In a world in which pharmaceutical companies bombard consumers with ads for drugs that treat everything from anxiety to ADHD, it's easy to regard a pill as the be-all and end-all to life's difficulties. Research on the effectiveness of the most commonly prescribed medications show that these drugs can alleviate the symptoms in people with severe depression. This fact didn't stop Dr. Peter Kramer from claiming recently in a highly controversial New York Times article that antidepressants are good for almost all of what ails us mentally, even if we're psychologically normal or perhaps a bit neurotic. We're not told, though, that results of drug company sponsored studies that don't show a positive effect of medications are not published, a problem called the "file drawer" phenomenon.
What you might not know is that these drugs are not effective for moderate or mild depression symptoms. What's worse, their side effects and interactions with other medications can make someone's psychological symptoms worse and cause serious health problems. As if this weren't bad enough, the majority of drugs intended to treat psychological disorders are not prescribed by mental health experts, but by physicians who in 15 minutes or less dispense therapy in a bottle without trying to address the patient's thoughts or feelings.
The public is not being served by these pharmacological solutions to life's problems. Moreover, the cost of these medications is adding to our whopping health care costs which themselves are tied in with the deficit, the debt ceiling problems, and escalating insurance premiums. For example, in 2010, according to an IMS report, antidepressants were the second highest class of medications prescribed by physicians in the U.S. (253.6 million prescriptions). The annual total price tag was11.6 billion U.S. dollars, which was 4% of all spending on prescription medications.
Psychotherapy is cheaper and more effective than medications for many of the problems that lead people to seek treatment. Estimates of
psychotherapy's effectiveness, based on hundreds of empirical studies, are that it works approximately 75-80% of the time. That's a pretty impressive figure. And believe it or not, psychotherapy is cheaper than prescription medications particularly when you consider the impact on your ability to
achieve your long-term life goals.
To be effective, psychotherapy needs to be provided in a way that meets a set of well-defined criteria. Condensing many hundreds of studies, psychologist Bruce Wampold, in a recent American Psychological Association symposium, boiled these ingredients down to this baker's dozen. I've listed them in brief and translated them into practical terms that you can use in evaluating mental health professionals serving you or those close to you.
1. Possession of a sophisticated set of interpersonal skills. Effective psychotherapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.
What this means for you: When you talk about what you're experiencing, does your therapist seem to be interested in learning about how you feel? Can your therapist communicate to you in language that you understand? Does your therapist talk about you, rather than him or herself?
2. Ability to help you feel you can trust the therapist. According to Wampold, people determine whether or not they can trust someone within 50 milliseconds of meeting them. Clients of effective therapists believe that their therapists will be helpful because the therapist communicates both verbally and non-verbally that he or she is someone the client can trust.
What this means for you: What do your inner vibes tell you when you first meet this person? Is this someone who allows you to feel that you can have a good working relationship and that your faith in this person won't be betrayed? It's true that the ethical code of psychologists includes the proviso that revelation of illegal or dangerous intention must be reported to authorities such as the police or social service agencies. However, even this requirement can help you feel that you can trust the therapist, because you know that you and the others you care about will be protected.
3. Willingness to establish an alliance with you. One of the solidest predictors of good therapeutic outcome is the feeling that clients are in a partnership with their therapists. This is known as the therapeutic alliance. Effective therapists are able to form these alliances with many types of patients.
What this means for you: Do have the sense that your therapist is interested in getting you on board by establishing goals that both of you agree on? Though the therapist is obviously the expert, do you feel that the therapist cares about your goals in therapy and is willing to work with you to set goals that both of you agree on?
4. Ability to provides an explanation of your symptoms and can adapt this explanation as circumstances change. Clients want to know why they're experiencing their symptoms even if this isn't the first time they've sought therapy. Effective therapists provide explanations that clients can understand but they are also willing to shift according to the way in which treatment unfolds.
What this means for you: Do you understand what the therapist says about the possible contributors to your symptoms? The explanation needn't be (and probably shouldn't be) "scientific;" it should be an explanation that is grounded in your own sense of who you are and why you're feeling the way you do. You should also feel that the therapist is willing to be flexible if circumstances change or new information about your symptoms becomes apparent over the course of treatment.
5. Commitment to developing a consistent and acceptable treatment plan. Effective therapists conduct an assessment very early in treatment. Following that assessment, they should develop a treatment plan and share that treatment plan with you.
What this means for you: Is your therapist sharing with you his or her plans for what type of therapy you'll be receiving? You should not feel unsure about what's happening or why. Unless you know what the treatment plan is, you run the risk of not complying with the therapist's recommendations because you won't know why they are important.
6. Communication of confidence about the course of therapy. An effective therapist keeps clients in therapy by communicating to clients the feeling that therapy will be worthwhile. These therapists allow their clients to feel secure in the knowledge that the therapists know what they're doing and why.
What this means for you: If you sense that your therapist is in control- not of you but of the course of therapy- you will be more likely to be able to make progress. Uncertainty about whether therapists know what they're doing can undermine the course of treatment. Obviously, if you're unhappy with something about the way that therapy is proceeding, you should be able to bring this up. However, a good therapist makes you feel that, like the insurance commercial states, you're in "good hands."
