Wednesday, July 26, 2017

Your Therapist: It May Be More Who S/he is than What Kind of Treatment S/he Provides

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.)