The placebo effect has become increasingly interesting to psychological as well as medical researchers. Apparently, a client's or patient's strong belief in the therapeutic value of a process sometimes has a measurable influence on his future health. The way belief can act in this way is not necessarily mysterious or mystical. If we are prepared to see emotional difficulties in terms of demoralization, then belief in therapeutic effectiveness is the most clear-cut counterbalancing force. Strong belief of this kind may be enough—if the client really wishes to change and if the therapist and the approach to therapy together can inspire the client's confidence in his own ability to regain control of his life—to help the client begin to lift himself by the bootstraps. Just what the necessary ingredients are to make this possible is not yet definitely known. Some approaches to therapy, however, seem to be more successful than others in inspiring confidence in clients with certain personality traits and with certain goals or problems. The best evidence for this comes from clients themselves, whose evaluations of their own experiences in therapy we will look at in a moment.
The second blow that fell on psychotherapy came from the spontaneous remission critics. Again, studies demonstrated certain facts:
* How long it takes for spontaneous remission to occur depends greatly on what sorts of emotional difficulties clients have. People with depressive or anxiety reactions tend, for example, to have spontaneous remissions faster than persons with obsessive-compulsive or hypochondriacal symptoms.
* The percentages of clients who do experience spontaneous remissions are related to the period of time a study uses as a basis. (The follow-up periods of different studies vary a great deal, from months to many years. As one researcher commented, "It is doubtful whether life can guarantee five years of stability to any person."[[12]])
[[12]] Eisenbud, quoted in H. H. Mosak, "Problems in the Definition and Measurement of Success in Psychotherapy," in Werner Wolff and Joseph A. Precker, eds., Success in Psychotherapy (New York: Grime & Stratton, 1952), p. 13.
* Spontaneous remissions frequently happen to clients whose lives improve because of fortunate events, such as an improved position at work, successful marriages and personal relationships, and periods during which pressing problems become fewer and life more stable.
Given these facts, spontaneous remission critics argued that, since many troubled individuals will get better anyway, without psychotherapy, we cannot know that psychotherapy caused any beneficial effects.
Again, poor logic. It is like saying that since certain bone fractures will eventually heal themselves in correct alignment, without being set in a cast, we cannot know for these cases that a cast had any beneficial effects. Well, for many people, a suitable psychotherapy serves much the same function as a cast does for a broken bone: it supports, lessens vulnerability, reduces pain, and makes life a little more comfortable until natural healing can take place. Again, whom do we ask to determine whether this is the case? We must ask the person with the fractured arm whether the cast made him or her more comfortable.
HOW PSYCHOTHERAPY CAN BE INJURIOUS TO YOUR HEALTH