Some patients say that psychotherapy (without medication) is helpful less than half the time! Though this percentage varies depending on diagnosis and much of the reporting is anecdotal, there is at a detailed and well-done 2003-2004 study that focuses on depression and its treatment. SAMHSA, the federal Substance Abuse and Mental Health Services Administration, reports that:
Adults with depression in the past year who received medication as well as talked to a professional were most likely to perceive their treatment as extremely helpful or helped a lot.
… [But] Of the adults who talked with a doctor or other professional for their depression [and didn’t receive medication], 40.5% reported it as extremely helpful or helped a lot, 29.2% reported that it offered some help, and 30.2% reported it was little or no help.
… [And] Of the adults who received medication for their depression, 52.7% reported it as extremely helpful or helped a lot, 28.0% reported that it offered some help, and 19.3% reported it was little or no help.
It’s unbelievable. Nearly one-third of patients with depression reported that therapy was pretty much useless. Can you imagine if antibiotics or a particular surgery failed a third of the time? Would the FDA allow this to continue? What if your car’s brakes were little or no help a third of the time? Psychotherapy is a health and safety issue, too.
Perhaps more questions need to be asked, such as: What were the professionals who were treating the 40.5% of patients who said it was “extremely helpful or helped a lot,” doing right? What methods, techniques, and therapy tools did these psychotherapists use? How did these patients find these therapists—were they referred by a doctor or other professional? Where do these therapists practice—in a particular state or region; in an outpatient clinic, inpatient program, or in private practice? Where did these therapists get their training? What were their credentials?
Responsibility for successful treatment lies with the therapist.
Recalcitrant or unmotivated patients must be inspired and motivated to succeed in their therapeutic goals. If goals are set and not met in a reasonable time-frame, then therapists are obligated to try new approaches or refer the patient to a therapist who has more experience in treating patients with particular issues. If personality disorders or any other problem exists that might be considered challenging to both patients and therapists, then specific training in evidence-based treatments must be acquired, or again, the patient should be referred to a therapist with skills and proven success with these issues.
For more on this issue, please listen to this brief MP3 of Michael Dresser and me discussing the Therapy Crisis and Solutions on the Dresser After Dark radio show, or on BlogTalkRadio as part of a collection of interviews with a variety of interesting guests.
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TPG at 6:48 pm on
February 19th, 2010Sometimes it is the relationship between therapist and client that heals. The warm loving/kindness can be transformational regardless of where it takes place or the credentials of the therapist. The chemistry, the resonance, the bouncing of mirror neurons that reflect rather than repel between two people can count for much more than qualifications ever will.
Therapy will never be an exact science and resistant clients are their own worst enemy.
TPG: Thank you for taking the time to research those links and send such relevant comments.
The sources are excellent, thank you. I
agree with your conclusion about both drugs and therapy. I’m hoping that this is a good starting point for more discussion for professionals both medical and non-medical (s well as patients/clients).
I believe therapy works, I believe medication works, but I also think that it is important for us all to keep improving. Quite often a well-planned (and sometimes serendipitous) combination of medication and talk therapy seem to benefit the patient the most. Naturally it depends on the patient, the diagnosis, the individual circumstances, etc.
Hi Sonia,
Thank you for sharing your comments. While I agree that the therapeutic relationship itself is transforming, it is important that a therapist is trained, educated and experienced with the particular problem a patient is facing. Additionally, while I don’t disagree that patients can set up obstacles to their own wellness, I believe it is the therapist’s responsibility to motivate each and every one of his/her patients. That is his job. Sure, patients have personal responsibility for their mental health in many ways. But it is the therapist’s job to help patients develop that sense of responsibility and teach them ways to put in place healing thoughts and behaviors. Otherwise, the relationship is a friendship not a therapeutic relationship and though friendships are important, one does not pay a professional fee for a friendship. Paying a therapist’s fee entitles a patient to a professional, experienced, ethical therapeutic experience that aims to help the patient by relieving his or her suffering, teaching him the skills needed to cope with his struggles, and so on. (Obviously, there is much more to it than can be written in a brief blog comment.)
Anne at 9:53 am on
February 24th, 2010Hi
I am a person who has had a major depression since around age 12 and am finally getting therapy as an offshoot of couples counseling. The therapist has been very skilled with couples counseling and we are almost done, but in private counseling with me around the depression, I am disappointed. Cognitive Therapy seems formulaic; writing in the Mind Over Mood workbook at home and then discussing it is not the same as having a significant interaction during the session.
I am grateful to my cohorts in NonViolent Communication (Marshall Rosenberg) who are actually more skilled in respectful compassionate communication than my therapist. Sessions with them go much deeper.
So, how can I change therapists? And find one who knows NVC?
Thank you.
(ps. I have been on medication for two weeks.)
(pps.I could be considered resistant; my depression says After all these years you are leaving me?)
Loretta at 10:12 am on
February 24th, 2010I went to counseling for over 6 months, and I didn’t feel any better. I did a lot of crying, but my depression never got better. Lucky for those that counseling does help.
Karen at 6:45 pm on
February 24th, 2010My therapist saved my life. Not because therapy lightened my depression; it didn’t. But by helping identify my bipolar disorder and sticking with me through five years of searching for the right meds, including helping me realize when I needed inpatient attention, my therapist kept me on the planet long enough to find the right chemical balance that FINALLY got me to the point where therapy (especially CBT) had an effect.
Athirson at 10:08 pm on
February 24th, 2010I underwent 10 years of therapy for avoidant personality disorder, PTSD and paranoia. In that time, I got absolutely nowhere and eventually gave up on it, seeing it for the monumental waste of money that it was.
So the only surprising thing about this article is the revelation that nearly 60% of the patients found therapy to be at least somewhat helpful.
John at 10:20 am on
April 9th, 2010My experience is very much like that of Athirson. I was in therapy for well over 12 years. My presenting complaint was OCD, a condition which was ignored by most therapists and sometimes badly misdiagnosed. (One professional actually thought I was schizophrenic, even though I was not hallucinating and not delusional). I derived no benefit from any of it, and lost a lot of money. I also found it very damaging to my self esteem. I too am surprised that anyone benefits. Contrary to what the article implies, I found medication to be even worse than psychotherapy. Now, as a 45 year old, I just try to get through life as best I can. I don’t focus on my own happiness. I know I will never be happy. I think more in terms of what I can contribute. The only good things in my life are contributions.
Dear John,
I am so sorry therapy was such an abysmal failure for you in the past–unfortunately this experience is shared by others. Might I share with you some of my thoughts? OCD is an extremely difficult disorder to diagnose and treat. I strongly believe that finding a psychiatrist that is also a psychopharmacologist who really understands how to do medication intervention can really help. I have seen success with people who had given up hope.
I am not sure this link will be helpful,http://www.ascpp.org/pages.aspx?PanelID=1&PageName=Information_for_Patients
and I understand that you are fed up with your experience, but perhaps you might reconsider. Either way, I wish you success and good health.
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Great piece. It reminded me of some of the great Jay Haley’s writing, where in his 1969 paper “The Art of Being a Failure as a Therapist”
http://www.ncbi.nlm.nih.gov/pubmed/5803602
…he contrasted the improvement rates (about 50%) of potential clients on a waiting list vs. those who actually got therapy. The results were not staggering in favor of psychotherapeutic intervention. In fact, 50 to 70% of the people on waiting lists opted not to go to treatment once they came to the top of the list! Essentially, they got better on their own.
For a nice summary of Haley’s article, with nice bullets on what to do in the room that’s right vs. what therapists tend to do wrong, see:
http://psychservices.psychiatryonline.org/cgi/content/full/51/8/1047
That said, the fact is that the FDA does approve drugs that don’t work 30% of the time or more. One could simply look at the current flap over SSRI antidepressants vs. placebos, but a less emotionally charged place to start would be with the newest TNF-blocker biologic drugs (Enbrel, Humira, Simponi, etc.) for the broad spectrum of autoimmune diseases including lupus and rheumatoid arthritis.
http://www2.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/06-15-2001/0001514793&EDATE=
Read through this pro-Enbrel press release, and you’ll see how this first anti-TNF blocker works…but not even close to universally.
Basically, despite their huge successes with a significant chunk of patients, and decent successes with another middling chunk of patients, patients do not respond to those drugs 30% of the time, or more. For many, these drugs fail.
Kinda like therapy.
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