CLAIMS AGAINST THE EFFECTIVENESS OF PSYCHOTHERAPY
If people who are emotionally troubled "get well" through psychotherapy in about the same length of time as those who are not given any treatment at all, we would be inclined to say that psychotherapy didn't help. Several studies have shown that the majority of people with "neurotic disorders" improve spontaneously, on the average, in one to two years.[[1]] When people with similar problems are treated with psychotherapy, the outcome is virtually the same: the spontaneous remission rate for all practical purposes is the same as the rate of success due to therapy. Psychotherapy doesn't seem to make a difference. We'll call this the spontaneous remission criticism and will come back to it in a moment.
[[1]] S. Rachman, The Effects of Psychotherapy (New York: Pergamon Press, 1971) p. 18.
Most studies of the effectiveness of psychotherapy make use of "placebo treatments": a group of emotionally troubled individuals is treated with one of the major approaches to psychotherapy by well-trained therapists, and another group of similarly troubled people is treated by untrained "therapists" who offer their clients a "therapy" that is simply made up but is carefully presented so as to be believable. And, again, it turns out that clients treated with the legitimate therapy improve, but not significantly more than those in the placebo group. We'll call this the placebo criticism and will come back to it, too, in a moment.
A few studies have shown that psychotherapy can actually be injurious to clients. A disorder brought about by medical treatment is called an iatrogenic disturbance. Iatrogenesis is the Greek word for "brought about by doctors." If the iatrogenesis criticism is valid, then therapy may be not only ineffective but sometimes actually harmful.[[2]]
[[2]] See, for example, Thomas J. Nardi, "Psychotherapy: Cui Bono?," in Jusuf Hariman, ed., Does Psychotherapy Really Help People? (Springfield, IL: Charles C. Thomas, 1984), pp. 154-164.
Together, these three criticisms have made therapists feel very defensive—and rightly so. If fictitious treatment by a mock therapist works as well as treatment provided by a man or woman who has trained long and hard for a Ph.D. or M.D., wouldn't you feel ill at ease—perhaps very much ill at ease!—charging your clients $75 to $100 an hour for your time for a service that is no better than none at all and may even cause your clients to get worse?
These are not trumped-up charges against psychotherapy that we can afford to ignore. Therapists don't like to confront them. Here are some of the results of research studies:
... [A]s compared with spontaneous remission, there is no good evidence to suggest that psychotherapy and psychoanalysis have effects that are in any way superior.[[3]]