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Ask the Mental Health Expert Archives 2001-2004

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Therapy Success Rates

Q. I am looking for information on therapy success rates. Can you give me any info on the different options and how successful they are/for which condition etc.?

A. I assume you mean "psychotherapy"? That's a huge topic, and I cover it in some detail in my book, A Consumer's Guide to Choosing the Right Psychotherapist. For the research details, you may want to see the book, The Benefits of Psychotherapy, by ML Smith, GV Glass, and TI Miller (Johns Hopkins U. Press, 1980). This meta-analysis is now 20 years old, but I think the essential conclusions have withstood the test of time. Basically, Smith et al found that all major types of psychotherapy were effective, though cognitive and cognitive-behavioral techniques had the edge for certain conditions. Since 1980, much of the research has focused on the treatment of depression. For example, Barkham et al (J Consult Clin Psychol 1999 Apr;67(2):201-11) compared a randomized controlled trial of cognitive-behavioral [CB] therapy to psychodynamic-interpersonal [PI] therapy, for mild-to-moderate depression.

The improvement rate at the end of treatment was 65% (for low-level clinically depressed subjects). There were no significant differences between CB and PI treatment methods, with the exception at 1-year follow-up, when the Beck Depression Inventory showed a significant advantage for CB. My reading of the literature is that cognitive-behavioral therapy (CBT) has the strongest data base for most common psychiatric disorders; e.g., most depressive and anxiety disorders. Interpersonal Therapy (IPT) may be a close second. This does not necessarily mean that CBT or IPT is more effective than other approaches, for every individual.

Psychoanalysts will often argue that not everything good and useful about therapy can be measured in controlled studies--there are often very subtle changes that a therapist (or patient) may notice, and which may not show up on a rating scale. For more information on specific disorders and their effective treatments, I strongly recommend Gabbard & Atkinson's text, Synopsis of Treatments of Psychiatric Disorders, 2nd ed., American Psychiatric Press, 1996. But, as I suggest in my book, a great deal of what works or does not work in psychotherapy depends on the match between the patient and the therapist-and whether the therapist is a decent, caring, attentive, and respectful person.

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August 2001

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