Does therapy work?

Therapy can be absolutely transformative but the therapist-client relationship really can make or break it. Someone can be very highly trained or skilled but they just aren't the right fit for you. If you're not the right fit, move on and try a different therapist, rather than saying 'Therapy doesn't work!'

I'm trained in CBT (alongside other therapies) and maybe 20% of clients find it highly effective but I also see a great many clients who were actively put off therapy by it. The NHS likes it because it's all about measurable outcomes in 6 sessions, as if human beings can be reduced to data points. For many clients I see, it is wholly inadequate. It is a very small part of my work.

The therapist should never be working harder than the client after the first couple of sessions. It's an active process. The great unspoken truth is that client motivation is a key factor. The more passive clients tend to need longer-term work but are more prone to dropping away. Change is hard work.

It can work. The mistake people make is thinking it's a magic cure all that will always work for all people. You can't go to one session with one therapist and be cured.

Ive had CBT (and whole package of other interventions) for anorexia about 20years ago and that worked on the issue
ive had psychoanalysis for the past 6 years and it has really helped me, things have fundamentally changed, i am not the same person i was 6 years ago and i am more happy, more satisfied with my life than i have ever been i also have much better relationships with people :) but it is a financial and a time commitment. Honestly if i think about my life now and my life back then, it is totally worth it!

It didn't for me.

We were told something similar by the consultant psychiatrist when I was first diagnosed but specifically applied to anorexia. That one third will make a full recovery, one third will live with anorexia all their life and the other third will sadly die.

Depends on the type of therapy you have, how long it lasts, how much / well you engage with it, and how well you and the therapist 'click'.
I had long term therapy (2 1/2 years) on the NHS just over ten years ago and it absolutely worked. Hardest thing I've ever done, but also the best. Therapist was experienced, consistent, gentle when necessary and tough when necessary. It was so good; I realised that at the time and in hindsight that's proved true. A lot depends on the therapist and the sort of therapy you're having, but to a certain extent, you also get out what you put in. It's can be tricky, because when something doesn't quite 'click' with it, it can be unhelpful, but when it works well it can be amazing.

It works if you are in the right mindframe to be able to engage with it and use the techniques you learn.

It's not a passive process, you need to actually work at it, and it can be mentally exhausting.

There were times in my life when it didn't work as I just wasn't mentally capable of doing it. Then later when I was capable, it did work and I've been mentally healthy (aside from a few natural reactions to horrible things happening to me) since then.

Sometimes you need to try different therapists, sometimes you need to try different therapy types, sometimes you need to shelve it for a while and come back later. This sometimes gives the impression that it doesn't work, but it doesn't mean to give up.

And sometimes physio doesn’t work, of course.

according to whom this thread, for starters?

I’m doing CBT and it’s hard work. I’m facing past traumas and it’s bringing all sorts up - I’m having vivid dreams about things from years ago and palpitations.

BUT I have had a few lightbulb moments which really have given me so much clarity and acceptance.

It’s tough so you have be in a relatively stable period in your life.

in sure there are other types of therapy for immediate issues such as trauma and illness, or emotional strife eg counselling etc.

Psychotherapy is also a good option but again I wouldn’t recommend it while you are in the throes of something.

Depends on the type of therapy and what you want to achieve.

All NICE guidance is available online for anyone to read, so have a look. NICE don't recommend anything without a solid evidence base.

Some therapies (notably CBT) only work if the individual engages fully in it.

I’ve always wondered how the outcomes of various forms of therapy are measured, how many people are helped by it and how many harmed.

Who else is supposed to do the work? It’s like physio - you’re given the tools for improvement, but at the end of the day it’s your brain, no one else can go in there and “fix” it

According to whom, though?

I’ve had 12 sessions of therapy for attachment issues which had permeated into most aspects of my life. When I say therapy has been transformative I’m not exaggerating.

There is a big but though - it depends what it is for, where you are in your life and how willing you are to work and reflect. All of these things aligned for me and it didn’t take much for me to unlock a part of my brain that had tried to bury away my past, and it was relatively straightforward from there.

I would also add that getting the right therapist makes a huge difference. In most cases a clinical psychologist is your best bet, and don’t be afraid to change if you feel like there is no connection.

Good luck!

Well, and the amount of effort put in by the client, too. If you do it right, it's brutally hard work in my experience, and involves being very honest with yourself, and often confronting really difficult stuff.

This won’t be a popular view but I do think therapy can be a bit cult like in its language and attitudes. I don’t like the way that if it doesn’t work it’s somehow your ‘fault’ - you weren’t ready, you didn’t put the work in, etc.

When I trained as a clinical psychologist (30 years ago) they used to quote that if you just stayed on the waiting list 1/3 got better, 1/3 got worse and 1/3 stayed the same.

There is / was a book called what What works for Whom by Roth and Fonagy. They did systematic reviews and looked at outcomes for different therapies and, although I cant really remember i think it said all therapies were about equal and theraputic alliance was most important - it was maybe the same thing as above.

@GooseyGandalf here is the image

@GooseyGandalf I've attached an image which is a widely used diagram about the the different factors influencing therapy. The client's extra therapeutic factors are things like their life situation; how much support they have; their motivation; access to money/resources to make change etc. It's taken from Michael Lambert's work from the 1990s which I appreciate is a bit old but I understand his findings have been born out in more recent research.

Having looked at the thing about thirds it's not from a specific study but is amore general observation made based on outcomes from lots of MH research from the 20th century; especially treatment for depression. It's called "the rule of thirds".

Yeah. It was offered to me and I thought if I said no, they'd say I wasn't bad enough to need help. So I said yes. It was a load of bollocks for me, personally, though. It actually made me worse 😂

Edited to add: sorry, It was CBT that was offered to me. I'm not sure if I'm allowed to request a specific type of therapy through the NHS

I’ve heard cbt is less likely to work with people with autism and DBT is more likely to help.

Yes it can work, but there’s lots of variables. Is it the right therapy/ therapist. Is the person ready for help etc.
my teen dd has therapy for anxiety (around 12 sessions) and she’s doing amazing now.

Exactly this. It’s like when you go to the physio - it’s not going to work unless you do the exercises they give you.

lots of people have told me I should get some therapy as I’m struggling to cope after Dh left me after 35 years of marriage but having looked into it I just can’t afford it. I spoke to someone locally who said I would need to go 8 to 12 weeks and it was £70 an hour visit

My experience is similar. The stuff CBT uncovered was absolutely no use for overcoming anorexia at the time. But now I’m a healthy weight the insights I gained from CBT help me in many aspects of my life.