Monday, April 23, 2012

Therapy Effectiveness: Who gets the glory or the blame?

As a clinical psychologist who has been working in the field for years, I have provided therapy for children, adults, and couples. My philosophy has always been to meet clients at a middle ground and work towards mutually defined treatment goals. There are times when treatment progresses quickly over the course of several months, and there are times where it seems that no progress has been made. A recent New York Times (NYT) opinion article ( titled: “In Therapy Forever: Enough Already” sparked my idea for this current post. Looking at these two sides of the coin, who gets the glory when therapy is a success and who gets the blame when it appears ineffective?

To summarize the NYT’s article, the author wrote that:
A patient recently told me that, after seeing her therapist for several years, she asked if he had any advice for her. The therapist said, “See you next week.” 
When I started practicing as a therapist 15 years ago, I thought complaints like this were anomalous. But I have come to a sobering conclusion over the years: ineffective therapy is disturbingly common.

So if “ineffective” therapy is common, who is to blame? Often in my clinical practice patients bestow gratitude upon their therapist when they note improvements in their lives and their symptoms decrease. Conversely, as noted in the NYT’s article, therapists hold the majority of the blame if progress is slow or nonexistent. According to the Society of Clinical Psychology (a division of the American Psychological Association) research indicates that on average 15 to 20 sessions are required for 50% of patients to recover as indicated by self-reported symptom measures. Clinical research also suggests that people with co-occurring conditions or certain personality difficulties may require longer treatment (e.g., 12-18 months) for therapy to be effective. Given the data, it’s possible that some of those patients who are in therapy for years may have complex conditions or may be working with therapist who is not using evidence based treatments. Anecdotally, I’ve worked with numerous patients over the years, and occasionally we make a decision to terminate if the patient or I feel no progress is being made for various reasons.
Research has also indicated that the following variable impact treatment progress (this list is not exhaustive):
·         Frequency of appointments (e.g., attend weekly versus monthly)
·         Levels of symptom distress (i.e., is the problem long standing)
·         Therapist and patient adherence
o   The therapist implements the treatment as designed
o   The patient complies with treatment recommendations and homework

In the effort of full disclosure, I believe it is the therapist duty to identify with the patient why treatment has been a success or non-effective. When I terminate with my patients I consistently discuss progress towards meeting goals as well as pitfalls towards success. In my view, both the therapist and the patient contribute to whether therapy is effective or ineffective. It’s not a one-way street.  

Written by Erlanger Turner, Ph.D.

© Copyright 2012 Erlanger A. Turner 

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