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.

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
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?)

My 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.

My 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.