What kind of therapy is best for me?
By David G. Markham, L.C.S.W.
I have been depressed and unhappy for many years, and have finally wondered whether psychotherapy can help me. I have done some reading and talked to friends and I know that there are psychoanalytically trained therapists and cognitive behavioral therapists, and people who do all kinds of therapy. I found a web site which said there are over 500 different kinds of psychotherapy. I even wonder if hypnosis would help me? How can I choose what kind of therapy would be best for me?
You have asked an excellent question and one which many people find perplexing. There are many ways I could answer your question. Let's start with the practical approach first.
I think the best way to find a therapist is to ask friends, relatives, your doctor or pastor if they know of a good therapist. I think the best way to find a therapist is the same way to find any professional, by asking other satisfied clients.
A more conceptual way of answering your question would be to share a little bit about the therapy field. There are many schools of therapy which have their own training programs and credentialing standards. These programs "certify" the competence of the practitioners in their method. The fact is that competence does not equal effectiveness. In other words, a practitioner can be very competent and heavily credentialed but still not help the client achieve any better outcomes than someone less well trained. This seems to be a puzzle in the field. Often psychotherapy training programs and institutes claim that their credentialing standards exist to protect clients. Interestingly, there is no evidence that any particular model or technique gets better results than others when scientifically evaluated.
When researchers examine the outcome in psychotherapy they find that the variables which contribute to good outcome are as follows: extra-therapeutic factors 40%, relationship factors 30%, hope and expectancy 15%, model and technique of the therapist 15%
Extra-therapeutic factors include things like persistence, openness, faith, optimism, supportive family, membership in a religious community, satisfying work, good friends, enjoyable hobbies, and all the other positive things in a client's life before they enter therapy.
Relationship factors include feeling understood by the therapist, having trust and confidence in the therapeutic relationship, feeling cared about, etc.
Hope and expectancy sometimes has been referred to as the placebo effect, that is, does the client believe that therapy can help? The more the client believes that therapy can help, the more likely it is that it will.
The model and technique of the therapist only accounts for 15% of the outcome, while the other three factors account for 85% of the likelihood of a positive outcome.
So, to answer your question about how to choose a therapist, I think it is important to find a therapist whom you feel understood by, whom you come to feel you can trust and put your confidence in. A couple of visits should be enough to make this determination. If you have met with a therapist two or three times and still don't feel understood by that person, or feel you can trust and put your confidence in that person, it is not that psychotherapy can't help, it is just that you have a bad match and you should save your time and money and try again with someone else.
The outcome research is very clear that psychotherapy does help and that the majority of people who use psychotherapy report improvement in as few as 4 sessions.
The overall length of therapy depends on the client’s goals and purposes. In a crisis, most clients find things improving in 4 to 8 sessions. For other problems and concerns, clients may want to continue in therapy for several months. It usually isn’t necessary to meet with the therapist weekly after the initial phase of therapy (the first 3 or 4 visits) and clients may want to meet with the therapist every other week or every three weeks, or once per month. Sometimes people want to see how things go for a period of time and return on an as needed basis.
Usually within a month or two, most clients find that they are managing things more effectively in their lives, and they are feeling better.
Reference ; The Heroic Client, Barry Duncan and Scott Miller, San Francisco: Jossey-Bass, 2000, pp.56-61