How Psychotherapy is Effective for Treating Mental Disorder? | Psychology

In this article we will discuss about how psychotherapy is effective for treating mental disorder.

Introduction to Psychotherapy:

In the 1950s only 1 percent of the population of the United States had ever had contact with a trained therapist; currently this figure is about 10 percent. What accounts for this change? Part of the answer involves shifting attitudes toward the idea of participating in psychotherapy.

Once, there was a stigma attached to this process. People spoke about it in hushed tones and often did their best to conceal the fact that someone in their family or they themselves had received therapy. This was certainly true in my own family; my parents refused to discuss my grandmother’s problems with me.

While negative attitudes about psychotherapy have not entirely vanished, they have certainly weakened. As a result, growing numbers of people are now willing to seek assistance in dealing with problems that threaten their happiness and well-being.

Another factor is the growing sophistication and effectiveness of various forms of psychotherapy. In recent decades many new forms of therapy have been introduced, and these are applicable to a wider range of disorders and a broader range of people than was true in the past. These trends, too, have contributed to the boom in psychotherapy.

Study of the Effectiveness of Psychotherapy:

Efficacy research psychologists believe, provides a very rigorous test of the potential effects of any form of therapy. If, in such research, participants who receive therapy do show greater improvement than those who do not, we can have high confidence in the conclusion that “this form of therapy works it is significantly better than no treatment.”

Although there is no doubt that efficacy studies are very valuable in this respect, it is also clear that they are not totally conclusive. As noted by Martin Seligman (1995), a former president of the American Psychological Association, such stud­ies have certain drawbacks, the most important of which is this: In efficacy studies psychotherapy is not practiced as it is in the real world.

Thus, it is impossible to tell whether forms of therapy found to be effective in such studies would also succeed under natural conditions. For instance, in efficacy studies psychotherapy continues for a fixed num­ber of sessions; but in actual practice this is rarely the case therapy continues until people improve.

Similarly, in efficacy studies only one type of ther­apy is used; under natural conditions therapists switch between techniques until they find one that works. Participants in efficacy studies are as­signed to a type of therapy they have not necessarily sought; in actual practice individuals actively shop for and choose therapists. Finally, in efficacy studies participants have a single psychological disorder; in field settings patients often have several disorders.

Because of these differences, Seligman (1995) concludes, efficacy studies do not necessarily tell us whether a given form of therapy succeeds un­der natural conditions. To answer that question, he suggests, we need effectiveness research; research that examines how individuals respond to therapy as it is normally delivered in real-life settings.

Such research must, of necessity, lack some of the rigor of efficacy studies—after all, it is purposely conducted under naturalistic conditions. To be useful, there­fore, effectiveness research should be large-scale in scope, involving participation by thousands of persons.

One major study of this type has been con­ducted by an organization with no ax to grind in the field of mental health: Consumer Reports, a magazine that tests and compares a wide range of products for its subscribers.

The survey asked readers whether they had sought help with an emotional problem during the past three years, and if so, who had helped them; friends, clergy, family doctors, self-help groups, or a wide range of mental health professionals (psychiatrists, psychologists, social workers, marriage counselors, and so on).

In addi­tion, the survey asked questions about the duration and frequency of therapy respondents had received and—perhaps most important of all—about how helpful the therapy had been. The main point here is to illustrate how an effectiveness study works.

In essence, it is designed to obtain information on the experiences of large numbers of persons who actually received various kinds of therapy—or received no help at all. No, such studies don’t have the scientific rigor of efficacy studies; but as compensation for this, they do reflect the impact of various kinds of therapy as people “out there” actually experience them.

By combining the rigor of efficacy studies with the large samples and real-life experiences of effec­tiveness research, psychologists believe that they can accurately determine whether and to what ex­tent various kinds of psychotherapy succeed. This combination of approaches appears to be an espe­cially powerful one, so now let’s see what the find­ings of research using these methods have revealed.

The Effectiveness of Psychotherapy- An Overview of Key Findings:

In 1952 Hans Eysenck, a prominent psychologist, shocked many of his colleagues. He published a paper indicating that psychotherapy is ineffective. In his article Eysenck reported that about 67 percent of patients with a wide range of mental disorders improve after therapy, but that about the same proportion of persons receiv­ing no treatment also improve. This was a disturbing conclusion for psychologists and quickly led to a great deal of research on this issue. After all, if the same proportion of people recovers from mental disorders with and without therapy, why bother?

As you can probably guess, the findings of later studies, including results of efficacy studies and effectiveness research—pointed to a very different conclusion. Contrary to what Eysenck suggested, psychotherapy is helpful. Apparently, Eysenck overestimated the proportion of persons who recover without any therapy, and also underestimated the proportion who improve after receiving therapy.

In fact, many reviews of exist­ing evidence—more than five hundred separate studies on the effects of therapy—suggest that therapy does work. More people who receive psychotherapy show improvements with respect to their mental disorders than persons who do not receive therapy. Further, the more treatment people receive, the more they improve, the fewer symptoms they show, and the less distress they report.

Interestingly, however, the amount of professional experience therapists have, how long they have been doing therapy, does not seem to matter. Some studies suggest that experienced therapists obtain better outcomes than inexperienced ones, but in general there is no significant difference between these groups. Why? Perhaps because novice therapists make up for their lack of experience through greater enthusiasm.

In sum, available evidence (and there is a lot of it) points to the following overall conclusion. Psychotherapy is not perfect, it doesn’t produce improvements for everyone. But yes, it does work, it helps many people suffering from mental disorders to recover from these problems.

The results of various therapies are found to be similar. The explanation that has emerged in recent years goes something like this. Various forms of therapy do differ in their rationale and in their pro­cedures, but under the surface all share common crucial features. It is this shared core that accounts for their effectiveness. What is this common core?

It may include the following features:

First, all major forms of psychotherapy provide troubled individuals with a special type of setting; one in which they interact closely, usually one-on-one, with a highly trained and empathetic professional. For many clients this opportunity to interact with another person who seems to understand their problems and genuinely to care about them may be a unique and reassuring experience, and may play an important role in the benefits of many diverse forms of therapy.

Second, every form of therapy provides individuals with an explanation for their problems. No longer do these seem to be mysterious. Rather, as therapists explain, psychological disturbances stem from understand­able causes, many of which lie outside the individual. This is something of a revelation to many persons who have sought in vain for a clue as to the causes of their difficulties.

Third, all forms of therapy specify actions that individuals can take to cope more effectively with their problems. No longer must they suffer in silence and despair. Rather, they are now actively involved in doing specific things that the confident, expert therapist indicates will help.

Fourth, all forms of therapy involve clients in what has been termed the therapeutic alliance; a partnership in which powerful emotional bonds are forged between the person seeking help and the therapist. This rela­tionship is marked by mutual respect and trust, and it can be a big plus for people who previously felt helpless, hopeless, and alone.

Combining all these points, the themes of hope and personal control seems to emerge very strongly. Perhaps diverse forms of therapy succeed because all provide people with increased hope about the future plus a sense of heightened personal control.

To the extent that this is the case, it is readily apparent why therapies that seem so different on the surface can all be effective. In a sense, all may provide the proverbial light at the end of the tunnel for people who have been struggling through the darkness of their emotional despair.

Culturally Sensitive Psychotherapy:

Despite improvements in the DSM-IV designed to make it more sensitive to cultural differences, existing evidence indicates that race, gender, ethnic background, and social class may all affect the process of diagnosis. For instance, African Americans are more likely to be diagnosed as schizophrenic and less likely to be diagnosed as showing affective (mood) disorders than are persons of European descent.

If racial and ethnic factors can influence the diagnosis of mental disorders, it is not surprising to learn that they can also play a role in psychotherapy. For example, therapists and clients may find it difficult to communi­cate with one another across substantial culture gaps, with the result that the effectiveness of therapy is reduced. Even worse, most forms of psychotherapy were originally developed for, and tested with, persons of European descent.

As a result, they may not be entirely suitable for use with individuals from very different backgrounds. Concern over these issues has led many psychologists to call for efforts to make various forms of therapy more culturally sensitive. This suggestion implies that all forms of therapy should take careful account of the values and traditions of minority cultures.

Cultural factors may also play a role in individuals’ willingness to enter therapy in the first place. In many Asian cultures, for instance, it is not considered appropriate to talk about one’s personal feelings or even to focus on oneself individually; rather, emphasis is placed on being part of the social group. Such views may sometimes restrain persons in need of assistance from seeking it.

Fortunately, growing evidence suggests that therapists can sometimes overcome such culturally derived reluctance to enter psychotherapy. For instance, Szapocznik and his colleagues (1990) have found that culturally sensitive procedures can help overcome the reluctance of persons of Hispanic descent in the United States to enter family therapy.

When psychologists used culturally sensitive techniques to approach troubled families, fully 93 percent began therapy; this was much higher than the 42 percent who agreed when standard techniques that largely ignored culture were employed.

Through careful attention to cultural factors and differences, psychologists can help ensure that psychotherapy is sensitive to the varied needs of persons from different cultures, and so increase the chances that it will accomplish its major goal: helping to alleviate mental disorders.