Therapy Effectiveness? It?s the Relationship, Stupid

Interesting article. I'm not really sure what I think. I think the relationship is very important to some and not so much to others, but surely it always plays a role in therapy?

[barbella]

Thanks for posting this article, puzzle bug! I am grateful to have a T that I've formed a positive relationship with. I feel she gets me. I think relationship is important with just about everything so I may be biased.

I am one of those who believe that my healing has happened within and because of the relationship between t and I. I've fought against it, struggled with it, loved it, hated it.... every possible feeling about it, I've had it.... and talked through it with her.... and gradually over time have found healing in it.

[atisketatasket]

Like the article. Especially the bit about therapists staying humble.

My idea of a good therapeutic relationship is where they don't annoy me too much and just let me get on with things.

[here today]

Interesting article.

For any clients with interpersonal difficulties (like me) it seems like the relationship with the therapist would definitely be a factor.

Not sure that it affects the effectiveness of therapy, but I think it’s fair to say that I entered therapy with no idea of what a relationship is. So I wonder if it might not be helpful to provide some psycho-education to clients if/when they seem not to understand what a relationship is?

How can therapists recognize such clients? One idea that occurs to me is that if we seem to have what might be described as object-relations problems then there’s a good chance we haven’t a clue what a real relationship with another human being is. Yes, ideally, therapy can provide that. But that’s the ideal and, as the article notes, all too frequently does not happen in practice. If clients can’t help things on our side, because we have no clue what a real relationship is, seems like that’s got to be an impediment to the therapy working?

I expect anybody who has read any of my posts before is tired or hearing how long I’ve been in therapy. I’m tired of doing it. Am I the only old person so frustrated? Is my case that unique? I suspect not but do not know for sure. Measuring effectiveness is something that insurance companies are certainly interested in. Who is there who is interested in improving effectiveness?

[Pennster]

I feel slightly confused by that article- it says only 12% of the success of therapy is dependent upon the relationship, if I'm reading it properly. So I get that this is the most important thing that the therapist has any control over, but I feel like there is a lot more to it than just the relationship.

I had a good relationship with my first therapist, but his method of working was all wrong for me. Even if our relationship had been perfect, I think I would have been in trouble with his approach.

[here today]

Originally Posted by Pennster

. . .I had a good relationship with my first therapist, but his method of working was all wrong for me. Even if our relationship had been perfect, I think I would have been in trouble with his approach.

Can you identify what has been most helpful to you in therapy? Something related to one of the other factors mentioned in the article or something else?

[Pennster]

Originally Posted by here today

Can you identify what has been most helpful to you in therapy? Something related to one of the other factors mentioned in the article or something else?

Oh, with my current therapist now, it's been his style of working that has been extremely helpful. We have a great relationship, but the way he works has been focused on helping me see all the ways I have to help myself. I had no idea about meditation, mindfulness, yoga, self-compassion, etc, and all of these have been extremely effective in helping me to overcome past trauma and to realize that there are many things I can do to turn my mood around on a daily basis and my life around on a longer-term basis. It's been really focused on helping me find my strength within myself.

The relationship helps, sure. But I feel like I needed more than a relationship - with my old therapist I needed much more concrete help - I just felt retraumatized by my him, because his modality totally prevented him from making any recommendations that might helped me to better deal with the feelings that the work we were doing was stirring up. I had no idea how to take care of my emotional and mental health at all, and I needed someone who had a bit more of a plan for helping me to figure all that out.

I do believe relationships can be healing, but 12% isn't that much, and I wouldn't go by this research alone, if at all, to make choices. I've had good relationships with T's but I was still left with depression. But despite my own experience, I think it's overrated.

It's not much different than research that might show Prozac is superior over Zoloft. And then it turns out that Prozac yields only 10% more improvement over placebo in comparison with Zoloft's....Hypothetical example, but I've read many studies just like this and am just not motivated in looking up the exact numbers. So maybe my chances of improvement are higher if I take Zoloft, but that is just the average of 200 or so people's response. It's really unknown how these meds work too.

Actually, I think therapy research is probably less valid than med studies because of the difficulty in quantifying the variables. And these studies usually don't include all of those who dropped out, who were perhaps worsened from the treatments.

Statistical significance does not equate to clinical significance. I point this out because then people go around saying, for example, Prozac is the best treatment for depression, when really, that is not really the whole truth. That's what I mean by overrated.

And I used to go by this too, until I learned more about how research works. Now I'm rethinking my choices and choices I've made in the past. I just don't think MH treatments are sophisticated. It's all we have.

But just because it's all we have doesn't mean we shouldn't question, raise the bar, or accept the status quo, or seek out new information. I think enough work has been done with SSRI type meds and psychotherapy of this sort; wish researchers would move on to more novel ideas.

Most of the reasons for therapy’s success are simply unknown. This should keep therapists humble. After unknown factors, come ‘patient factors’, together accounting for 70% of the success pie. Next come therapy relationship, treatment method, and individual therapist factors. The relationship, according to the meta-analysis results, comes out at 12% — also not a stunning percentage, but the largest over which the therapist has any influence. It also seems to me that within the “client” and “unknown” factors are areas, such as availability of social support, and practical issues, which a good therapist should be listening to and working with.

[BudFox]

The article seems largely inconclusive. Strange that 12%, in terms of the relationship factor, is considered significant. Strange also that the number is so low.