How effective is therapy? What makes therapy more effective? And, what evidence bears on answering these questions? Key findings from a series of recent meta-analyses, statistical procedures that combine the results of many studies and are viewed as the strongest basis for drawing scientific conclusions, have yielded the following, often surprising findings:
- Much of the research before 2000 that supported the superiority of one theoretical approach to therapy over another has been discredited due to researcher bias. Thus, the best available research evidence indicates that in general, cognitive behavioral therapy (CBT), psychodynamic therapy and humanistic psychotherapy produce roughly equivalent results.
- Some treatment methods do enjoy a slight superiority in the treatment of some problems. Cognitive behavioral therapy is somewhat more effective in the treatment of anxiety due, it is thought, to the reassuring nature of its highly directive and structured approach to treatment. On the other hand, humanistic psychotherapy with its focus on the importance of the therapeutic relationship is somewhat more effective in treating relational problems.
- When the treatment of all sorts of client problems are considered, different therapeutic techniques make only a very small contribution to therapeutic effectiveness.
- Therapist’s relational qualities, on the other hand, have been found to be 5-10 times more powerful than therapeutic techniques in improving client outcomes.
- The research indicates that it is not so much what therapists do that is helpful, but how they do it. Therapists who are experienced as accepting, understanding and genuinely interested in their clients consistently help clients more so than therapists who offer less of these Rogerian facilitative conditions.
- A good therapist has a considerable impact on the outcome of therapy. Therapist relational qualities are twice as effective as antidepressant medications in improving outcome.
- Research provides strong support for the central tenant of humanistic psychotherapy that the relationship between client and therapist is a primary vehicle for change. A therapy relationship that is characterized by client-therapist agreement on therapy goals, collaboration in the therapy process and a warm working relationship yields the best outcome.
- The single greatest determinant of improvement in therapy is the client’s resources. The client’s level of motivation, relational capacities, cultural background, expectations, preferences and level of defensiveness all have an empirically demonstrated relationship to outcome. To be most effective therapy should recognize and enhance the client’s contribution to treatment outcome and be individualized according to outcome-relevant client characteristics.
Overall about two-thirds of all those seeking therapy improve. These odds for improvement, while comparable with the treatment effectiveness of many medical treatments for diverse disorders, can be improved by therapists who demonstrate a demeanor of acceptance, understanding and genuine interest in their clients, develop a collaborative working relationship with their clients, acknowledge and enhance clients’ contribution to treatment, and tailor their treatment to outcome-relevant characteristics of individual clients.
If you are interested in finding out more information about most of the meta-analyses whose results were cited above, read: Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press.
By Dr. Kevin Keenan, PhD, LP, MSP Core Faculty
Dr. Keenan is currently writing a chapter in the book he is co-editing: “The Good Therapist: Evidence for the Essential Qualities of the Effective Therapist” in Cain, D., Keenan, K., and Rubin S., Humanistic Psychotherapies: Handbook of Research and Practice, second edition, soon to be published by the American Psychological Association