© 2018 Dr. Eric Olsen, all rights reserved
It's an understandable question given how therapists and therapy are portrayed in the movies and television (not to be confused with reality) or covered in the news media (also not to be confused with reality).
And, because of the still prevalent stigma of mental health treatment, you don't hear a lot from the millions of people who've benefited from therapy. Instead, therapy makes the headlines when someone with a history of mental health treatment goes on a shooting spree or kills her children in the midst of a psychotic post partum depression.
Well, the good news is that therapy works. Below I'll cite some classic studies that have demonstrated that fact incontrovertibly. The bad news is that too many people feel embarrassed to seek therapy and too many insurance companies treat therapy as the unwanted (perhaps even illegitimate) step-child of healthcare -- even when research studies have demonstrated repeatedly that a comprehensive mental health benefit with easy access to care reduces the utilization and costs of general medical treatment (the so-called Medical Cost Offset discussed below).
Empirical Studies
Here's what the U.S. Surgeon General has said: "Mental disorders are treatable ... the evidence for treatment being effective is overwhelming ... the inescapable point is that studies demonstrate conclusively that treatment is effective."
In a study published in 1999 in the book The Heart and Soul of Change: What Works in Therapy, authors T. Asay and M. Lambert reviewed a large number of studies that compared groups of people who received therapy with those who did not receive therapy. (The title of the chapter is: "The empirical case for the common factors in therapy: Quantitative Findings," pages 33-56) Most of the studies found that the average "treated" person is better off than 80 percent of those without the benefit of therapy.
In his book, The Great Psychotherapy Debate: Models, Methods, and Findings, published in 2001, Bruce Wampold reached the same conclusion, i.e., if there are two groups of people,with similar problems and one group receives therapy and the other doesn't, those who receive therapy will be better off than 80 percent of those who don't.
Cognitive Therapy or Psychodynamic Therapy
Insurance companies tout cognitive therapy because it purportedly benefits people more than psychodynamic therapy and is allegedly more cost-effective than psychodynamic therapy. Critics of insurance and managed care companies suggest that "cost-effective" actually means that insurance companies reap higher profits by promoting cognitive therapy.
Consumers Union Studies
The non-profit Consumers Union has published several large-scale surveys of its members' use of mental health services. The first survey, published in the November 1995 issue of Consumer Reports magazine, reported the experiences of more than 4000 members.
Among those who described their emotional state as "very poor" at the start of therapy, 44% said they now feel "very good." Another 43% said they improved significantly. Thus, a total of 86% of respondents reported at least significant improvement.
People experienced three kinds of improvements. Their initial presenting problems eased, they felt better able to relate to others and to work productively, and their increased self-understanding led to improved self-esteem and more enjoyment of life.
Regarding the length of therapy, "longer therapy was associated with better outcomes." People in therapy more than six months reported better gains than those who stopped therapy earlier. People who stayed in treatment more than two years reported the best outcomes of all.
In October 2004 Consumer Reports published another study of 3,079 readers experience of talk therapy and drug therapy for depression and anxiety. This study showed how the effects of drug therapy and talk therapy occur on a different timeline. People whose treatment was primarily medication improved considerably within a few visits. Compared to those who had fewer than 13 talk therapy sessions, those taking medication improved about the same. However, those who had more than 13 talk therapy sessions had a better outcome than those whose treatment was mainly medication. "The most successful patients were those who received a balance of drug and talk therapies."
The report noted that in the previous ten years the average number of talk therapy visits people received for mental health problems had declined dramatically (from more than 20 visits in 1994 to 10 visits in 2004). The authors concluded: "Since our survey indicates that longer-term therapy is linked to more positive outcomes, that trend is troubling."
Medical Cost Offset
In 1993, the National Institute of Mental Health released a study which found that the cost of covering mental illness on the same basis as medical illness would cost only $6.5 billion and that spending this extra amount would save U.S. taxpayers $8.7 billion in indirect costs associated with untreated mental illnesses. (Goodwin, F.K., & Moskowitz, J. (1993). Health care reform for Americans with severe mental illness: Report of National Advisory Mental Health Council.)
In a 1997 study, a research team analyzed the results of 18 studies of various treatment methods for a variety of presenting problems. They found that psychological treatment yielded a whopping 90% reduction in overall healthcare costs. The studies also showed reduced employee absenteeism and increased productivity. (Gabbard, G. et al. The economic impact of psychotherapy: A Review. American Journal of Psychiatry, 154 (2), 147-155.)
In an article published in 1999, J. Chiles et al. combined the results of a series of studies from 1967 to 1997. They found psychological services decreased medical expenses among surgical patients and among those who tend to "over-utilize" medical services. Even when the cost of providing services was included in the overall costs, the average savings was 20%. (Chiles, J. et al. 1999. The impact of psychological interventions on medical cost offset: a meta-analytic review. Clinical Psychology, 6 (2), 204-220.)
In a 1999, study in Great Britain, researchers found that as few as eight sessions of interpersonal therapy reduced: the number of inpatient hospitalizations, appointments with primary care physicians, nursing visits, use of all medications and care provided by relatives. In this study the cost per patient for psychological treatment was $2115 - the reductions in overall costs per patient (listed above) was $2600. (Guthrie, E. et al. Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Archives of General Psychiatry, 56, 19-26.)
And, because of the still prevalent stigma of mental health treatment, you don't hear a lot from the millions of people who've benefited from therapy. Instead, therapy makes the headlines when someone with a history of mental health treatment goes on a shooting spree or kills her children in the midst of a psychotic post partum depression.
Well, the good news is that therapy works. Below I'll cite some classic studies that have demonstrated that fact incontrovertibly. The bad news is that too many people feel embarrassed to seek therapy and too many insurance companies treat therapy as the unwanted (perhaps even illegitimate) step-child of healthcare -- even when research studies have demonstrated repeatedly that a comprehensive mental health benefit with easy access to care reduces the utilization and costs of general medical treatment (the so-called Medical Cost Offset discussed below).
Empirical Studies
Here's what the U.S. Surgeon General has said: "Mental disorders are treatable ... the evidence for treatment being effective is overwhelming ... the inescapable point is that studies demonstrate conclusively that treatment is effective."
In a study published in 1999 in the book The Heart and Soul of Change: What Works in Therapy, authors T. Asay and M. Lambert reviewed a large number of studies that compared groups of people who received therapy with those who did not receive therapy. (The title of the chapter is: "The empirical case for the common factors in therapy: Quantitative Findings," pages 33-56) Most of the studies found that the average "treated" person is better off than 80 percent of those without the benefit of therapy.
In his book, The Great Psychotherapy Debate: Models, Methods, and Findings, published in 2001, Bruce Wampold reached the same conclusion, i.e., if there are two groups of people,with similar problems and one group receives therapy and the other doesn't, those who receive therapy will be better off than 80 percent of those who don't.
Cognitive Therapy or Psychodynamic Therapy
Insurance companies tout cognitive therapy because it purportedly benefits people more than psychodynamic therapy and is allegedly more cost-effective than psychodynamic therapy. Critics of insurance and managed care companies suggest that "cost-effective" actually means that insurance companies reap higher profits by promoting cognitive therapy.
Consumers Union Studies
The non-profit Consumers Union has published several large-scale surveys of its members' use of mental health services. The first survey, published in the November 1995 issue of Consumer Reports magazine, reported the experiences of more than 4000 members.
Among those who described their emotional state as "very poor" at the start of therapy, 44% said they now feel "very good." Another 43% said they improved significantly. Thus, a total of 86% of respondents reported at least significant improvement.
People experienced three kinds of improvements. Their initial presenting problems eased, they felt better able to relate to others and to work productively, and their increased self-understanding led to improved self-esteem and more enjoyment of life.
Regarding the length of therapy, "longer therapy was associated with better outcomes." People in therapy more than six months reported better gains than those who stopped therapy earlier. People who stayed in treatment more than two years reported the best outcomes of all.
In October 2004 Consumer Reports published another study of 3,079 readers experience of talk therapy and drug therapy for depression and anxiety. This study showed how the effects of drug therapy and talk therapy occur on a different timeline. People whose treatment was primarily medication improved considerably within a few visits. Compared to those who had fewer than 13 talk therapy sessions, those taking medication improved about the same. However, those who had more than 13 talk therapy sessions had a better outcome than those whose treatment was mainly medication. "The most successful patients were those who received a balance of drug and talk therapies."
The report noted that in the previous ten years the average number of talk therapy visits people received for mental health problems had declined dramatically (from more than 20 visits in 1994 to 10 visits in 2004). The authors concluded: "Since our survey indicates that longer-term therapy is linked to more positive outcomes, that trend is troubling."
Medical Cost Offset
In 1993, the National Institute of Mental Health released a study which found that the cost of covering mental illness on the same basis as medical illness would cost only $6.5 billion and that spending this extra amount would save U.S. taxpayers $8.7 billion in indirect costs associated with untreated mental illnesses. (Goodwin, F.K., & Moskowitz, J. (1993). Health care reform for Americans with severe mental illness: Report of National Advisory Mental Health Council.)
In a 1997 study, a research team analyzed the results of 18 studies of various treatment methods for a variety of presenting problems. They found that psychological treatment yielded a whopping 90% reduction in overall healthcare costs. The studies also showed reduced employee absenteeism and increased productivity. (Gabbard, G. et al. The economic impact of psychotherapy: A Review. American Journal of Psychiatry, 154 (2), 147-155.)
In an article published in 1999, J. Chiles et al. combined the results of a series of studies from 1967 to 1997. They found psychological services decreased medical expenses among surgical patients and among those who tend to "over-utilize" medical services. Even when the cost of providing services was included in the overall costs, the average savings was 20%. (Chiles, J. et al. 1999. The impact of psychological interventions on medical cost offset: a meta-analytic review. Clinical Psychology, 6 (2), 204-220.)
In a 1999, study in Great Britain, researchers found that as few as eight sessions of interpersonal therapy reduced: the number of inpatient hospitalizations, appointments with primary care physicians, nursing visits, use of all medications and care provided by relatives. In this study the cost per patient for psychological treatment was $2115 - the reductions in overall costs per patient (listed above) was $2600. (Guthrie, E. et al. Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Archives of General Psychiatry, 56, 19-26.)