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The Evidence for Psychotherapy

This week’s New York Times Op-Ed section contained a piece, entitled “Psychotherapy’s Image Problem,”  that any consumer of mental health services will likely read with great interest.  If someone you know is aware that you or your family member is in treatment, they’ll almost surely be sending you the link to ensure you’re “in the know.”

While we at Think:Kids are proud that our treatment approach, Collaborative Problem Solving, is and continues to be well-studied—we are ongoingly giving our work research scrutiny—and that it sits on some of the current lists of evidence-based practices, there are some crucial points that we think must be spoken to.

First of all, being a program within Massachusetts General Hospital, a major academic medical center where much important psychopharmacology research occurs, and seeing complex kids, for whom medication is often a crucial component to their effective care, we are uneasy at the pitting of psychotherapy against medication.  We’ve seen too many families caught in this cultural crossfire, when all they are doing is trying to do right by their kids.  The fact is, even while we do tend to believe that there is good enough evidentiary support for psychotherapy that it is typically worth trying first, some patients and families, for various and complicated reasons, might prefer to start with medication, and this preference should in many cases be honored.

Second, we want to support the article’s pointing out that, simply put, psychotherapy works.  It boasts very strong and long-standing evidence of being effective, with average “effect sizes” (a statistical indication of how strong an average effect of a treatment is) that surpass many well-regarded and widely accepted medical interventions.

On the other hand, virtually all of the therapy approaches that have gone to the effort to study their effectiveness have in fact been proven to be effective, leaving patient preference—what specific therapy resonates—a crucial consideration in choice of treatment approach.  In many cases, and this is in fact true of our own domain of work with behaviorally challenging kids, there are multiple available “evidence based treatments” to choose from.  Being an educated consumer and knowing what treatment goals are most valuable to you, and what treatment procedures will feel most congenial, is critical.  For instance, we here at Think:Kids value greatly the fact that our approach has the advantage of improving the helping relationship between adult caregivers (parents or teachers) and kids as one of its demonstrated outcomes.

Finally, as the noted psychotherapy researcher Bruce Wampold has stated, “Nobody needs an empirically supported therapy that isn’t working for them.” Which is to say, we still have to make sure that a particular patient is benefitting, and monitoring your treatment progress, or possible lack thereof, is an essential aspect of our involvement with patients.

As is typically the case, the reality of any situation is often more complicated than meets the eye.  Let us know your own responses to this article, and to these issues!

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