Coping with Stress, Anxiety and Depression

What’s the most effective psychotherapy?

Posted Nov 07, 2019

Pixabay/Under water
In over your head
Source: Pixabay/Under water

According to T.S. Elliott, “If you aren't in over your head, how do you know how tall you are?”  But if you are already in over your head—coping with stress, anxiety and depression—what’s the most effective psychotherapy

The Centers for Disease Control and Prevention (CDC), estimates that 50 percent of all Americans are diagnosed with a mental disorder at some point in their lifetime. The good news is that if someone who feels stressed, anxious or depressed is not alone. The bad news is that no one knows the underlying cause of mental disorders or the most effective way to treat them.

Not knowing the underlying cause of mental disorders, psychotherapists can only treat symptoms. Yes, there have been various etymological theories, particularly psychoanalytic. Although psychoanalysis has provided some useful insights into human behavior, it's methods are far too theoretical, cumbersome, and expensive to be used for treating the general public. A more accessible version, transactional analysis, was popularized in the later 1950s but soon gave way to other treatments.      

Starting in the 1950s, a mechanical cause-effect approach, behaviorism, came into vogue, which held that learning and subsequently all human behavior was little more than a stimulus-response reaction, similar to what occurs when we reward our dogs (and young children) for compliant behavior.

Following behaviorism, in the 1960s and 1970s, the humanistic movement arrived, which focused on promoting positive, holistic change with a supportive, genuine, and empathic therapeutic relationship. At its extreme, the humanistic movement culminated in an often ridiculed trauma-based therapy that held that, as infants, people repressed excessive pain, which—when evoked as adults in therapeutic groups through wild screams—resolved the underlying pain responsible for mental malaise.   

In the 1970s, existential theories, although less popular, led to therapies that focused on coming to terms with meaninglessness in life, inevitable death, and the assumption of personal responsibility. Also this period saw the development of a cognitive approach, combined with behaviorism, oriented toward symptom-relief through changing negative self-assessments. It is in marked contrast to insight-based approaches, such as psychodynamic and humanistic therapies.   

Since the 1970s, other approaches have been developed, focusing on the context of the family, whereby the therapist “joins” the family system in order to understand the invisible rules that govern its functioning, and ultimately disrupting the dysfunctional relationships that have led to the pathology.  In this perspective, the illness lies not with the particular client but within the family system.   

In another form of group therapy,  T-groups, participants learn about themselves through interaction with each other. It uses feedback, problem solving, and role play to provide insights into ourselves and others. In sharp contrast to the humanist approach, people often hear unpleasant truths about themselves and learn to deal with it. 

Since the 1990s, there’s been a passionate debate among clinical scientists and practitioners about the superiority of one therapeutic approach over another, particularly “evidence-based” practices versus others.  While many Ph.D. training programs in clinical psychology have taken a strong empirical approach to psychotherapy, other training programs and psychologists are now adopting an eclectic orientation. This integrative movement attempts to combine the most effective aspects of all the schools of practice.

Correlational data indicate that most of the major therapies are about of equal effectiveness and that the therapist, client, and the therapeutic alliance account for a larger portion of client improvement than the procedure itself. 

One consequence is that therapists who have not successfully resolved their own mental issues may not convey the warmth, empathy, and reassurance clients need to benefit from the exchange.

Until the arrival of a scientifically based etymology, patients can feel free to choose the symptomatic approach that holds the most appeals to them. And, more importantly, for anyone contemplating therapy, do not waste time on a therapist with whom you don’t feel a genuine connection at your first session, regardless of his or her credentials or recommendations.  

This blog was co-published with PsychResilience.com