Does therapy work?

Yes. Yes it does.  That’s the short answer. The longer answer is the same as it is for most interesting questions: it depends. “How can talking to someone fix my problems?” is one question I’ve come to know well.  As much as I dread the accompanying politely dubious facial expression that seems to say “I’m not convinced your profession is not a deluded pseudoscience,” I can also recognize that incredulity is appropriate and normal. Especially for those seeking therapy who want to hope that their lives can change, but are vulnerable to further disappointment.

But I absolutely love when someone comes back for their second session, sometimes one of those same dubious faces, and says, “I felt so much better after leaving here last week.” A common analogy people use is “like a weight has been lifted.”

The work of University of Texas psychology researcher James Pennebaker focuses on the role that self-disclosure, such as in therapy, plays in physical and emotional health.  Pennebaker concludes that “holding back or inhibiting our thoughts and feelings can be hard work,” that incurs real costs. The body must expend sustained effort to inhibit the desire to divulge something that feels important, and that chronic effort takes its toll on the cardiovascular, immune, and other physical systems. Conversely, the physical body as well as the mind is healthier when permitted to express oneself freely to another person.

Beyond Pennebaker, a wide body of psychology research supports talk therapy as a first-line intervention for most mental health conditions, with or without accompanying medication.  Medication and therapy together are generally more effective than either alone.  Therapy is longer lasting in effect than medication, as the behavioral change that results has ongoing application.  Furthermore, many individuals are understandably uncomfortable with medication prescribed for mental health conditions and its side effects.

There are numerous processes at work in the therapy hour. Processing complicated, sometimes contradictory thoughts and feelings in a time that is unambiguously “yours.”  Gaining perspective through the eyes of another person who has no stake in the outcome. Hearing yourself explain your reasoning aloud and thinking “Yes, that’s why I feel that way” or, in other cases, “That makes no damn sense.” Learning new skills or concepts that can help you understand yourself better and, when necessary, change.

Good therapy not only works; it is the proverbial truth that sets you free. The truth about what you need and who you are, and the freedom to live it out.  It is a stop sign held up, that requires you to pause before you proceed with the routine business of life. Without such a pause it’s too easy for us to continue on autopilot in our own daily loops, mindlessly zipping from home to work and back again.  Therapy challenges these assumptions about life and the part we play, and invites us into a wider world.

This post addresses the question of therapy’s effectiveness. In two weeks I’ll be posting about how it works, in the spirit of continuing to demystify the (often mystifying) world of mental health.

References

Pennebaker, J. (1997.)  Opening up: the Healing power of expressing emotions. New York, NY:  Guildford Press.

Manber, R., Kraemer, H., Arnow., B., Trivedi, M., Rush, A., Thase, M., Rothbaum, B. (2013).  Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone. Journal of Consulting Clinical Psychology, 76(3) 459-467.

Imel, Z., Malterer, M., McKay, K., Wampold, B. (2008).  A Meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110(3) 197-206.