Does Therapy Work? The Effectiveness of Psychotherapy

Does Therapy Actually Work?

Hundreds of outcome studies indicate that roughly 75% of people who participate in therapy experience some benefit.¹ Studies have shown that two thirds of people who enter therapy report improvement in their overall functioning after treatment.² In a broad review of hundreds of outcome studies, results showed that the typical client is better off than 80% of people who do not receive any treatment.¹

However, the question of whether therapy works is complicated due to the fact that each person entering therapy has their own unique goals in mind. While one person may want to feel less anxiety, another may have the goal of improving their relationships or their overall satisfaction with life. Therefore there is no single, universal measure of success.

Different Types of Therapy Work Better for Different Concerns

Over a dozen different forms of psychotherapy exist, and some have been shown to be more effective for particular client problems. Certain forms of therapy, particularly Cognitive Behavioral therapy, have been more thoroughly researched than others. This is due to the relative ease of standardizing CBT methods as well as behavioral outcomes. It is more difficult to standardize the approaches used in Psychodynamic therapy and in Humanistic therapies because of the critical importance of the therapeutic relationship in bringing about change.³

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a brief form of therapy that works by changing a person’s thoughts and behaviors in order to improve their mood or daily functioning. The client learns to identify their thoughts and behaviors which are linked to their feelings of anxiety, depression, or other problems. They can then change these thoughts and behaviors in order to change how they are feeling. The objective of CBT is to bring about significant change in a structured and efficient way.

Hundreds of outcome studies have been conducted to evaluate the results of CBT for a wide range of emotional and behavioral problems. Strong support exists for the use of CBT in treating anxiety disorders, including Generalized Anxiety Disorder and Social Anxiety Disorder.^1,4,5 CBT has also been shown to be effective for the treatment of episodes of depression.⁶ Also, CBT brought about a large reduction in symptoms of PTSD, with improvements maintained at 12 months after treatment.⁷

Humanistic Types of Therapy

Humanistic therapy takes various forms, including Person-Centered, Gestalt, Existential, Transactional, and Logotherapy. All of these forms are based upon the belief that every person has the ability and desire to reach their potential through personal growth. The therapist offers support and guidance to help the client overcome problems and reach their personal goals.

Humanistic therapies have been shown to be effective for clients with anxiety or depression. Benefits from Person-Centered therapy were noted even for clients with severe symptoms and for those with long-term symptoms.⁸ Both Logotherapy and Gestalt therapy have been effective in treating anxiety, depression, and aggression.⁹ Improvements made during Humanistic therapy have been demonstrated to be stable over time.¹⁰

Solution-Focused Brief Therapy

Solution-Focused Brief Therapy (SFBT) is a short-term, goal-directed approach in which the purpose is to help the client discover, clarify, and accomplish their own solutions to problems. This therapy involves setting clear and realistic short-term goals. While it usually takes 6 to 8 sessions, results are sometimes accomplished in one session.

SFBT has been shown to be most effective for family-related problems such as parenting teens and coping with family consequences of addiction.^11,12 It is best suited for problems that have step-by-step solutions which can be worked out. Some studies do show the effectiveness of SFBT for a broad range of client concerns, including emotional and relational issues.¹³

Psychodynamic Therapy

Psychodynamic therapy works to help the person gain insight into their problems by considering how their patterns of behavior have developed over time. These patterns may involve the use of unhealthy defense mechanisms. Once the unhealthy defenses are discovered, the person can work toward changing them into more productive behavior.

Studies have shown that psychodynamic therapy is as effective in treating depression and some anxiety disorders as the evidence-based forms of therapy, and that benefits continue after therapy ends.¹⁴ Although it is not the recommended first treatment for Borderline Personality Disorder, it has been shown to be effective for the long-term treatment of this disorder.¹⁵

Interpersonal Therapy

Interpersonal therapy is directed toward relief of symptoms of depression and anxiety by resolving interpersonal conflicts. It is based upon the belief that relationship problems directly affect a person’s ability to cope with daily stress. It is a time-limited and structured approach which usually takes from 12-16 sessions.

Studies have shown significant positive outcomes when Interpersonal therapy is used in the treatment of depression.^16,17 It is particularly effective in treating depression among teens.¹⁸

Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) works by teaching particular skills to help the client tolerate emotional distress. A second focus is on problem-solving skills so that extreme behaviors can be recognized and replaced with more effective behaviors. While it was first developed to treat highly suicidal clients, it has been adapted to be more broadly useful.

Due to its focus on managing suicidal behavior and other self-destructive behaviors, DBT is believed to be the best practice for the treatment of borderline personality disorder.¹⁹ Studies show that DBT is consistently effective at controlling self-destructive behaviors, and in improving compliance with treatment.^20,21

Other Therapy Types You Might Encounter

• Motivational Interviewing (MI) is effectively used in the treatment of substance abuse and other unhealthy habits.²² A review of 72 studies showed that MI had a significant effect in three out of four of the studies.²³
• Acceptance and Commitment Therapy (ACT) uses mindfulness and other behavioral strategies. It has been very effective in the treatment of depression, anxiety, addiction, and physical health problems.²⁴ ACT has also been adapted for use with the typical problems of adolescents.²⁵

Does Therapy Work for Everyone?

Psychotherapy is very effective for individuals, couples, families, children, and teens. Whether to enter therapy as an individual, couple, or family depends on the types of concerns that the person is having and the willingness of other family members to participate. At times, therapy might begin as individuals and then shift to couples’ therapy or family therapy.

Individual Therapy

The majority of studies about the effectiveness of therapy have been done on the outcomes of individual therapy.^2,26 A major factor in the outcome of individual therapy is the quality of the relationship between the person and that particular therapist. It is critical to find a therapist with whom you feel comfortable talking about your concerns. Clients may need to meet with more than one therapist in order to find a good fit and get the most out of therapy.

Couples Therapy

Couples therapy is recommended for any couple in distress and unable to resolve their differences on their own. Two major factors which determine a benefit to couples therapy are the motivation of each person to improve their relationship, and the timing of seeking help. The sooner the better when working to resolve problems in a partnership.²⁷

There are several commonly used models of couples therapy, including Emotionally Focused Couples Therapy, Gottman’s Method, and Psychodynamic Couples Therapy. Outcome studies have been done on each of these models, with overall results showing the effectiveness of all three. Couples therapy is most effective in reducing complaints between partners, increasing communication, and improving intimacy.^28,29,30

Family Therapy

Family therapy is the preferred treatment approach when there are ongoing conflicts among family members or when a child shows persistent aggressive behavior. It is also directed at strengthening emotional bonds between family members who may have become distanced. The family therapist usually views the concerns in terms of the whole family as a system, rather than one person being the sole cause of the problem. Finding a family therapist who is a good fit with your family is the key to success.

Studies have shown family therapy to be effective in reducing complaints particularly for problems related to conduct disorder, substance abuse, and depression. It can be helpful for a range of emotional and behavioral issues.³¹

Children & Teens

Children and teens respond well to certain forms of therapy for different types of problems. Child behavior therapy is effective for coping with ADHD as well as disruptive behavior disorders.This approach usually includes some parent training in behavior management. Cognitive behavioral therapy works well for children with depression, anxiety, or PTSD.³²

Adolescents with disruptive behavior respond particularly well to family therapy, in which family members learn better communication skills and conflict resolution skills.³³ Adolescents with depression benefit from Interpersonal therapy, in which they learn new ways to handle relationship problems.¹⁸ DBT can also be used to help adolescents learn how to better deal with their emotions in a number of conditions.