What makes psychotherapy work?

Clinical psychologist and clinical professor of psychiatry at UCSF

Their wordsThe phrase "your feelings are valid" does not invite curiosity or deeper self-understanding, which is the point of psychotherapy. It is the mirror image of "stop whining and get a grip." One sounds warm and one sounds harsh, but neither deepens self-awareness.

Founder of the International Center for Clinical…

Their wordsSince 2012 when the first study appeared in the literature, others have been published documenting the tendency of practitioners to overestimate their effectiveness - on average, by 65% (1, 2).

Founder of the International Center for Clinical…

Their wordsOver the last 50 years, treatment methods have proliferated despite a lack of evidence of differential effectiveness between approaches. And even when a randomized controlled trial indicates a particular approach works, none show practitioners become more effective when they are trained in that modality.

Founder of the International Center for Clinical…

Their wordsIt turns out that therapists who perform well on the FIS establish stronger relationships and are more effective (2). More to the point, the evidence shows FIS-related skills are trainable and that such training leads to better results (3, 4, 5).

Founder of the International Center for Clinical…

Their wordsIndeed, as I've reported in previous posts, research not only shows therapists do not improve with time and experience in the field, but on average become less effective (1, 2, 3, 4).

Founder of the International Center for Clinical…

Their wordsIt's time for the field to stop attributing benefits to clinical experience. Beyond the obvious ethical concerns, doing so actually prevents us from improving our effectiveness!

Founder of the International Center for Clinical…

Their wordsIf one really wanted to know whether a treatment (e.g., CBT, IPT, ACT, EMDR) was more effective, it had to be directly compared to an approach intended to help - what Wampold and colleagues termed, a "bona fide" treatment. Doing otherwise, they argued, conflated artifacts of research design with actual research results.

Clinical psychologist and clinical professor of psychiatry at UCSF

Their wordsThe American Psychological Association (APA) just issued guidelines for treating trauma. Patients and therapists would be wise to ignore them.

Clinical psychologist and clinical professor of psychiatry at UCSF

Their wordsIt takes more than 20 sessions, or about six months of weekly therapy, before 50 percent of patients show meaningful improvement. It takes more than 40 sessions for 75 percent of patients to show meaningful improvement.

Clinical psychologist and clinical professor of psychiatry at UCSF

Their wordsThe term "evidence-based therapy" is also, de facto, a code word for "not psychodynamic."

Clinical psychologist and clinical professor of psychiatry at UCSF

Their wordsNo research ever suggested that manualized CBT was more effective than psychodynamic therapy. It was just more often researched. There is a world of difference between saying a treatment is less often researched and saying it has been scientifically discredited.

Clinical psychologist, EMDR consultant and yoga teacher in Boulder, Colorado

Their wordsIt may not be stored there, but what you're tapping into, it's not a repository of the memory, but it's part of this mind-body feedback loop where there's a sensation that your brain has an association to that might have a familiarity to a time in which you felt sad or scared.

Clinical psychologist, EMDR consultant and yoga teacher in Boulder, Colorado

Their wordsthe issue that I take with some of the language around "the body keeps the score" is that it maybe doesn't also recognize that the body also carries so much wisdom and so much intelligence and kind of helps guide us towards healing

Marriage and family therapist working from attachment…

Their wordsWhen you get angry fast, it usually is not because you are "too much." It is often because your nervous system learned to live on alert.

Clinical psychologist, EMDR consultant and yoga teacher in Boulder, Colorado

Their wordsPolyvagal theory provided me with a coherent framework for understanding why cognitive insight alone often fails when a nervous system is in defensive dominance. In such states, higher-order cortical processes are functionally constrained.

Psychiatrist and clinical assistant professor at Case…

Their wordsThe Rumpelstiltskin effect is not a claim that receiving a diagnosis is a net benefit or a net positive. It is a claim that the mere act of receiving a diagnosis can be beneficial.

Psychiatrist and clinical assistant professor at Case…

Their wordsThe emotional and relational dynamics are not an intrusion upon the work of prescribing. They are a part of the work itself.

Family therapist and founder of Relational Life Therapy

Their wordsIn my practice, I have seen that opening neural pathways can lead to profound change, to brand-new traits and behavior, sometimes in a matter of minutes.

Family therapist and founder of Relational Life Therapy

Their wordsNeurobiologists tell us that it takes two things to unlock and open up a neural pathway. The first is that the implicit must be made explicit. Sometimes you need help seeing what you don't see. But you must be open to the feedback. Second, there must be some sort of recoil, a sense of discrepancy, of "Oh no, I'm not sure I really want to keep doing that."

Psychotherapist, founder of The Cognitive Therapy Center…

Their wordsIn 30+ years of working with narcissistic men mostly - yes, it is possible for people to change. And even narcissists can change. Now, I don't really believe anyone changes completely, but it is possible to get meaningful change.