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Does therapy work?

There are a lot of ways to answer this question. There's a fairly large body of research that examines therapy outcomes (i.e., whether it "works" or not), and the factors that lead to successful therapy. When I have more time I'll write another post that goes into that research in more detail.

For now, I want to address on a basic level this very common question, whether therapy works. The short answer is, yes, most of the time it does work in helping people feel better and/or cope better with life challenges. Several large studies support this, as do the outcome surveys that I and other therapists use to track clients' progress and satisfaction with therapy. Again, there's much more to write here about the scientific details of measuring improvement, but for now we'll keep it simple.

So if therapy tends to work, an equally interesting and important question is, under what conditions does it work best? There's lots of research available about this, too, but for now I'm going to focus on a few main themes. Therapy works best when:

- The client and therapist feel they are working together as a team

- To focus on and improve agreed-upon problems

- Using methods that both agree are likely to be helpful

So it's important in shopping for a therapist that these conditions are met. If you therapist feels too adversarial to be on your team, or if you really came to talk about how you can't have an orgasm and the therapist persists in bringing up your late grandmother (for reasons you don't fully understand) these are red flags. Similarly, if you really feel you need to be wrapped in a blanket and "rebirthed," and your therapist is not down with that, there's a mismatch in approach. You want to feel reasonably comfortable that the team spirit, shared focus, and agreed-upon methods are in place in order to feel confident that this is going to help you.

Another important factor is cultural awareness, sensitiviety, and skill. You want a therapist who can talk to you skillfully about your experience of being black, or Jewish, or gay, or a woman, or trans, or someone who is struggling financially, or whatever, and feel that they have some idea of the issues you are facing and is able to relate to you as a person.

Finally, what are some of the things that people in therapy do that make therapy more or less successful? This is from my own clinical experience and I don't have a reasearch study to back me up on this, but I see these over and over again. It is really helpful to be able to:

- Suspend disbelief about your ability to change: Lots of people come to therapy having felt or behaved a certain way for a very long time, and are extremely doubtful that they can change. I totally understand this. At the same time, you must be willing to set aside the belief "this probably won't work" and just try the things that you and your therapist talk about. Especially if you're a smart person and used to being right about things, avoid the impulse to talk yourself out of trying things! A good mantra for a person in therapy is, "It's possible..." feel better, to have a good relationship, to have an orgasm, etc.

- Persist until you are satisfied: A lot of people leave therapy before their goals are met. Sometimes it's about time, or money, feeling no change in symptoms, or feeling somewhat better, not wanting to "need" therapy, or that belief we just talked about that it isn't going to work. It's like climbing partway up the mountain then just camping out near the bottom when you really wanted to be at the top. It's like having a contractor build you a house, then firing him before it's done and saying, "no worries, I'll put in all the windows and stuff." If basic conditions I talked about above are met and if it's at all possible for you to give it more time, do so. Stick it out. Sometimes stuff takes time.

- Give your therapist feedback: We as therapists should ask from time to time whether we're addressing your concerns and how things are going. During these times, or whenever sometime comes up, please be honest if something isn't working well or if you have questions. I know it's uncomfortable, though at the same time, this can help get the work back on track for everyone.

- Be willing to change: Ultimately, no matter the root cause of a problem, the only thing we can really change is how you deal with it NOW. Therapy is really about that, changing old patterns so that life going forward is more satisfying.

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