There is now plenty of evidence that, on the whole,
therapy/counseling is helpful to people with a range of problems, such as
depression, anxiety, and addictive behaviors.
(The evidence was not always clear; way back when I was in grad school, there
was a bunch of research questioning the value of talk therapy – but it turned
out that lumping all therapists and patients together kind of averaged good and
bad results.)
Most of the research on the effectiveness of psychotherapy
tends to focus on comparing this treatment with that treatment, or with no
treatment. Thus, you have a myriad of
schools of therapy with their own particular techniques, each making a case
that their approach is the most helpful one.
(They can’t all be right, of course, and findings that are not
replicated across researchers and settings are of questionable value.)
My own doctoral dissertation study compared a
cognitive-behavioral alcoholism treatment with a “traditional” treatment. I was not at all surprised to find, when I followed
50 people for a year after treatment, that there was no meaningful difference
in their outcomes. One recurrent finding
is that the type of treatment makes
less difference than many of the characteristics of the individual, such as
whether s/he is employed (i.e., has structure), married (i.e., not alone), and
hangs out with heavy drinkers.
But probably the most important factor about therapy (though
it is the subject of many fewer studies) is not the treatment model but rather
the specific therapist and the therapeutic relationship. A former classmate of mine, now a celebrated
psychology professor, reminded me about this at a recent reunion – it’s not a
new discovery, but resurfaces in different forms every several years. The importance of the provider’s personality
and the treatment relationship, in fact, also applies to strictly medical
providers – there is an increasing body
of literature on how doctors’ and nurses’ attitudes and interpersonal behavior
affect patients’ confidence and outcomes.
Generally, people beginning therapy, which sometimes means
sharing some private information for the first time, need to feel that they are
heard and understood, and to develop a sense of trusting the therapist. Decades ago, the then-prominent Rogerian school
of therapy emphasized that, crucially, a helpful therapist shows a combination of empathy, genuineness, and warmth (or unconditional positive regard). These conclusions have held up over time. It appears that patient characteristics
matter as well – those who make harsher judgments of themselves may also find
it harder to trust or respond positively to a therapist.
It’s
still worth learning about the treatment orientation, and particularly the
experience, of your new therapist. But
if, after a few sessions, you don’t feel understood or trusting, it may be
worth trying another therapist. (If it
happens repeatedly with one therapist after another, however, that’s can be a
signal to examine what barriers you
may be bringing into the sessions.)
