Psychotherapy Works: A review, by Larry M. Friedberg, Ph.D., of:
"The Effectiveness of Psychotherapy: The Consumer Reports Study"
by Martin Seligman, University of Pennsylvania
Consumer Reports (November 1995) published the article: "Mental Health: DOES THERAPY HELP?" Based on the results of the large-scale consumer survey on which this article is based (and on many other controlled psychotherapy research studies) the answer is a resounding YES! This article presented the results of an in-depth survey of 7,000 Consumer Reports subscribers: 4,100 went to some combination of mental health professionals, family doctors and support groups, and of these, 2,900 saw a mental health professional. This is a very large sample for a study of psychological treatment. Nowhere else are such large sample sizes available in the (large and growing) literature on the effectiveness of psychotherapy which used treatment-control group comparisons.
Findings of the Consumer Reports Study
Psychotherapy Works: The Consumer Reports study concluded that therapy works. The vast majority of patients benefited very substantially from psychotherapy.
Eighty-seven percent of patients who felt "very poor" or "fairly poor" at the beginning of therapy improved. Outcome measures included:
Improvement in the specific problem that led the respondent to therapy
Overall satisfaction with the therapist's treatment of the respondent's problems; and
Global improvement in the respondents' "overall emotional state".
The longer patients stayed in treatment, the better the results of the treatment in terms of satisfaction and outcomes.
The longer the treatment, the more positive the outcome. This connection between the duration of appropriate treatment and its outcome has been repeatedly demonstrated in controlled studies. It is known as the Dose Effect.
It is important to remember that the vast majority of people, even when therapy is unlimited in its availability, end therapy before six months have passed (90% before 20 visits; Coopers and Lybrand, actuarial data).
In the majority of cases, psychotherapy worked better than medication.
Psychotherapy alone was as effective as psychotherapy combined with medications such as Prozac or Xanax. There was no difference between psychotherapy alone and psychotherapy plus medication for any kind of disorder.
This is consistent with controlled studies showing that psychotherapy leads to superior results over medication for depression and panic disorder.
Sixty percent of patients who took medications said they were helpful, versus 90% for psychotherapy alone. But half of the respondents who took medication complained of problems with their medications, the most frequent being drowsiness or a feeling of disorientation. This is not to say that psychiatric medications are not helpful, when appropriately prescribed.
People who saw a mental health counselor for more than six months did much better than those who saw their family doctor for psychological problems.
Family doctors failed to refer patients to mental health specialists.
Almost half of respondents who saw their family doctors received medication alone without the benefit of contact with a mental health professional.
In the Consumer Reports study only one-quarter of patients seen first by their family physician were referred to a mental health professional.
Only half of those with severe distress were referred on.
Sixty percent of patients with panic disorder or phobias were not referred to a mental health specialist, in spite of considerable evidence that specific psychological therapies are highly effective for these disorders.
Other research cited by Consumer Reports has shown that family doctors often fail to diagnose mental health problems (50% to 80% of these problems are not diagnosed).
When family doctors prescribe psychiatric medications, they sometimes prescribe them at too low a dose or for too short a time.
These factors explain why, in the Consumer Reports study, only half of the respondents were highly satisfied with treatment by their family doctors, in contrast to mental health professionals.
No specific kind of psychotherapy did better than any other for any problem. Psychologists, psychiatrists and social workers also did equally well, and were significantly superior in outcome to marriage counselors.
Managed care intrusions into psychotherapy treatment interfered with its outcome:
Respondents whose choice of therapist or duration of care was limited by their insurance coverage did less well than consumers whose treatment was not managed.