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Which Therapy is Best?

Will Koehler

In your search for a therapist you may find yourself asking which type of therapy is best for you. There are many types of psychotherapy and each therapeutic method has its own theory of change and set of interventions (the techniques utilized to facilitate change). Which type of therapy is best and which one is best for you, depends on many factors.

Some of the more common therapies you may encounter is your search are:

  • Cognitive Behavioral (CBT)
  • Psychodynamic/Psychoanalytic
  • Relational
  • Dialectical Behavior Therapy
  • Rapid Eye Movement Desensitization Therapy
  • Emotion Focused

A more comprehensive list as well as descriptions of the various Therapeutic Methods can be found here: www.goodtherapy.org.

Some therapeutic modalities are said to be “Evidence-Based Practices” or “Empirically Supported Treatments” (ESTs). When a treatment is said to be one of these it means that it has been subject to rigorous research, of which the guidelines are described here: www.apa.org.

Some research has shown various forms of therapy may be more efficacious than others at treating specific disorders. For example, a mood disorder like depression, has shown to respond well to: Non-directive Counseling, Problem-solving Therapy, Psychodynamic Therapy, Interpersonal therapy, and Cognitive Behavioral Therapy. CBT has also been shown to work well at treating Obsessive Compulsive disorders. If you have been given a specific diagnosis, or are seeking therapy for a specific phobia or trauma, you may want to seek a therapist that specializes in a method for your particular diagnosis.

However there is some debate and controversy in the field of psychology about research findings showing one method to be more efficacious over another. Criticisms of research are backed up by new experiments and analysis, suggesting that there may be factors which have unduly influenced previous research outcomes.

Interestingly some research has indicated that different therapies are about equal in their effectiveness. This phenomena has been dubbed the “The Dodo Bird Verdict”, so named after a passage in Alice’s Adventures in Wonderland by Lewis Carol, wherein a Dodo suggests a race in which all participants run about however they like and in whatever direction while all will be declared winners in the end. According to Mick Cooper in his book, Essential Research Findings in Counseling and Psychotherapy,

“This leads us on to one of the best established findings in the counseling and psychotherapy research field: that if one looks at the data on the comparative efficacy of different therapies (either across studies or within the same study), rather than the data on which specific therapies have been shown to be efficacious with specific psychological problems, there is an overwhelming body of evidence to suggest that there is little difference in how efficacious different psychological therapies are.”

Ultimately, some research supports specific modalities and yet other research supports general aspects of all theories. While this may seem contradictory and silly, the good news is that these arguments are about WHAT makes therapy effective, and not the IF (many studies have shown that it is, whether or not we agree on the “how”).

Actually, its been suggested that only about 15% of the therapeutic outcome depends on the modality itself, and the other 85% is based on factors like client expectations (you think the therapy is going to work), client strengths (determination, resiliency, introspection, willingness, outside support) and strength of the therapeutic relationship (you feel like it’s a good fit).

chart

Source: Lambert, M.J., & Barley, D.E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. In J. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. Oxford University Press.

Mick Cooper has these suggestions about finding a therapist in his book, Essential Research Findings in Counseling and Psychotherapy:

  • If you are experiencing a specific form of psychological distress, you may want to consider seeing a therapist who is trained in one of the empirically supported treatments for that difficulty.
  • Think about seeking a therapist who can help you capitalize on your strengths: for instance; if you are good at understanding why you do the things you do, an insight oriented therapist (such as a psychodynamic practitioner) may be more suited to you than a behaviorally oriented one.
  • If you are from a marginalized social group, you may find it particularly helpful to make sure that they are fully accepting and valuing of who you are.
  • Ask potential therapists what thoughts they may have on why you are facing the difficulties you are and what they think might help. If these are radically different from you own understandings it may be more difficult to establish a good working relationship.
  • If you find that things are getting worse after a few sessions, try to address this with your therapist and talk about ways in which the therapy might be more helpful to you. Given the tendency for clients to defer to their therapists, this can be difficult to do, but addressing difficulties early on in therapy can make a significant difference to the eventual outcomes.
  • And remember, probably the best predictor of the outcomes of therapy will be the extend to which you are actively involved in the process: ‘Clients, not therapists, make therapy work’ (Duncan et al.,2004:12).

There are no absolute guidelines for choosing a therapist or a specific kind of psychotherapy. It’s a combination of factors you should consider and most people need to “shop around” to find a therapist that’s a good fit. Most therapists will offer a free phone consultation for just that reason. I hope reading this has helped narrow your search.

If you’re interested in how I practice, check out this page here: Therapy