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EFFECTIVENESS OF PSYCHOTHERAPY How much better off is a person who receives psychotherapy than one who gets no treatment at all?

EFFECTIVENESS OF PSYCHOTHERAPY How much better off is a person who receives psychotherapy than one who gets no treatment at all?

We have noted that some psychotherapies are generally effective, but how much better are they than no treatment at all? Researchers have found that roughly twice as many people (two-thirds) improve with formal therapy than with no treatment at all (Borkovec & Costello, 1993; M. J. Lambert, 2001). Furthermore, many people who do not receive formal therapy get therapeutic help from friends, clergy, physicians, and teachers. Thus, the recov- ery rate for people who receive no therapeutic help at all is quite possibly even less than one-third. Other studies concur on psychotherapy’s effectiveness (Hartmann & Zepf, 2003; M. J. Lambert & Archer, 2006; Leichsenring & Leibing, 2003), although its value appears to be related to a number of other factors. For instance, psychotherapy works best for rela- tively mild psychological problems (Kopta, Howard, Lowry, & Beutler, 1994) and seems to provide the greatest benefits to people who really want to change such as Brooke Shields (Orlinsky & Howard, 1994).

Finally, one very extensive study designed to eval- uate the effectiveness of psychotherapy was reported by Consumer Reports. Largely under the direction of psychologist Martin E. P. Seligman (1995), this investi- gation surveyed 180,000 Consumer Reports subscribers on everything from automobiles to mental health. Approximately 7,000 people from the total sample responded to the mental health section of the ques- tionnaire that assessed satisfaction and improvement in people who had received psychotherapy, with the following results.

First, the vast majority of respondents reported significant overall improvement after therapy (Seligman, 1995). Second, there was no difference in the overall improvement score among people who had received therapy alone and those who had com- bined psychotherapy with medication. Third, no differences were found between the various forms of psychotherapy. Fourth, no differences in effectiveness were indicated between psychologists, psychiatrists, and social workers, although mar- riage counselors were seen as less effective. Fifth, people who received long-term therapy reported more improvement than those who received short-term therapy. This last result, one of the most striking findings of the study, is illustrated in Figure 13–1. Though the Consumer Reports study lacked the scientific rigor of more traditional inves- tigations designed to assess psychotherapeutic efficacy (Jacobson & Christensen, 1996; Seligman, 1995, 1996), it does provides broad support for the idea that psychotherapy works.

Which Type of Therapy Is Best for Which Disorder? An important question is whether some forms of psychotherapy are more effective than others (Lyddon & Jones, 2001). Is behavior therapy, for example, more effective than insight therapy? In general, the answer seems to be “not much” (J. A. Carter, 2006; Hanna, 2002; Wampold et al., 1997). Most of the benefits of treatment seem to come from being in some kind of therapy, regardless of the particular type.

As we have seen, the various forms of psychotherapy are based on very different views about what causes mental disorders and, at least on the surface, approach the treatment of mental disorders in different ways. Why, then, is there no difference in their effectiveness? To answer this question, some psychologists have focused their attention on what the various

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