Over the decades, and especially since the pandemic, the stigma of therapy has faded. It has come to be perceived as a form of important self-care, almost like a gym membership — normalized as a routine, healthful commitment, and clearly worth the many hours and sizable amounts of money invested. In 2021, 42 million adults in the United States sought mental-health care of one form or another, up from 27 million in 2002. Increasingly, Americans have bought into the idea that therapy is one way they can reliably and significantly better their lives. (View Highlight)
Hoy en día ir a psicoterapia es tan común como ir al gimnasio.
Hundreds of clinical trials have now been conducted on various forms of talk therapy, and on the whole, the vast body of research is quite clear: Talk therapy works, which is to say that people who undergo therapy have a higher chance of improving their mental health than those who do not (View Highlight)
Wampold is best known for research suggesting that all types of evidence-based talk therapies work equally well, a controversial phenomenon known as the Dodo Bird effect. (The effect takes its name from the Dodo in “Alice’s Adventures in Wonderland,” who, when asked to judge a race, decrees, “Everybody has won, and all must have prizes!”) (View Highlight)
Pim Cuijpers, a professor of clinical psychology at Vrije University in Amsterdam, co-wrote a 2021 meta-analysis confirming that therapy was effective in treating depression compared with controls, but he also found that more than half of the patients receiving therapy had little or no benefit and that only a third entered “remission” (meaning their symptoms lessened enough that they no longer met the study’s criteria for depression) (View Highlight)
Such different interpretations of the data persist in part because of some of the field’s particular research challenges, starting with what constitutes a suitable control group. Many researchers put half the people who sign up to participate in a trial on a waiting list, in order to use that cohort as a control group. But critics of that method argue that languishing on a waiting list puts patients in an uncomfortable state of limbo, or makes them less likely to seek help from other sources, thus inflating the difference between their well-being and the well-being of those who received care. Other researchers try to provide a control group by offering a neutral nontherapy therapy, but even those are thought to have some placebo effect, which could make the effect of therapy look smaller than it really is. (One researcher, in trying to devise a neutral form of therapy to serve as a control, even managed to stumble on a practice that improved patients’ well-being about as well as established therapies.) (View Highlight)
The finding that all types of therapy work equally well, Driessen believes, could be hiding the variation that exists from person to person. Given the state of research, it is impossible to know what to recommend for an individual patient. “I don’t know which of these treatments will work best for you,” she resorts to saying. “And that is something that I, as a clinician, find very unsatisfying.” (View Highlight)
The most significant difference in patient outcomes, Wampold says, almost always lies in the skills of the therapist, rather than the techniques they rely on. Hundreds of studies have shown that the strength of the patient-therapist bond — a patient’s sense of safety and alignment with the therapist on how to reach defined goals — is a powerful predictor of how likely that patient is to experience results from therapy (View Highlight)
To demonstrate the skills that do correlate, Timothy Anderson, director of the Psychotherapy & Interpersonal Process Lab at Ohio University, studied groups of therapists who have been rated by patients as highly effective. He put them through a monitored exercise in which they were asked to respond to video clips featuring actors playing out difficult situations that commonly arise in therapy. “The patient might be saying, ‘This isn’t working — you can’t help me,’” Anderson says. He found that the highest-rated therapists tended, in those moments, to avoid responding with hostility or defensiveness, but instead replied with a pairing of language and tone that fostered a positive bond. “That’s displayed by the therapist saying things like, ‘We’re in this together,’” Anderson told me, “even when the patient is saying, ‘You can’t help me no matter what.’” Among the other qualities that these therapists displayed were verbal fluency — the ability to speak clearly in ways the patient could quickly grasp — along with an ability to persuade the patient and to focus on a specific problem. (View Highlight)
The therapist Stephen Mitchell has described therapy as a “shared effort to understand and make use of the pains and pleasures of life’s experiences.” Therapy, in his language, is not a practice that tries to fix any one thing, but one that aspires to help its participants build the most out of the challenges that face them (View Highlight)