Psychotherapy-An Active Agent: Assessing the Effectiveness of Psychotherapy and Its Curative Factors
Bachar, Eytan, The Israel Journal of Psychiatry and Related Sciences
Abstract: In the last two decades there has been a remarkable expansion in research on psychotherapy in two areas: (a) assessing the effectiveness of psychotherapy compared to wait-list, no-treatment patient groups and groups treated with pharmacotherapy; (b) investigating curative factors in the therapeutic process: the extent of the psychotherapist 's experience and kinds of interventions and errors in handling techniques. The first section of the review deals with the first of these areas and the second with the other. The following are the main research findings: 1. The effectiveness of psychotherapy compared to wait-list and non-treatment groups has been proven by so many research papers that there is hardly any need to do so again; 2. Psychotherapy was found to be effective in treating focused psychiatric disorders such as OCD, depression and anxiety disorders (with preference to cognitive-behavioral approaches over psychodynamic approaches, and in some instances in preference to pharmacotherapy). Psychotherapy was also effective in less focused disorders, such as personality disorders and mixed neurotics (with preference to psychodynamic approaches over cognitive-behavioral approaches); 3. The advantages of patients receiving psychotherapy over those who did not receive it persisted in follow-up studies of one year's duration or more; 4. Psychotherapy was more effective than "psychotherapeutic placebo" (the encounter between therapist and patient where systematic psychotherapeutic work using one out of the three main psychotherapeutic approaches is experimentally prevented), which in turn was more effective than wait-list or non-treatment groups; 5. Psychotherapeutic maintenance of one session a month was effective in preventing relapse; 6. Experienced psychotherapists are more effective than beginners; 7. Empathy, the ability to identify the central thread of the session, and encouragement of the patient to reflect were found to be the key factors in techniques most associated with therapeutic success.
At a time when changes in the financial structure of health services all over the world are taking place, it is important to review the effectiveness of psychotherapy, the durability of its outcome and its advantages in relapse prevention. The research literature provides clear, definite and positive answers to the question of whether psychotherapy is effective. It also leads to the conclusion that psychotherapy works as an active, defined and predictable agent rather than a vague non-specific placebo like condition.
Meta-analytic studies (a kind of research that reviews papers by analyzing and quantifying them in a sophisticated manner, sometimes encompassing more than 500 research reports and reaching a measure across all these studies) found that, at the end of psychotherapy, the average patient was in better mental health than 80% of the people in wait-list and non-treatment groups (1, 2, 3).
Meta-analytic studies (1, 3, 4 and 5) and literature review (6) consistently show that psychotherapeutic treatments produce effect size (magnitude of therapeutic change expressed in terms of standard deviations) of 0.8 to 1.0 equivalent, for example to antidepressant medication. Surprisingly, it seems that psychotherapy is one of the best documented medical interventions in history (7).
Specificity of a Certain Technique to a Certain Condition
Results in treating depression with psychotherapy appeared consistent. In all metaanalytic reviews, patients undergoing psychotherapy surpassed no-treatment and wait-list control patients. For example, Dobson (7) reports that the average patient treated with Beck's cognitive therapy surpassed 98% of the control patients. Similar, but less dramatic results, are reported by Robinson et al. (8), who found that behavioral, cognitive-behavioral and, to a lesser extent, "general verbal therapies" all had positive outcomes compared with non-treatment or wait-list control groups. …