Assessing psychotherapy's effectiveness
Is therapy working ( source American Psychological Association APA)
Some people wonder why they can't just talk about their problems with family members or friends. Psychologists offer more than someplace to vent. Psychologists have years of training and experience that help people improve their lives. And there is significant evidence showing that psychotherapy is a very effective treatment.
How effective is psychotherapy?
Hundreds of studies have found that psychotherapy helps people make positive changes in their lives.
Reviews of these studies show that about 75 percent of people who enter psychotherapy show some benefit. Other reviews have found that the average person who engages in psychotherapy is better off by the end of treatment than 80 percent of those who don’t receive treatment at all.
How does psychotherapy work?
Successful treatment is the result of three factors working together:
Evidence-based treatment that is appropriate for your problem.
The psychologist's clinical expertise.
Your characteristics, values, culture and preferences.
When people begin psychotherapy, they often feel that their distress is never going to end. Psychotherapy helps people understand that they can do something to improve their situation. That leads to changes that enhance healthy behavior, whether it's improving relationships, expressing emotions better, doing better at work or school, or thinking more positively.
While some issues and problems respond best to a particular style of therapy, what remains critical and important is the therapeutic alliance and relationship with your psychologist.
What if psychotherapy doesn't seem to be working?
When you began psychotherapy, your psychologist probably worked with you to develop goals and a rough timeline for treatment. As you go along, you should be asking yourself whether the psychologist seems to understand you, whether the treatment plan makes sense and whether you feel like you're making progress.
Some people begin to feel better in about six to 12 sessions. If you don't start seeing signs of progress, discuss it with your psychologist. Your psychologist may initiate a conversation about what to do. If he or she doesn’t, bring it up yourself. You could ask your psychologist about additional or alternative treatment methods, for example. Sometimes speaking up to your psychologist can be very empowering, especially since your psychologist will be understanding and nonjudgmental instead of offended.
Keep in mind that as psychotherapy progresses, you may feel overwhelmed. You may feel more angry, sad or confused than you did at the beginning of the process. That doesn’t mean psychotherapy isn’t working. Instead, it can be a sign that your psychologist is pushing you to confront difficult truths or do the hard work of making changes. In such cases, these strong emotions are a sign of growth rather than evidence of a standstill. Remember, sometimes things may feel worse before they get better.
In some cases, of course, the relationship between a patient and the psychologist isn't as good as it should be. The psychologist should be willing to address those kinds of issues, too. If you’re worried about your psychologist’s diagnosis of your problems, it might be helpful to get a second opinion from another psychologist, as long as you let your original psychologist know you're doing so.
If the situation doesn't improve, you and your psychologist may decide it’s time for you to start working with a new psychologist. Don’t take it personally. It’s not you; it’s just a bad fit. And because the therapeutic alliance is so crucial to the effectiveness of psychotherapy, you need a good fit.
If you do decide to move on, don’t just stop coming to your first psychologist. Instead, tell him or her that you’re leaving and why you’re doing so. A good psychologist will refer you to someone else, wish you luck and urge you not to give up on psychotherapy just because your first attempt didn’t go well. Tell your next psychologist what didn’t work to help ensure a better fit.
Process of Therapy
By Michael Herkov, PhD
© 2000 University of Florida Brain Institute
While each individual experience of therapy is likely to vary, the following can give you an idea of what to expect as you enter therapy.
Your first contact with a therapist is likely to be with an office staff person. In a private office setting, your first contact will likely be with the therapist himself. This is the time to ask questions about fees, hours (e.g., evening appointment availability) and cancellation policy (e.g., will you be billed for missed appointments?). In the clinic setting, you can get some general information about the therapist (e.g., education, general orientation). However, more detailed information should likely be directed to the practitioner.
The staff person you speak with will ask you a number of questions. After obtaining some general demographic data, he will ask for an overview of your problem, and whether anyone referred you to this particular therapist. You will also discuss any insurance or payment issues.
Based on your needs and the therapist’s schedule, an appointment will be made. Occassionally, due to the nature of your problem and the therapist’s experience or schedule, the therapist may decide that your problem would be better treated by someone else. Such a situation is merely an affirmation by the therapist that you deserve treatment by a therapist best able to meet your particular situation.
Upon arriving at your first appointment, you will be given paperwork to fill out. This may include a detailed personal history (e.g., information about you parents, marital situation, physical health, medications) as well as insurance information (your insurance card will likely be copied). There is also likely to be information about the confidentiality of the sessions and any limits to that confidentiality will be presented.
Meeting the therapist
The initial visit can vary considerably and will depend on the practitioner’s professional background and personality. Some practitioners will review your paperwork and start the discussion there. Other professionals will engage in general discussion not related to your problem and work their way into the reason for the visit. Some practitioners may get right to the point. Keep in mind that there is no single "right" way to begin a session.
Most therapy sessions last 45 or 50 minutes, although more time may be taken for the initial interview. Near the end of the session, the therapist might summarize what has taken place and make recommendations for future sessions or additional referrals (e.g., psychological testing, medication evaluation). Do not be surprised if the therapist has questions at the end of the session or is unsure as to your diagnosis. Often, more than one session is needed to obtain this information.
Early in therapy, you and your therapist will likely develop a treatment plan. Remember, the treatment plan is a joint effort between you and the therapist. It is likely to include structured tasks for you to complete or issues for you to consider between sessions. Your treatment plan may also include goals and criteria for assessing when these goals have been reached. Some therapists will use a written treatment plan, signed by the patient and therapist. Other therapists will use a less formal plan. Either way, you should know the goals of treatment and how you will accomplish them.
Length of therapy
How long a person is in therapy depends on a variety of factors such as the type and severity of problem, therapist’s orientation and affordability. Some therapists practice a brief therapy that targets specific symptoms. Brief therapy can range from six to 25 sessions. Sessions are most often weekly but may be more or less frequent.. Some persons might require additional time, especially if symptoms are severe or their problems are especially complicated (e.g., abuse).
At the beginning of your therapy, you should discuss with your therapist how long he anticipates therapy lasting. While such estimates are subject to change, they can be useful in gauging your progress or your desire to begin the therapeutic process.
Process of therapy
In cognitive-behavioral therapy, the therapeutic relationship goes largely unexamined, but in interpersonal or psychodynamic therapies, the relationship itself is used as an instrument of change. Unlike most social relationships, the therapeutic relationship is examined to enable the patient to gain insight into her attitudes and expectations. Like all relationships, the therapeutic relationship will pass through different stages at different times.
Initially, the patient is likely to feel good about therapy. You may feel a tremendous sense of relief. Much of this comes from talking about your problem with an attentive, caring person. You may also feel relief that you now have an expert who can help you with your problem. Having a plan of action can reduce anxiety and instill hope.
Individuals may experience a range of intense feelings towards the therapist. Such emotions often reflect old feelings originally felt towards a parent, sibling or other important family member. The technical term for this phenomenon is "transference," and the "working through" of such feelings can help the patient to grow emotionally and to free themselves from emotional blocks and/or inhibitions.
Like most relationships, the therapeutic relationship can have its ups and downs. The initial exuberance felt during the initial stages of therapy may fade. The therapist whom you once saw as supportive and understanding can now seem challenging. This is not unusual or an indication that your therapy is stalled. It is important that you stick to your plan during this time and push ahead. It will help if you share your feelings with your therapist. This process can often uncover uncomfortable emotions that can be addressed.
26 December 2014Choosing a therapist
Making your choice ( BACP Web site source)
It is likely that there will be more than one practitioner to choose from in your area of the country. BACP Accredited Counsellors, Trainers and Supervisors have achieved a substantial level of training and experience approved by the Association. These practitioners are clearly indicated in bold black and will have the letters ’BACP’ in the ’Registration/accreditation’ column for their entry.
However there may be other considerations to be taken into account, and the details provided will give useful information including the practitioner’s training, experience and special interests. Below is a brief explanation of the information we list, and how it can help you find a practitioner who meets your specific needs.
I am registered/accredited with: tells you which organisation the individual is registered or accredited with.
My Code(s) of Ethics is: tells you which organisation’s Code of Ethics the practitioner is covered by.
My qualifications are: tells you what qualifications the practitioner has achieved. Common qualifications such as diplomas, degrees and certificates, and subject topics such as counselling, are abbreviated. Most practitioners also give the year in which they achieved the qualification. This should give you an indication of the depth of their experience.
I have special interest/experience in: tells you in what areas the practitioner may have specialised work-experience or training, e.g. relationships, cancer or depression. It may be a good idea to seek a practitioner who has specific experience that can meet your needs.
My theoretical approach is: tells you the way in which the practitioner approaches their counselling/psychotherapy service. For example, Jungian and Freudian approaches relate to the work of specific psychotherapists. In general, theoretical approach is less important than the quality of the counsellor. In some situations though, theoretical approach can be important.
I see: tells you which types of clients the practitioner often sees. For example, some practitioners are specially trained to work with couples, families or groups. More information/explanation about this may also be found in the Additional information section.
This is how I work: tells you how the practitioner works. For example, you may feel you require a set amount of sessions (time-limited), or are sure you will require the practitioners services over a longer period of time (long-term face-to-face work).
I also work in: tells you if the practitioner speaks a language other than English. For some languages, you might need to search for a counsellor in another county to your own.
Additional information: gives you more information about the practitioner. This will help you build up a more distinctive picture of their experiences & background.
My fees: tells you what the practitioner charges for a session, which is normally 1 hour. You may also find here additional information about reduced fees (concessions) and to whom they apply. Few practitioners can afford to work for nothing, so for free or low cost counselling you need to look at the organisations.
Only you can decide whether a practitioner will be right for you. Before deciding on your therapist, do not be afraid to ask questions or request further information. Most practitioners will be happy to provide additional information over the phone. Then ask yourself if you would feel comfortable telling this person intimate details of your life. Do you feel safe with them? Do you like their manner towards you? Could you be completely open with them?