Relationship’s role in therapy?

How important is it to get the right kind of counseling/therapy modality? How important is it to get the right person?

These questions plague both researchers and the people looking to get better. Why do some clients get better and others do not? Why do some therapists have a better success rate and others do not? Does the kind of therapy matter?

Well, as you can imagine, the answer is, “it depends.”

Yes, diagnosis and assessment do matter. If your child begins to struggle with bed-wetting after having been continent, you need to know what the problem is and what to do about it.

But, consider this: various studies make overlapping comments as to what really is going on when people get better

• One researcher suggests that some 85+% of the reason for change are factors pertaining to the client and what is called “extratherapy” factors (social support, physical health, etc. )
• Another places the portion the therapist plays in the 13% or so

Confusing? Consider this stark fact presented at a recent conference I attended

Patients receiving placebos from the top (best?) 1/3 psychiatrists fared better than patients who received actual medications from the bottom 1/3 psychiatrists. This was cited from the following study: Kim, D., Wampold, B. E., & Bolt, D. M. (2006). Therapist effects in psychotherapy: A random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data. Psychotherapy Research, 16(2), 161-172.

So, when you are looking for a therapist or psychiatrist, you may want to know if he/she studied at Harvard or a degree mill. But, you may be better served to by one who listens to you, doesn’t fall asleep, and is able to collaborate with you to find a solution that works for you.

The moral of the story? Better to have a good psychiatrist with no meds than a poor one with a gunnysack full of pills.