Every year, about 24 million Americans receive therapy for psychological disorders. They spend, in total, more than $16 billion for these services (Olfson & Markus, 2010). And those figures are just for outpatient mental health services, that is, therapies delivered to people who do not require an overnight hospital stay. Many others experience severe mental disorders that require hospitalization; for example, more than a third of a million people in the United States are hospitalized for schizophrenia, a disease whose total cost to the U.S. economy runs in the tens of billions of dollars (“Schizophrenia Facts and Statistics,” 1996–2010).

These numbers raise two questions: (1) What are the therapies for which tens of millions of people are spending tens of billions of dollars? (2) Do they work? We’ll address these questions in the rest of the chapter.

The therapies on which people spend time and money are, in a word, diverse. Two factors fuel diversity. One is the diversity of disorders and people who suffer from them (Nathan & Gorman, 2007). Clinicians develop different therapies for different psychological problems. Furthermore, they adapt standard methods to individual clients; one prominent therapist (Irvin Yalom, interviewed in Howes, 2009) even suggests that “you have to develop a separate new therapy for every single patient. So for some patients the goal will be this and for some the goal will be that.”

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The second factor is that different clinicians embrace different therapy strategies, that is, different approaches to reducing psychological distress and improving mental health. There are two main types of strategies, psychological therapies and drug therapies:

Professionals who provide psychological therapies are called psychotherapists. What exactly do psychotherapists do?

It depends. Psychologists hold different beliefs about the best psychological techniques for improving mental health; thus, there are different types of psychological therapy. Five types are particularly prominent: psychoanalysis, behavior therapy, cognitive therapy, humanistic therapy, and the family of group therapies. (The approaches to psychotherapy are very closely related to the various personality theories; see Chapter 13.)

PSYCHOANALYSIS. Psychoanalysis is a psychotherapy strategy developed late in the nineteenth century by Sigmund Freud, a physician in Vienna, Austria (Freud, 1900; Freud & Breuer, 1895). It is an example of insight therapy, in which therapists help clients identify and understand—or “gain insight into”—the root causes of their psychological symptoms. Insight into one’s own mental life is thought to improve psychological well-being (Cameron & Rychlak, 1985). Freud developed a unique method for gaining insight: the free association method.

The free association method is a therapy technique in which patients are encouraged to say anything that comes to mind when they contemplate their psychological problems; they “free associate” to the problems. Freud instructed his patients not to hold anything back. They were to voice any thought that came to mind, even if it seemed trivial (Bellak, 1961). Freud did not interfere with the free associations. He merely took notes on the client’s thoughts and analyzed their content. The idea was that, eventually, the free associations would lead to deeply significant psychological content, such as memories of traumatic events in the past.

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Why not just ask clients directly to talk about this significant psychological content? Freud’s answer is that they are unable to do so. Troubling memories are stored in the unconscious, a region of mind whose contents are hidden and unusually inaccessible. In Freud’s theory, the mind is like a library with different levels, and the unconscious is like a large basement level that is locked. The unconscious contains a lot of material, but you can’t access it without a key. The free association method is the key that lets people into the unconscious mind.

Freud explains that some life experiences are so emotionally disturbing that people don’t want to think about them. To stop doing so, people repress them; that is, they transfer memories of the events from their conscious mind (the part of mind of which you are aware) into the unconscious. Once deposited there, the unconscious thoughts do not just go away. Rather, their emotional energy endures. This energy can break out of the unconscious and cause emotional and physical distress. People experience distress but don’t know why; they lack insight into its unconscious causes.

Through the free association method, people gain this insight. As therapy proceeds, they uncover topics of deeper and deeper emotional significance, eventually encountering the underlying cause of their emotional disturbance. This process can be slow. Patients may be in psychoanalysis for years, overcoming their resistance to thinking about emotionally disturbing past events only gradually (Sandell et al., 2000). But once they gain insight into this material, aided by interpretations provided by the therapist, their mental health is expected to improve. Their conscious mind should gain strength, the unconscious should lose strength, and the person should become relatively free of debilitating psychological distress (Cameron & Rychlak, 1985). A large-scale meta-analysis of the effectiveness of psychoanalytic therapy provides scientific evidence that the approach has long-term benefits for the majority of clients (de Maat et al., 2009; also see Shedler, 2010).

Freud’s approach exemplifies the medical model of psychological disorders (Elkins, 2009; Macklin, 1973). The patients’ problems of living—their disturbances in thinking, emotion, and behavior—are interpreted as symptoms. In the free association, Freud searches for their underlying causes in the unconscious. Therapy ultimately targets the purported causes: the unconscious content.

Another key psychoanalytic process is transference, which occurs when a patient unintentionally responds to a therapist as if the therapist were a significant figure (e.g., a parent) from the patient’s past. Emotions originally experienced with the significant figure are “transferred” to the therapist. Transference is significant in that, once past emotions are reexperienced in therapy, they can be analyzed. Through this analysis, the patient can gain insight into how past emotional experiences are causing current distress (Cameron & Rychlak, 1985).

During and after Freud’s lifetime, a large number of other therapists developed therapy methods that were inspired by, but were not identical to, Freud’s approach. The resulting set of therapy approaches—Freud’s psychoanalytic therapy and the related methods—are referred to as psychodynamic therapies. The term psychodynamic refers to a flow of mental energies within the mind (Chapter 13). Psychodynamic therapists share a concern with identifying, in therapy, aspects of mental life that may be unknown to the client, yet that contribute to emotional distress. They attend to the ways in which past life events affect clients’ present-day experiences, and they encourage clients to discuss not only problems of everyday life, but also thoughts that arise in fantasy, dreams, and daydreams (Shedler, 2010).

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BEHAVIOR THERAPY. Behavior therapy is a strategy in which therapists aim to directly alter clients’ patterns of behavior. By learning more adaptive ways of behaving, clients’ psychological lives improve (O’Donohue & Krasner, 1995).

Behavior therapy differs considerably from psychoanalysis. Psychoanalysts analyze the client’s past. Behavior therapists focus, instead, on the present and the future. They try to identify behavioral problems the client is experiencing now, and to teach new behaviors that will be effective in meeting upcoming challenges. This practical, problem-focused approach can sometimes produce behavior change quite rapidly (O’Donohue, Fisher, & Hayes, 2003).

Behavior therapists change clients’ behavior by altering their environment. They know that, in general, environmental experiences shape behavior (Skinner, 1953). Strategically changing clients’ environments therefore may change their behavior and improve their well-being. Here’s an example. If a client is depressed, the behavior therapist might direct the client into new environments that can lift the depression mood—such as settings in which they dress attractively, engage in meaningful conversations, have a good meal, and spend time with other people who are not depressed (Lewinsohn & Graf, 1973). No matter what the past causes of clients’ depression might have been, these new environments can alleviate depressed mood.

Behavior therapy is grounded in research on learning (Chapter 7). Historically, learning researchers first identified environmental factors that modify emotion and behavior in laboratory studies. Behavior therapists then put the research findings into practice, via three steps of reasoning: (1) Clients experience distress because environments they experienced in the past did not teach them behaviors that are useful in their present circumstances; (2) it’s never too late to learn, thus clients can learn useful new behaviors in therapy; and (3) factors shown, in basic research on learning, to modify emotion and behavior could be used to teach clients the new behaviors (Bandura, 1969; Schachtman & Reilly, 2011).

To see how the behavior therapy strategy can be put into practice, consider an application in which therapists worked with couples experiencing high levels of marital distress (Christensen et al., 2004). For the couples, being in therapy was like taking a class—on “how to be a good marital partner.” Therapists taught them behaviors that are good for relationships. For instance:

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To determine whether therapy worked, therapists measured marital satisfaction both before and after therapy. Behavior therapy significantly improved couples’ satisfaction with their marriages (Christensen et al., 2004).

An effective behavior therapy technique is the token economy, in which therapists reward desirable behavior by administering reinforcers that make those behaviors more likely to occur (see Chapter 7). The reinforcers are tokens—for example, a plastic chip—that people later can exchange for something valuable (e.g., food). Token economies are designed to increase the frequency with which people perform desirable behaviors. In one study (Maley, Feldman, & Ruskin, 1973), conducted with female patients in a mental hospital, psychologists gave women tokens when they engaged in desirable behaviors such as personal grooming or communicating appropriately with hospital staff. The tokens later could be exchanged for snacks and cigarettes. Compared to patients who did not experience the token economy, token-economy patients displayed better communication, less confusion and strange behavior, and more positive mood. Tokens, then, reduced abnormal behavior.

Token economies illustrate a fundamental principle of behavior therapy, namely, that behavior is controlled by its consequences. People do things that bring rewards. They avoid performing behaviors that bring punishments. Following this simple yet powerful principle enables behavior therapists to reduce people’s maladaptive behavior.

In addition to modifying behavior, some behavior therapy techniques directly target emotional reactions. Behavior therapists combat the emotions of fear and anxiety with exposure therapy, in which clients are brought into direct contact with an object or situation that arouses their fear (McNally, 2007). A client who is obsessively anxious about germs, for example, may be exposed to materials that are dirty. Someone afraid of heights may be brought to a high floor of a tall building. Therapists ensure that no harm occurs to the client during exposure. The client, then, simultaneously experiences (1) the feared object and (2) an absence of harm. This two-part experience modifies the client’s emotional reactions (Foa & Kozak, 1986). The emotion lessens or extinguishes; the extinguishing of an emotion is the reduction in emotional response that occurs when an anticipated emotionally arousing consequence does not occur.

The behavior therapist Joseph Wolpe (1958) pioneered an exposure therapy called systematic desensitization. Systematic desensitization reduces fear by exposing clients to feared objects in a slow, gradual manner. The exposure can occur through real-life experience or by having clients imagine themselves in a feared situation. In either case, clients first confront a circumstance that is only moderately challenging for them (e.g., someone afraid of heights might be asked to imagine standing only a few feet off the ground). They then confront increasing levels of challenge (e.g., the person imagines looking out from the second, third, and fourth floors of a building). The goal is for clients to remain calm, so that they associate the objects with calmness rather than fear. This reduces their fear response. Exposure therapies have proven highly effective in reducing anxiety (McNally, 2007) across a number of different anxiety disorders, as we discuss later in this chapter.

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COGNITIVE THERAPY. In cognitive therapy, therapists try to improve mental health by changing the way in which clients think. They try, in other words, to change clients’ cognitions.

Cognitive therapy is grounded in a simple yet important idea: Thinking processes are at the heart of psychological distress. Certain types of thoughts—negative interpretations of statements people make about you, pessimistic expectations about your own abilities, blaming yourself for circumstances that may be beyond your control—can make you depressed or anxious.

These negative thoughts are self-defeating; that is, they interfere with people’s ability to successfully improve their lives. A person whose thoughts about the future are pessimistic may give up on life plans that actually could succeed. Someone who sets unrealistically high goals may make herself tense and doom herself to disappointment. People with low opinions about their value as a person makes themselves depressed. The causes of the bad outcomes—giving up, tension, disappointment, depression—are the cognitions: the pessimistic beliefs, unrealistic goals, and low opinions of oneself.

Cognitive therapists argue that many of these negative beliefs are irrational. Irrational beliefs are demanding, dogmatic thoughts that cause people to experience negative emotions (Ellis & Dryden, 1997). The beliefs are called “irrational” because they distort reality illogically. In so doing, they bring about psychological distress; people irrationally make themselves feel bad through their own beliefs.

The irrational thoughts targeted in cognitive therapy may be familiar to you. Do you ever think that you can’t be happy unless you have more friends? Or more money? Or that you must become more successful in school or must make someone else happy for you to be happy yourself? Such beliefs are common yet, to the cognitive therapist, irrational because they can doom you to unhappiness. The cognitive therapist thus combats them. For instance, when a client said he was unhappy because his wife’s pushy parents did not respect him, his cognitive therapist explained that his unhappiness was caused not by the in-laws, but by the client’s own irrational beliefs (Barry, 2009)—in particular, the belief that he must have his in-laws’ respect to be happy. The therapist challenged the belief: “Why do you need your [in-laws’] approval … where did you learn that you have a duty to obey [their] wishes?”

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One proven method for changing negative, irrational cognitions is Beck’s cognitive therapy, developed by the physician Aaron T. Beck (1979). Beck explains that the thoughts which create distress often are automatic thoughts, that is, thoughts that spring to mind rapidly and unintentionally. People don’t intend to think thoughts that create distress. They just pop into mind. When contemplating the future, the depressed person automatically thinks, “Things will go badly.” When considering an upcoming social event, the socially anxious person automatically thinks, “I’m going to look like an idiot.”

Cognitive therapists try to change automatic thoughts through conversations with clients that aim to achieve a number of therapeutic goals:

Let’s see how cognitive therapy works in a case involving a suicidal patient (P). The therapist (T) tries to prevent a suicide attempt by changing the patient’s thoughts—specifically, by replacing thoughts about reasons for dying with thoughts about reasons for living (Williams & Wells, 1989, pp. 212–213).

As you can see, the cognitive therapist tried to change the client’s way of thinking. The therapist did so subtly—not by proclaiming, “You must live!” but by leading the client into a personal exploration of reasons why suicide might not be a good idea.

In some ways, cognitive therapy resembles behavior therapy. Both endeavor to teach clients new skills. Both focus on challenges in the here-and-now environment rather than emphasizing causes of distress that lie deep in a person’s past, as in psychoanalysis. Because of these similarities, cognitive therapy often is called cognitive-behavioral therapy. Yet the approaches do differ. Unlike behavior therapy, cognitive therapy focuses on personal beliefs and skills that involve thinking. Rather than trying to change the client’s environment, the cognitive therapist changes how clients think about their environments and personal experiences. New thoughts, in turn, lead to new, more adaptive behavior.

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HUMANISTIC THERAPY. Humanistic therapy is a strategy in which therapists provide clients with supportive interpersonal relationships. In humanistic therapy, the quality of the relationship between the therapist and the client is key. Therapist and theorist Carl Rogers explains the approach: “If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth and change, and personal development will occur” (Rogers, 1961, p. 33).

Humanistic therapists believe that a good client–therapist relationship is fundamentally similar to relationships that may occur outside of therapy. Do you have a particularly strong, supportive relationship with someone whose wisdom and insight you value and who listens carefully when you talk about yourself? Maybe it’s a relative, a coach, or a minister or other religious figure? If so, you may sense that the relationship benefits you psychologically. You can converse seriously, exploring questions about your life, your future, and yourself. This, in turn, helps you to understand, as well as be more accepting of, yourself, and thus to grow psychologically—to achieve greater maturity. This is the sort of relationship humanists try to establish in therapy.

Of course, for many people the answer to the question above is no; they lack a strong, supportive relationship with someone who listens closely to them. This absence can harm psychological development. Humanistic therapists tell us that just as a seed needs water to grow, a person needs personal relationships to grow. By providing such relationships in therapy to people who may lack them outside of therapy, the humanistic psychologist provides the support that clients need to achieve psychological growth.

To develop strong personal relationships with their clients, humanistic therapists follow three basic guidelines—what Rogers (1961) calls three “conditions” needed for therapeutic success. They are genuineness, acceptance, and understanding.

Humanistic therapists believe that these three therapeutic conditions are not only necessary for therapy to succeed, but also are sufficient. Humanistic therapists do not try to modify their clients’ thoughts, as cognitive therapists do. They instead try to develop a relationship in which they can understand their clients’ thoughts. Once this relationship is achieved, the client naturally “will discover within himself the capacity” to grow (Rogers, 1961, p. 35). The agent of psychological change, in the humanistic view, is not the therapist. It is the client.

GROUP THERAPY. Therapy does not always consist of one-on-one encounters between a therapist and client. Therapy also can be conducted in groups. Group therapy is any type of psychological therapy in which a therapist meets together with two or more clients.

One benefit of group therapy is efficiency. Mental health services can be delivered to more people, in any given amount of time, when therapy is conducted in groups. Efficiency, however, is not group therapy’s main advantage. As Yalom (1970) explained in a classic text, group therapy introduces a number of psychological processes that may benefit clients, including the following:

Group therapists foster these beneficial group dynamics through a number of steps (Yalom, 1970). First, they form and maintain the group, ensuring that members show up and participate in discussions. Second, they establish and maintain norms for group behavior—a particular challenge because these norms differ from those of ordinary life; in group therapy, people comment about others in an open, emotional manner that would be inappropriate elsewhere. Finally, therapists draw group members’ attention to what Yalom calls the “here and now”: thoughts and emotions as they are occurring during the course of the therapy session. The group scrutinizes its own experiences. Members thus gain insight into their interpersonal behavior.

Table 15.2 summarizes the five different therapy strategies we have discussed.

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ECLECTIC, INTEGRATIVE PSYCHOLOGICAL THERAPIES. After learning about these different forms of therapy, you might be wondering which is most popular. It turns out, rather than “picking one,” a popular strategy is to combine the virtues of different approaches to fit the needs of the individual client. Integrative psychotherapy is an effort to combine systematically the methods of different schools of therapy (Thoma & Cecero, 2009). The resulting combination is described as eclectic therapy, an approach that creatively draws upon any therapeutic method available (Jensen, Bergin, & Greaves, 1990). (The notions of “integrative” and “eclectic” therapy overlap; some therapists describe their approach as “eclectic-integrative”; Garfield, 1995.)

In surveys, more than two-thirds of practicing therapists in the United States describe their orientation as eclectic (Jensen et al., 1990). Therapists trained in one approach commonly explore therapy methods developed in others (Thoma & Cecero, 2009).

Psychological disorders are just that: psychological. Their defining features are troubling alterations in psychological experience: thought, emotion, and behavior. Yet if you want to treat these disorders, one option is to shift from a psychological to a biological level of analysis.

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Psychological disorder can result from a malfunctioning brain. If so, then altering brain function might relieve psychological distress. Biological therapies for psychological disorders, as noted earlier, are therapy approaches that alter the anatomy or physiology of the brain in an effort to improve mental health. By far the most popular of the biological therapies are drug therapies.

THE HISTORY OF DRUG THERAPIES. The discovery that drugs could alleviate mental illness was accidental. In the 1940s, a physician in France was searching for a drug that would help surgical patients during their postoperative recovery. The drug he tried, thorazine, worked; postoperative patients were calm and relaxed. Psychiatrists guessed that this drug might benefit others—not only people who were anxious about surgery, but also those whose emotions stemmed from a mental disorder.

Their guess proved correct. The drug originally designed for surgical patients calmed people suffering a state of severe excitation known as mania (discussed later in the chapter). It had additional beneficial effects as well. After taking the drug, patients whose thinking was confused and who were worried that others were out to get them began to think more clearly.

These unexpected findings triggered a burst of scientific research in the 1950s that ushered in a new era in the treatment of severe mental illness (Valenstein, 1998). The medical community quickly embraced the finding that psychotic disorders (Chapter 16) could be treated with drugs.

Other accidental findings followed. Physicians noticed that when patients received a drug designed to treat tuberculosis, their mood changed; the drug made them happy. This drug quickly was put to use in the treatment of depression (Valenstein, 1998).

Not all drug therapies were developed accidentally, however. A treatment for depression was based on a theory about brain functioning (Carlsson, 1999). The theory was that the neurotransmitter serotonin is related to mood; specifically, greater serotonin activity in the brain should make mood more positive. Scientists designed selective serotonin reuptake inhibitors, or SSRIs, to alleviate depression by increasing serotonin activity. They do so by interfering with a biochemical process known as reabsorption. In reabsorption, some of the serotonin that one neuron could use to communicate with a second neuron is absorbed back into the first neuron. SSRIs block reabsorption (Figure 15.1). The amount of serotonin available for neuron-to-neuron communication thus increases. Some of the most popular antidepressants, such as Prozac and Zoloft, are selective serotonin reuptake inhibitors.

Drug therapies have revolutionized the treatment of mental illness. The biggest change occurred in the treatment of psychotic disorders. Until the mid-twentieth century, patients with severe mental disorders generally were unable to care for themselves. They commonly lived in mental hospitals under conditions that, today, seem inhumane: herded into overcrowded psychiatric wards where they received few if any beneficial treatments (Frank & Glied, 2006). Antipsychotic drugs improved their plight. The drugs increased patients’ thinking abilities, enabling them to leave hospital care; the mental hospital population plummeted (Manderscheid, Atay, & Crider, 2009; Figure 15.2). Patients who previously would have been isolated in psychiatric wards lived productively in the community. As a result, “the lives of most people with mental illness are better today than they were fifty years ago” (Frank & Glied, 2006, p. 2).

WHY DRUGS HAVE PSYCHOLOGICAL EFFECTS. You learned in Chapter 2 (also see Chapter 3) that brain cells communicate chemically. Chemical substances known as neurotransmitters travel from one brain cell, or neuron, to another. These chemical transmissions determine the level of activity of the cells of the brain.

These basic facts about brain functioning are key to understanding why drugs affect mental health. Drugs are chemical substances. Most chemical substances you ingest have little or no effect on brain functioning because of the body’s built-in protection system: the blood–brain barrier, which is a set of biological mechanisms in the body’s circulatory system that stops substances in the bloodstream from entering into brain tissue. The molecules of some chemical substances, however, are small enough that they permeate the blood–brain barrier and make their way into the brain (Julien, 2005). Some of these small chemical substances affect the functioning of brain cells and therefore alter thinking. They are known as psychoactive substances, chemical substances that affect psychological processes of perception, thinking, or emotion (World Health Organization, 2004). (We’ll discuss specific psychoactive drugs later in this chapter and in Chapter 16, when we explore specific mental disorders and their treatment.)

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One way in which drugs have psychological effects, then, is that they directly alter chemical activity in the brain. A second way that drugs can affect mental health is through placebo effects. A placebo effect, in drug therapies, is any medical benefit that is not caused by biologically active properties of the drug. Researchers demonstrate placebo effects by giving some patients pills that have no medicinal qualities—fake, “placebo” pills. Patients are not told whether they are receiving real medicine or a placebo. Although the placebo has no biological effects, many patients improve anyway. Among depressed persons, 30% show reduced depressive symptoms after taking a placebo (Rutherford, Wager, & Roose, 2010).

What is the cause of placebo effects? The main source appears to be people’s beliefs. People who get a medication (or, in the case of a placebo, a pill that they think is a medication) believe that, as a result, they will improve. This expectation of improvement becomes a “self-fulfilling prophecy”; the expectation of improvement creates an actual improvement (Kirsch, 2010; Rutherford et al., 2010).

Placebo effects raise challenges for researchers who want to show that a real drug uniquely benefits mental health. They must demonstrate not only that people who receive the drug improve; they also need to show that people on the drug improve more than those who get a fake drug—a placebo. Sometimes this is surprisingly difficult to demonstrate (see This Just In later in the chapter).

OTHER BIOLOGICAL THERAPIES. The psychological effects of drug therapies can be slow. Even the manufacturers of antidepressant drugs recognize that patients may not experience benefits until after taking them consistently for four weeks or more (“Highlights of Prescribing Information,” 2014). If a patient is severely depressed and suicidal, or if a range of medications has not helped, some therapists then employ electroconvulsive therapy.

In electroconvulsive therapy (ECT), physicians deliver electrical currents to the brain. The electricity creates a brief brain seizure, that is, a period of abnormal electrical activity in the brain, during which a person loses consciousness. Studies indicate that electroconvulsive therapy benefits severely depressed individuals, reducing depressive symptoms in the majority of such patients (Rudorfer, Henry, & Sackeim, 2003). Why does it work? Good question; the mechanisms through which ECT reduces severe depression are not well understood. However, recent evidence indicates that the therapy may disrupt connections in the brain that contribute to depression. Specifically, the brains of people with severe depression often feature atypically strong connections among those parts of the brain involved in thinking and in emotion. ECT can disrupt these connections, which reduces depressive symptoms (Perrin et al., 2012).

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Another alternative to drug therapies that has been tried is surgery. In principle, surgeons could treat mental disorders by intervening directly in the brain. They could remove a malfunctioning brain system or sever its connections to other regions of the brain, thereby cutting off its influence. In lobotomy, a surgeon damages brain tissue in the frontal regions of the brain, specifically, the brain’s frontal cortex.

The origins and popularity of lobotomy lie in the past. Physicians in the first half of the twentieth century believed that a malfunctioning frontal cortex was the root of severe mental illness. They thus reasoned that damaging the cortex and its connections to the rest of the brain would alleviate mental illness (Lerner, 2005). This idea affected medical practice; by mid-century, about 20,000 lobotomies had been performed in the United States (Govan, 2011). Today, the procedure is rare. Contemporary health professionals view lobotomy as a crude and inhumane process. Drug therapies are, by far, the preferred alternative for alleviating psychoses.

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People who suffer from psychological problems have one big question: Which therapies work best? They want therapies that will improve their mental health, and quickly.

In the early days of clinical psychology, it was hard to tell which therapies worked best. Actually, it was hard to tell if they worked at all. Evidence of therapy effectiveness was meager and of poor quality. The predominant evidence was case studies; therapists reported on the effectiveness of their favored therapy method with individual patients. Case study evidence has two big limitations (see Chapter 2):

To identify cause and effect—that is, to determine whether therapy was the true cause of a change in symptoms—one must compare people receiving therapy to other people, in a control group, who receive no therapy.

Today, this superior evidence is readily available. Clinical psychologists conduct research to identify empirically supported therapies (Kendall, 1998), that is, therapies whose effectiveness is established in carefully controlled experimental research. To qualify as an empirically supported therapy, a therapy method must be shown to be superior to no-therapy control groups, placebo medications, or other treatments known to be effective (Chambless & Ollendick, 2001).

Many types of therapy have, in fact, received empirical support—in other words, many really do work. Key evidence comes from studies with controls groups that eliminate the possibility of experimenter bias (see Research Toolkit). In the remainder of this chapter and in Chapter 16, we’ll review therapies after presenting the characteristic experiences associated with a given psychological disorder. When, in this review, we say that a given type of therapy has been shown to benefit people suffering from the disorder, we mean that it is empirically supported—shown, in experimental research with control conditions, to work.

RESEARCH TOOLKIT