Is There Proof That Psychotherapy Works?

Can you even measure mental health success?
One of the weaknesses of the evidence-based approach is that psychotherapy is by nature very challenging to study in a trial. Psychotherapy, unlike handing pills out to patients, is difficult to standardize, since the skill of the therapist and what’s actually covered in the sessions varies from case to case.

Some experts feel that CBT has earned its reputation as a highly successful evidence-based therapy mainly because it is particularly well-suited to the randomized controlled trial (RCT), which is considered the gold standard for scientific study and is used to test new drugs.

Unlike psychodynamic therapies and psychoanalysis, which can go on for months or even years, the average length of a CBT treatment is about four months of weekly sessions—a perfect amount of time for a controlled trial. CBT, moreover, is a highly structured therapy with specific "lesson plans" for each session, which makes it easy to write manuals and ensure that each patient receives approximately the same treatment. (The limited number of sessions and standardized treatment has also made CBT attractive to insurance companies, incidentally.)

Even CBT therapists concede that this is a factor. "We certainly have many scientific studies that show effectiveness," says Aldo Pucci, PsyD, president of the National Association of Cognitive-Behavioral Therapists. "The reason we do is because cognitive-behavioral therapies are much more conducive to being researched. I’m not in a position to say that we have a great deal of evidence that cognitive-behavioral therapy is more effective than other approaches, such as psychoanalysis."

Dr. Gourguechon believes that the definition of evidence should be expanded to reflect the aspects of psychoanalysis and other treatments that are difficult to capture in a scientific study. “I don’t know if doing a full RCT of psychoanalysis is impossible, but it seems almost impossible to me,” says Dr. Gourguechon. “There are certain kinds of treatments that just don’t lend themselves to that kind of study. So are you willing to accept a different kind of evidence, like anecdotal studies or case studies?” She adds, “There are some medical-economic interests that prefer to limit evidence to randomized controlled trials.”

Trust your gut when it comes to therapy
If you’re shopping around for a therapy or wondering whether the therapy you’re in now is a good fit, don’t ignore the research—but don’t follow it blindly either. Most therapists agree that, regardless of your symptoms or what the research shows, it’s far more important to find a skilled and experienced therapist with whom you connect.

It’s important to remember that talk therapy, no matter how structured and studied it may be, is not a pill.

“The idea that psychotherapy is like medicine, that there’s one treatment that’s better for a particular disorder because it focuses on the particular deficit—like antibiotics for a gastric ulcer—is a myth,” says Wampold. “That’s not true in psychotherapy. What’s really important is the therapist.”