Evaluating Psychotherapy: Does Therapy Work?

Psychologists tend to agree that therapy is better than no therapy, if only because rates of spontaneous remission (spontaneous healing) are low. On the other hand, there isn't much agreement about which therapies work best. Based on research that scans many studies (meta-analysis), some conclusions can be drawn:

Psychotherapy is effective for most people.

However, psychotherapy doesn't work for everyone. It isn't a "silver bullet."

No single form of therapy works best for every problem, although specific kinds of treatment appear more effective for certain kinds of problems most of the time, but not always. Thus, cognitive therapy is often best for panic disorders, but not always.

Most therapies share a set of similar elements. These include the opportunity for the patient to form a positive relationship with a therapist, receive an explanation for his or her symptoms, and confront negative emotions.

Because of what you've just read about the relative merits of different approaches to therapies, it isn't surprising that
many therapists take an eclectic approach. That is, they pick and choose among different approaches based on an individual's apparent needs in a specific case.

Biomedical Therapy

Drug Therapy

Biomedical therapy is aimed at identifying biological factors underlying psychological disorders. In general, this approach has focused on drugs that can alter the operations of neuro- transmitters and cerebral neurons in such a way as to relieve or control symptoms.

Antipsychotic drugs work primarily by blocking dopamine receptors in the brain's synapses, although there are other kinds of antipsychotics that work to alter neuro- logical chemistry in specific parts of the brain. The problem with antipsychotics is that they can alleviate symptoms only if the drug regimen is continued. Take away the drugs, and the symptoms reappear.

Antidepressant drugs are used to reduce or soften the effect of depressions. They're also used to treat bulimia and certain kinds of anxiety disorders. (Depression is often accompanied by anxiety.) Details about different kinds of antidepressants are summarized in Figure 1 on page 469 of your text. A natural antidepressant, a plant called St. John's wort, is widely prescribed in Europe but is given less attention in the United States. Its effectiveness is considered uncertain.

Mood stabilizers include lithium, used successfully in cases of bipolar disorder. What makes mood stabilizers unique
is their potential capacity to prevent the recurrence of manic-depressive episodes.

Anti-anxiety drugs are very frequently prescribed by American physicians. As your text points out, more than half of American families have members who have been on one of these kinds of drugs at some point.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is still used to treat severe depression, but its use remains highly controversial. Side effects are often alarming, including loss of recent memory. Over the years, researchers, physicians, and "veterans" of ECT have argued that the procedure is akin to torture and should long since have been abandoned. Perhaps it will be as a new alternative to ECT is introduced. Transcranial magnetic stimulation (TMS) is intended to create a magnetic pulse that can be aimed precisely at certain parts of the brain. While TMS results have been promising in some respects, there remains the problem of side effects, such as convulsions
and seizures.

Psychosurgery

Psychosurgery is the use of brain surgery to reduce symp- toms of mental disorder. This type of surgery was used in the past by destroying or removing parts of the brain. While the procedure could reduce symptoms of mental disorder, such surgeries came with drastic side effects. Such surgery is much less common today and is only used in specific circumstances.

Biomedical Therapies in Perspective

While biomedical approaches to psychological disorders have radicalized treatment regimens and no doubt reduced suffer- ing for many people, problems remain. Drug side effects can be serious. Furthermore, drug therapies can mask symptoms such that it's quite difficult to get at underlying problems that caused a person to seek therapy in the first place.

Perhaps, as we learn more about the nature of human con- sciousness, we'll find some optimal balance among different kinds of therapies.

Community Therapy: Focus on Prevention

Community psychology is aimed at preventing or minimizing the incidence of psychological disorders. An initial approach to this sort of thing began in the 1960s with an effort to create a network of community mental health clinics. However, due to funding cuts at state hospitals, there has been a trend toward deinstitutionalization, which hasn't gone too well. As mental hospitals have been emptied, more and more of the indigent and homeless-including an alarming number of military veterans-are either wandering the streets with shopping carts or being jailed for want of adequate public health facilities.