Speaking of Psychology - Making psychotherapy work for you (SOP25)

Episode Date: May 25, 2015

Research has shown that psychotherapy is an effective tool for people who are dealing with a wide range of mental and behavioral health issues, yet people are still hesitant to visit a therapist for treatment. In this episode, we talk with psychologist and researcher Bruce Wampold, PhD, about why psychotherapy works and can often be a better alternative to medications. APA is currently seeking proposals for APA 2020, click here to learn more https://convention.apa.org/proposals Learn more about your ad choices. Visit megaphone.fm/adchoices

Psychotherapy is a personal process for many people. What works for me may not work for you. But in other health care settings, there is research that has offered some guidance to people looking for the right therapist and the right treatment. In this episode, we talk with psychologist and researcher, Bruce Wampold, about how to make psychotherapy effective and long-lasting. I'm Audrey Hamilton, and this is speaking of psychology.

Bruce Wampold is the Patricia L. Walit Professor of Counseling Psychology at the University of Wisconsin-Madison. He's also director of the Research Institute at Modembad Psychiatric Center in Norway. He served on the American Psychological Association's Presidential Task Force on Evidence-Based Practice in Psychology, and his research on psychotherapy and methodology has been published in several APA journals, including Psychological Bulletin, American Psychologist, and the Journal of Consulting and Clinical Psychology. He is author of the book The Great Psychotherapy Debate, which is a synthesis of empirical

research on psychotherapy and provides a model for understanding how psychotherapy works. Welcome, Dr. Wampold. Thank you. Psychotherapy is tremendously effective for many people, but is it correct to say that psychotherapy works differently for different people? Well, there's many approaches to psychotherapy, and many people come with different kinds of problems, different styles. So yes, it does work differently for different people, but in the core, it's probably more similar than it is different. So if I were a client seeking therapy, how would I know I'm getting the best treatment? And like you said, I know we're all different, we all have our different issues, but there's got to be a way to determine what's working for you.

Well, psychotherapy is a very personal process. You have a therapist and delivering a particular kind of treatment. The most important thing is that you have faith in the therapist and the treatment method the therapist is using with you. And this is something you should discuss with your therapist. So if you feel like you're not making progress and most patients make relatively significant progress in the first five or six sessions, then you should discuss that with your therapist and discuss the progress you're making and how therapy is progressing. So what you're saying, every therapist is different and has their own style, but what qualities do all effective therapists have? You know, and how can a patient select some of those qualities to treat their specific issues?

Well, it's true. Therapists have a lot of different styles, and they're successful therapists who are very different than others who are also successful. But there is a common core we know now of characteristics and actions of effective therapists. Effective therapists have a very sophisticated set of interpersonal skills that are focused on helping the patient. Successful therapists or effective therapists are able to form a working relationship with a variety of patients. And effective therapists seem to be those who are reflective and practiced deliberately to get better. So for the patient, it's really difficult to assist. whether the therapist has these qualities.

But again, this is something that should be discussed with the therapist in terms of do you feel like you're making adequate progress in the therapeutic endeavor. How long should that progress take? Are we talking weeks, months, years? Well, it really depends on the problem people bring. Many problems that people bring to therapy are really amenable to a treatment of five or six. or 10 sessions make significant progress. Therapy is something that you don't just do once in life and you're cured.

You might feel quite satisfied for several years, and then there's another stressor in your life or something happens and you want to go back, and that's perfectly ordinarily. There are some disorders, severe disorders, in which it's more like a chronic disease like diabetes, and you might require more intensive care for longer periods of time. Is this something you should be discussing with your therapist at the start of your treatment? How long should you be going before you see some benefits?

Absolutely. This is something the therapist should assess and discuss with you and you should get an idea about what is the conditions of the therapy, both in terms of its length, but the activities you're going to do, your prognosis and these kinds of things. We know now that therapy can be as effective as medication for some of these disorders. You know, clinical trials have been done on this. Yet many doctors prescribe psychotropic medications without even recommending therapy.

Why is that? You know, when are medications appropriate? Well, there's a complex question. I can say, you know, that every clinician practices within their discipline. So physicians are medical doctors, so the first thing they think of is prescribing a medication. So it's not surprising that that would be frequently used. But we do know, as you mentioned, that psychotherapy is as effective as medications for many of the disorders, mental disorders. And it's more enduring.

So when you discontinue medication, some of which have some pretty significant. side effects. People relapse, whereas with psychotherapy, you learn some skills and ways to overcome or accept your difficulties that are longer lasting. Do you find that more people are looking toward psychotherapy because of this very reason, like you mentioned, the side effects, et cetera, and the fact that they're being able to do it more naturally? Well, I think there's a lot of people who really naturally believe in psychotherapy, and that would be their first choice. There's other who are skeptical of psychotherapy and maybe would benefit from other practices, although psychotherapists are really good at working with people even if they're resistant. So I wouldn't say if you don't

believe in psychotherapy is not going to be helpful. That's not really true. But again, so much of it is determined by the person who's treating you. So if you talk about your depression or anxiety with a physician, you're more likely to get medication. That's a kind of a natural consequence, although there's many physicians who recognize the importance of psychotherapy. There are some situations where medication and therapy can work together. There's some research to indicate that the combination is beneficial, but again, it's a case-by-case basis.

And the advantage of dual care like medication and psychotherapy over psychotherapy, over psychotherapy by itself is small. There is a lot of research out there on different kinds of psychotherapies, not just necessarily the therapist, but the therapies themselves, some of which you published and studied. Can we say what makes one type of therapy more effective than another? Well, the research literature really indicates that there isn't one treatment, one kind of psychotherapy that's demonstrably better than any other.

So they all work differently. The activities that are involved in the treatments are different. And what seems to be important is that the patient believes and has faith in this particular method. What works best for them? Some people want a more concrete structured treatment like cognitive behavioral therapy. Other people find more exploratory and interpretive treatments like dynamic treatments. more acceptable. So there's a variety of treatments. There's a variety of people, and it's important to find one that seems to fit for you and works. Where do people research this type of therapy?

I mean, if I'm not sure what I would fit best with, how do people kind of look into the types of therapies that are out there? Well, that's a difficult thing to do because some therapists will advertise this is the kind of therapy I do. Some therapists will wait until they understand the patient's problems and the context before they decide how they're going to work together. But it's really difficult for somebody in the public to say, well, you know, I want brand X. Right. Although, you know, if you want cognitive behavioral therapy, there's organizations which will refer you to cognitive behavioral therapist. same with dynamic therapists and so forth.

So that is possible. But again, what I advise people to do is to go to a therapist who is recommended to them and see if this fits, see how it works. Much like a medical doctor, you know, you kind of don't know until you get in their room and see what... That's right. And what's really interesting is that somebody might recommend therapist X because they had a really good experience. and you might not find that style compatible with you at all. Yeah.

Well, thank you, Dr. Wanfold, so much for joining us today. You're welcome. Thanks very much. You can find more information on psychotherapy effectiveness on our website, speakingof psychology.org. With the American Psychological Association, Speaking of Psychology, I'm Audrey Hamilton.