Clinical PsychologyLearning Lab

Psychotherapeutic interventions

Essential questions about psychotherapy

Does therapy work? Is longer better? Who drops out? Is one therapy best? What are the common factors? Can therapy harm?

Source: Chapter 10 Advanced about 35 minutes

What this module draws on:

  • Textbook concept The ten essential questions about psychotherapy (Ch. 10).
  • Contemporary update Updates on common factors and harm.
  • Original elaboration Myth-or-evidence activity.

Learning objectives

After this module you should be able to:

  1. Summarise evidence that psychotherapy is generally effective.
  2. Discuss duration, dropout and the durability of effects.
  3. Explain the 'equivalence' debate and common factors.
  4. Identify why change is difficult and how therapy can cause harm.

Introduction

The textbook organises the outcome literature into ten questions that students, clients and policymakers commonly ask. The answers are more nuanced than slogans.

Does psychotherapy work? Textbook concept

Eysenck's 1952 critique claimed therapy did no better than spontaneous remission. Subsequent reviews and meta-analyses, beginning with Smith and Glass (1977), concluded that psychotherapy is generally effective, with the average treated client better off than most untreated people. Effectiveness in routine practice also appears substantial, though usually smaller than in controlled trials.

Duration, dropout and durability Textbook concept

  • Many therapy episodes are brief; the textbook notes an average of around six sessions in the data it reviewed.
  • Brief treatment is often as effective as longer treatment for many problems, though some studies suggest longer treatment helps some clients more.
  • People with fewer economic and educational resources have been more likely to drop out in the studies reviewed — a service-design issue, not a client failing.
  • Effects of therapy often last beyond its end, especially when skills are practised; relapse prevention matters.

Is one therapy better than another? Textbook concept

Many comparative studies have found similar overall outcomes between well-delivered, bona fide therapies — sometimes called the 'Dodo bird verdict'. Others find specific treatments work better for specific problems (for example exposure for phobias and OCD). Both can be true: common factors carry much of the effect, while specific methods matter more for some conditions.

Common factors and why change is hard Textbook concept

Change is difficult because habits are reinforced, avoidance brings short-term relief, and environments often reward the old pattern. Ambivalence is normal, not resistance to be defeated.

  • The therapeutic relationship (alliance).
  • Expectations of improvement (hope).
  • Confronting the problem.
  • Experiences of mastery and control.
  • Attributing success to one's own efforts.

Professional training, costs and harm Textbook concept

The textbook notes research failing to show that highly trained professionals consistently outperform less trained helpers in outcome, while professionals have broader skills for complex cases. It reports studies suggesting psychological interventions can reduce medical service use. And it acknowledges that therapy can harm — through poor fit, incompetence, boundary violations or unhelpful techniques.

Worked example: Explaining evidence to a client Original, fictional

A fictional client asks, 'Will therapy definitely fix this?' An honest answer: 'Most people who come to therapy for problems like yours improve, but not everyone, and not always quickly. We'll check progress together every few weeks so that if this approach isn't helping, we can change it.'

Interactive activity

Myth or evidence?

Decide which statement better reflects the research summarised in the textbook.

1 Statement: 'Psychotherapy works no better than the passage of time.'
Show the reasoning

Best answer: Myth — reviews show therapy is generally effective. Eysenck's claim prompted research that found therapy generally effective.

2 Statement: 'Longer therapy is always better.'
Show the reasoning

Best answer: Myth — brief therapy is often as effective, though some clients benefit from longer treatment. Duration should match need; brief treatment often suffices.

3 Statement: 'Therapy cannot harm anyone.'
Show the reasoning

Best answer: Myth — some clients deteriorate, and poor practice can harm. Deterioration and harm are documented; monitoring reduces risk.

4 Statement: 'The therapeutic relationship is associated with outcome across many therapies.'
Show the reasoning

Best answer: Evidence — the alliance is a robust common factor. The alliance consistently predicts outcome.

Knowledge check

5 questions. Every option has an explanation. Your answers are not sent anywhere when JavaScript is available; without it, they are checked by the server and immediately discarded.

1 Whose 1952 paper claimed psychotherapy was no more effective than spontaneous remission?

Multiple choice Intermediate

Basis: Textbook concept, original question

2 The 'Dodo bird verdict' refers to:

Multiple choice Advanced

Basis: Textbook concept, original question

3 The textbook reports that clients with fewer economic and educational resources were more likely to drop out of therapy in the studies reviewed.

True / false Introductory

Basis: Textbook concept, original question

4 Which is a common factor?

Multiple choice Introductory

Basis: Textbook concept, original question

5 What is the best way to reduce the risk of harm in therapy?

Multiple choice Intermediate

Basis: Textbook concept, original question

Summary

  • Therapy is generally effective, though not for everyone.
  • Brief therapy often suffices; dropout is linked to access and resources.
  • Many therapies show similar overall effects; specific treatments matter for some problems.
  • Common factors include alliance, hope, mastery and confronting problems.
  • Therapy can harm; monitoring and ethics reduce risk.

Questions for reflection

  1. If many therapies produce similar results, what should guide your choice of approach for a particular client?

Key terms

Further reading

  • Textbook Plante, T. G. (2005). Contemporary clinical psychology (2nd ed.). John Wiley & Sons.
  • Cited in textbook Eysenck, H. J. (1952). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology, 16, 319–324.
  • Cited in textbook Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752–760.
  • Cited in textbook Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965–974.
  • Contemporary Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge.
  • Further reading Barkham, M., Lutz, W., & Castonguay, L. G. (Eds.). Bergin and Garfield's handbook of psychotherapy and behavior change (latest edition). Wiley.

Practise in the case lab: Meera: chest pain, emergency visits and fear of dying · Imran: work stress, rising alcohol use and high blood pressure