Fighting Fear

Confronting phobias and other fears

The Effectiveness of Psychotherapy

How do you measure growth?


It is the conviction of most psychotherapists that their efforts produce a significant effect. For one thing, patients report that they are being helped. However, clinical studies examining the benefits of psychotherapy have given ambiguous results. Some investigations seem to suggest that psychotherapy, even in the hands of a highly trained professional, is ineffective, judging, at least, from how well someone appears to be two or three years after seeking out treatment. Persons placed on a waiting list, but never treated, turn out to be as well-adjusted as those who are! Other outcome studies, perhaps, are more encouraging. The fact is, though, all of these studies are misleading: the long-term influence of psychotherapy is simply too subtle to measure bv current techniques in outcome studies. One might just
 as well try to determine the effect of four years of college by measuring the wisdom with which college graduates conduct their lives, and comparing it with that of high school graduates.

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The immediate effects of psychotherapy are also important, and are, after all, what patients are looking for when they come to treatment. Some patients come in the midst of crisis. A relationship has faltered, an anticipated job has fallen through. Or the crisis may be just the ordinary upsets of life that happen from time to time--when a young person moves away to college--or when a middle-aged person has to cope with the various physical and emotional demands that are referred to commonly as “change of life.”  Those are some of the circumstances; but the symptoms are usually of anxiety or depression. The more severe symptoms of a psychosis are less likely in patients who come primarily for psychotherapy, although therapy is relevant, too, in the treatment of those conditions.

And when patients see a therapist, they do as a rule feel less anxious and less unhappy. They are encouraged and comforted by the process of psychotherapy; and that alone is sufficient justification for it. Therapists sometimes take up a special place in their patients’ lives. They may come to represent a friend or even a kind of parent—someone who is objective, but who roots for them. The patient’s success in life may turn on issues of morale. The therapist being hopeful encourages the patients to feel the same way.

Other kinds of treatment also cannot be measured simply by outcome. Psychotherapy is similar to the rest of medicine in this respect. For example, most childhood illnesses are self-limited. Consequently, a group of children treated for certain conditions might be indistinguishable six months later from another group who had been similarly ill, but who had had no treatment; yet while they were ill, they might have felt much better by virtue of taking medicine to relieve their pain and discomfort, and by getting proper nursing care.

Emotional illnesses are still more sensitive and more responsive to proper care. The results one
might reasonably expect from a successful psychotherapy are as follows:
1. An immediate although perhaps modest relief of psychological pain and suffering.
2. A diminution of symptoms, in part because the patient is better able to adhere to other treatment regimens, including the use of drugs and other organic therapies.
3. An acceleration of the natural tendency of people to become well in time-- and in certain chronic conditions a slowing of the pathological process.
4. An avoidance of certain social catastrophes that acutely disturbed patients tend to visit upon themselves, such as the loss of a job, the dissipation of savings, the disruption of a family, and so on.
5. And certainly, in certain cases, the furtherance of a real growth of personality. The individual thinks better of himself or herself and is better able to cope with stress and with the vicissitudes of living. Individuals who have been in a successful  treatment have to a greater extent mastered themselves
and their environment. In such ways psychotherapy may have a crucial influence in someone who is emotionally disturbed—profoundly, if slowly, affecting both his attitudes and his behavior.


 A psychotherapist who is professionally trained over a period of years may find that years later he is still learning; yet  psychotherapy is not a technique of surgical precision, but rather a way of being with patient—an attitude. Like anything else people do, it can be done well or less well, or poorly. A therapist who is a good fit for one patient may not fit with another. This is similar to how friendships differ, depending on differences in personality.

Often patients come to therapy with distinct goals: the alleviation of symptoms of one sort or another, and then go on to contemplate other changes in the way they live. This is a laudable goal, although, at that point, treatment no longer fits the medical model. Treatment is directed at the difficulties everyone has in living, and not just in ameliorating certain symptoms.   (Drawn in part from “Caring: Home Treatment for the Emotionally Disturbed.”)© Fredric Neuman  Follow Dr. Neuman's blog at fredricneumanmd.com/blog

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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