that millions of dollars are spent each year on
studies comparing the approaches of experienced therapists. Never mind
that the more experienced, more educated therapists charge more money for
their services. The outcome of therapy is not enhanced by training,
education, or years of experience. It may not even matter whether there
is a live therapist present!
This is the startling conclusion of Andrew Christensen, Ph.D., and
Neil Jacobson, Ph.D. Their study, entitled "Who--Or What--Can Do
Psychotherapy?" appeared in the January issue of Psychological Science, a
publication put out by the politically brave American Psychological
Society.
Christensen, professor of psychology at University of California at
Los Angeles, and Jacobson, professor of psychology at the University of
Washington, contend that no one has made much of an effort to look at
therapy delivered by nonprofessionals, despite the fact that it proves
just as effective, or more effective, than therapy performed by
psychiatrists, psychologists, social workers, and family
therapists.
Nor has anyone rushed to fund the study of inexpensive yet
promising alternatives such as self-help and support groups led by
nonprofessionals, to say nothing of self-administered treatments via
self-help books or interactive computer programs--even though the
American Psychiatric Association estimates that 15 million people in the
United States participate in self-help groups.
"Most studies compare different types of professional treatments,"
Christensen notes. "It is discouraging, because the most common finding
is that there is no difference among treatments. We suggest that more
money be allocated to studying nonprofessional treatments--where the
results are promising and cost less to achieve."
Comparing professional and nonprofessional treatments tells us more
about what actually helps people get better, Christensen insists. He and
Jacobson reviewed studies done since 1979 that asked: Are professionally
trained therapists more effective than paraprofessional helpers without
professional degrees but often with specific training? One study they
reviewed showed no differences in the rates of psychological improvement
when professional therapists, averaging 23 years of experience--were
compared with liberal arts college professors having no experience or
training. Both were "treating" disturbed college students.
The duo also discussed a 1979 review of 42 studies that compared
professional and paraprofessional therapists. Only one component of the
study demonstrated superiority of professionals; in 12, paraprofessionals
actually helped people more. The remaining 29 found no
differences.
Over the years, the data from the troublesome 1979 review have been
reanalyzed using more stringent standards; each time the results have
come back stronger for paraprofessionals. One study concluded: "Clients
who seek help from paraprofessionals are more likely to achieve
resolution of their problem than those who consult professionals.
Hmmm.
"These are provocative findings for the psychotherapy community,"
note Christensen and Jacobson. "It is hard to imagine a study comparing
trained and untrained surgeons, or trained and untrained electricians,
for that matter. Dead patients in the first instance or dead trainees in
the second could be the unfortunate outcome."
The difference between surgeons and psychotherapists has a lot to
do with the difference between surgery and therapy. Across the board,
psychotherapy researchers agree that a positive therapist/client
relationship is the most important feature of successful
treatment.
But get this--the Christensen and Jacobson report questions even
the highly touted need for a therapist/client relationship.
Self-administered treatments worked just as well as those delivered by
live therapists, in certain cases. Computerized treatments have been
shown to work for obesity, phobias, and depression.
Observes Christensen: "With most professions it is very clear there
is a specific skill involved, but in psychotherapy it is not clear that
the skills of the therapist are any more helpful than the skills of
people with life experience in dealing with a problem."
Tags:
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mental health services,
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neil jacobson,
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psychological science,
psychotherapy,
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startling conclusion,
therapist client relationship,
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university of california at los angeles,
university of washington
