One of the major concerns expressed by many clients is the question of the effectiveness of psychotherapy in comparison with pharmacological treatments. Also of interest is whether one psychotherapeutic modality is more effective than another, for example; is Cognitive Behavioural Therapy (CBT) more effective than Psychodynamic Psychotherapy or Gestalt Psychotherapy?
What is psychotherapy?
Psychotherapy belongs to a school of healing practices that involve talking therapies to address psychological distress. Psychotherapy is an interpersonal treatment and is based upon psychological principles. Psychotherapy involves a trained therapist working with a client who may be experiencing a mental disorder, a problem, or complaint. The therapist adapts or individualises the therapy or therapies to meet the needs of the client’s disorder, problem, or complaint. Psychotherapy is delivered by professionals and paraprofessionals who include; psychiatrists, psychologists, psychotherapists, counsellors, social workers, relationship counsellors, and family counsellors.
To understand Psychotherapy, a brief history of its development is helpful. There are currently four main theoretical schools which offer different explanations, theories and techniques employed by therapists to assist clients. They are; psychoanalytic, behaviourism, humanistic, and postmodern therapies. The first force, Psychoanalytic therapy was, developed by Freud and neo-Freudians. This later evolved into psychodynamic psychotherapy, inter-personal psychotherapy, and object relationship theory. The second force, Behaviourism therapy; was developed by J. Watson and B. Skinner which evolved into Ellis’s Rational Emotive Therapy (RET), and Beck’s Cognitive Behavioural Therapy (CBT). Although many theorists suggests that there may not be a direct connection between Behaviourism, RET, and CBT, they are all placed into the same school and medical model.
The third force, Humanistic therapy, developed out of the horrors of World War II. Humanistic therapy believes in the phenomenological perspective or understanding of the subjective experience of the client. The main Humanistic theories developed were by C. Rogers Person Centred Therapy, F. Pearls Gestalt Therapy, and R. May’s Existential Therapy. The fourth force, post modern therapies, include, Narrative therapy, Solution-Focused therapy, and Collaborative Language Systems. There are currently over 500 different psychotherapy theories in practice.
But is psychotherapy really effective? A meta-analysis was undertaken by M. Smith and Glass, (1977) reviewing available controlled research. When they compared psychotherapy treatment group outcomes with no-treatment group outcomes the research suggested those who received psychotherapy had superior outcomes to those not receiving any treatment by .80 standard deviation units. Although .80 does not sound impressive, it is in fact a remarkably high number. What .80 really means is that the average client receiving psychotherapy will be better off than 79 percent of those who do not receive treatment, (M. Smith and Glass, 1977). Although this figure was disputed by many theoretical schools further meta-analysis over the years has produced very similar results.
A question still remains, which is the most effective psychotherapy? This question has also produced some surprising results. Behaviourists have always contested that CBT is the most effective therapy. The perception that it is the most effective therapy is partly due to its relationship to the medical model but also CBT researchers have highlighted that it is an evidenced based practice. The same meta-analysis by M. Smith and Glass (1977) suggested that there was a negligible difference between different psychotherapy’s efficacy. Except when CBT was employed there was minor increase in efficacy with clients experiencing depression. CBT was originally developed by Beck to assist clients who were experiencing depression.
The research also suggests that psychotherapy for many disorders is as effective as pharmacological treatments. But the effect of psychotherapy is longer lasting than medications. Psychotherapy aims to provide the client with coping skills to manage the world and their disorder.
Christopher Swane - Depression And Anxiety - Wellington