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Are All Therapies Equally Effective?

Unfortunately, the field of therapy is replete with myths and misconceptions.

Here are three widespread myths about psychological therapy. The first is increasingly held within the academic community while the second and third are embraced much more by therapists than clients! What do you think?

Myth: All therapies produce comparable results.

This is one of the more concerning myths that is based on recent metadata studies (i.e., a lot of very different studies' results lumped together and then statistically analyzed). The metadata (literally data about data) seem to suggest that any therapy is better than no therapy but that no therapy is better than any other therapy. many cases.

Sure, if one looks at the vast landscape of therapy from "thirty-thousand feet," most treatment outcomes will look basically the same just as most of the land from the window of an airplane at 30,000 feet often looks indistinct. But take a closer look and you'll see all sorts of unique features in any given area. Similarly, if you look closely at specific problems, you'll see very convincing research proving that some therapies work much, much better than others.

For example, with OCD there is no doubt that CBT emphasizing a method called exposure and ritual or response prevention (ERP) is incomparably superior to any other form of nonmedical treatment. In addition, almost all anxiety disorders (e.g., panic, phobias, and PTSD, to name a few) are more effectively treated with CBT and its derivatives than any other therapeutic approach.

So, if one is contending with garden variety angst or even mild to moderate depression, perhaps almost any therapy will be helpful and much better than doing nothing. But, if one is suffering from OCD, or from most other anxiety conditions, make no mistake; all therapies are NOT the same. Unless a person receives CBT from a competent therapist he or she will be unlikely to improve, regardless of what other therapies he or she undergoes.

Myth: Insight is necessary for lasting therapeutic change.

Adherents of "depth therapy" believe that drilling deep into the past, and into the presumed unconscious mind of their clients, will lead to transformational insights or intense cathartic reactions that are seen as necessary for true, therapeutic change. A process I call "psycho-archeology" that is of dubious benefit for most people.

The fact is, when therapy is conceptualized as a psychoeducational process rather than a "psycho-archeological" one, clients improve more rapidly and durably. Therefore, when therapy covers various behavioral and cognitive bases in the here and now, people really benefit without necessarily making any deep, psychological discovery about themselves or their past. That is, by teaching clients specific skills (e.g., assertiveness, emotional regulation, habit control, effective communication, etc.), and correcting misinformation while providing missing information, clients improve durably without ever experiencing any childhood epiphany.

Myth: It is necessary to maintain strict therapeutic boundaries.

Many therapists practice defensively, because they fear litigation; adhere to rigid, therapeutic boundaries because of Licensing Board regulations; or maintain strict boundaries because their approach is very boundary-based (e.g., psychoanalysis). Thus, many therapists will not answer simple questions ("Where are you going on vacation?"), disclose anything personal about themselves ("I was born in Johannesburg, South Africa."), or even accept a small gift from a client.

This topic is so huge that it requires a post unto itself. Suffice it say that sometimes a therapist can learn more helpful information about someone outside of the consulting room than in it. And, not surprisingly, in the vast majority of cases, graciously accepting a small gift from a grateful client is far more likely to benefit the therapy than harm it.

The genesis of rigid therapeutic boundaries is based on the psychoanalytic notion of "transference." This is the redirection to the therapist of emotions, usually about one's parents, that were originally felt in childhood. It is believed, therefore, that the therapist must be as much of a "blank slate" as possible or the transference can be muddied by the client knowing even simple details about the therapist. But in actuality, it seems that maintaining flexible therapeutic boundaries - and appropriate self-disclosure from the therapist - produces the best outcomes.

Of course, any therapeutically helpful boundary transgression must never involve sexual, exploitative, or manipulative conduct. But driving a stranded client home (who doesn't have AAA and whose car won't start), escorting people to various places during anxiety management exposure, or merely accepting a small gift is more likely to enhance therapeutic outcomes than hinder them. The interested reader is referred to A. Lazarus's and O. Zur's excellent 2002 book, Dual Relationships And Psychotherapy.

The upshot is simple:

1. There really are scientifically validated treatments of choice for a variety of problems. The idea that all therapies are basically equally effective is absurd.

2. It is not necessary to know the [theoretical] cause of a problem to solve it.

3. Therapists with responsibly flexible boundaries, who relate to their clients as human beings, usually produce the best outcomes.

Remember: Think well, Act well, Feel well, Be well!

Copyright 2017 Clifford N. Lazarus, Ph.D.

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This post is for informational purposes only. It is not intended to be a substitute for professional assistance or personal mental health treatment by a qualified clinician.