55 Evaluating Psychotherapies

55.4 How Do Psychotherapies Help People?

55-4 What three elements are shared by all forms of psychotherapy?

Why have studies found little correlation between therapists’ training and experience and clients’ outcomes? In search of some answers, clinical researchers have studied the common ingredients of various therapies (Frank, 1982; Goldfried & Padawer, 1982; Strupp, 1986; Wampold, 2001, 2007). Their conclusion: They all offer at least three benefits:

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Hope for demoralized people People seeking therapy typically feel anxious, depressed, devoid of self-esteem, and incapable of turning things around. What any therapy offers is the expectation that, with commitment from the therapy seeker, things can and will get better. This belief, apart from any therapeutic technique, may function as a placebo, improving morale, creating feelings of self-efficacy, and diminishing symptoms (Prioleau et al., 1983).
A new perspective leading to new behaviors Every therapy also offers people a plausible explanation of their symptoms and an alternative way of looking at themselves or responding to their world. Armed with a believable fresh perspective, they may approach life with a new attitude, open to making changes in their behaviors and their views of themselves.

A caring relationship Effective counselors, such as this chaplain working aboard a ship, form a bond of trust with the people they are serving.
An empathic, trusting, caring relationship To say that therapy outcome is unrelated to training and experience is not to say all therapists are equally effective. No matter what therapeutic technique they use, effective therapists are empathic people who seek to understand another’s experience; who communicate their care and concern to the client; and who earn the client’s trust through respectful listening, reassurance, and guidance. Marvin Gold-fried and his associates (1998) found such qualities in recorded therapy sessions from 36 recognized master therapists. Some took a cognitive-behavioral approach. Others used psychodynamic principles. Regardless, the striking finding was how similar they were. At key moments, the empathic therapists of both persuasions would help clients evaluate themselves, link one aspect of their life with another, and gain insight into their interactions with others.

The emotional bond between therapist and client—the therapeutic alliance—helps explain why some therapists are more effective than others (Klein et al., 2003; Wampold, 2001). One U.S. National Institute of Mental Health depression-treatment study confirmed that the most effective therapists were those who were perceived as most empathic and caring and who established the closest therapeutic bonds with their clients (Blatt et al., 1996). That all therapies offer hope through a fresh perspective offered by a caring person is what also enables paraprofessionals (briefly trained caregivers) to assist so many troubled people so effectively (Christensen & Jacobson, 1994).

These three common elements are also part of what the growing numbers of self-help and support groups offer their members. And they are part of what traditional healers have offered (Jackson, 1992). Healers everywhere—special people to whom others disclose their suffering, whether psychiatrists, witch doctors, or shamans—have listened in order to understand and to empathize, reassure, advise, console, interpret, or explain (Torrey, 1986). Such qualities may explain why people who feel supported by close relationships—who enjoy the fellowship and friendship of caring people—are less likely to need or seek therapy (Frank, 1982; O’Connor & Brown, 1984).

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To recap, people who seek help usually improve. So do many of those who do not undergo psychotherapy, and that is a tribute to our human resourcefulness and our capacity to care for one another. Nevertheless, though the therapist’s orientation and experience appear not to matter much, people who receive some psychotherapy usually improve more than those who do not. People with clear-cut, specific problems tend to improve the most.

RETRIEVAL PRACTICE

Those who undergo psychotherapy are _____________ (more/less) likely to show improvement than those who do not undergo psychotherapy.

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