Common Queries

Yes. Often emphatically so. Although finding the right therapist can be tricky. In general, be wary of those that overemphasize a particular therapy "brand." The acronyms are everywhere, but the hype often extends beyond the substance. Research does not support ascribing to a particular therapy brand as being predictive of effectiveness. In contrast, research demonstrates that the therapy PROCESS is predictive of outcome and many that ascribe to a particular theoretical orientation do not actually provide an experience that is consistent with their claimed philosophical convictions (Shedler, 2010). 

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For example, Castonguay, Goldfried, Wiser, Raue, & Hayes (1996) analyzed therapy transcripts and recordings collected as part of a larger study researching the effects of CBT and psychotropics on depression. They grouped therapists based on whether their process adhered more to a CBT prototype or more to a dynamic process orientation. What they found was that even though all these therapists were supposedly providing CBT, those that adhered to a more dynamic process and less to a CBT prototype were vastly more effective. In fact, a unique aspect of CBT, focusing on "distorted cognitions" was negatively correlated with outcome (i.e., the more it was emphasized the poorer the outcome). They found that this was often done to provide a "cognitive" rationale for a rupture in the working alliance (i.e., working relationship). Similar findings have emerged with comparable methodologies (Ablon & Jones,1998) but this level of analysis is not reflected in most research on psychotherapy. 

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Some key variables associated with positive therapy outcomes include the therapist having an emotion-focus, process orientation, and appreciation of the developmental nature of the condition being addressed. Psychotherapy is not about focusing on the past but the past illuminates the present. The therapist and client/patient should have a shared understanding of the goal(s)/purpose of treatment (i.e., working alliance; What's wrong? What do they hope to change? How will psychotherapy be helpful? Why now?). The relationship that undergirds treatment is ideally imbued with trust which fosters vulnerability and allows them to experience and work through the difficult emotions that drew them to therapy initially (Schore, 2012). Also, the relationship in "the room" can be used as a tool for understanding experiences, identify and explore patterns of behavior, and use this information to translate therapy gains into everyday life. Understanding typically precedes change.

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The emphasis on the relationship is not just a vague "liking" of each other, but is characterized by a certain level of bonding that allows for the patient to "take chances", for difficult emotions to be expressed (e.g., anger, heartbreak, shame) and worked through, for an independent perspective to be received and considered, and in turn this process tends to foster growth and autonomy.  

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Kristian Kemtrup, PhD, LMFT, talks more about therapy styles and outcome here: https://www.psychologytoday.com/us/blog/making-sense-of-therapy/202310/two-different-things-called-therapy

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The best quality research has consistently revealed that the duration of effective treatment often lasts 20-24+ sessions, with larger effects often coming with increased duration (Shedler, 2020). Similarly, multiple sessions per week produce significant therapeutic gains relative to single weekly sessions for depressed patients (Brujiniks et al. 2020) and treatment-resistant depression (Rost et al. 2019; Fonagy, 2015). Although some "brands" advertise short-term fixes, this is smoke and mirrors as the research often includes poor methodology (e.g., irrelevant comparisons, poor controls, arbitrary follow-up evaluations) and typically results in minimal or no improvements for those undergoing treatment (Shedler, 2018).