Psychotherapy--an active agent: assessing the effectiveness of psychotherapy and its curative factors

In the last two decades there has been a remarkable expansion in research on psychotherapy in two areas: (a) assessing the effectiveness of psychotherapy compared to wait-list, no-treatment patient groups and groups treated with pharmacotherapy; (b) investigating curative factors in the therapeutic process: the extent of the psychotherapist's experience and kinds of interventions and errors in handling techniques. The first section of the review deals with the first of these areas and the second with the other. The following are the main research findings: 1. The effectiveness of psychotherapy compared to wait-list and non-treatment groups has been proven by so many research papers that there is hardly any need t do so again; 2. Psychotherapy was found to be effective in treating focused psychiatric disorders such as OCD, depression and anxiety disorders (with preference to cognitive-behavioral approaches) over psychodynamic approaches, and in some instances in preference to pharmacotherapy). Psychotherapy was also effective in less focused disorders, such as personality disorders and mixed neurotics (with preference to psychodynamic approaches over cognitive-behavioral approaches); 3. The advantages of patients receiving psychotherapy over those who did not receive it persisted in follow-up studies of one year's duration or more; 4. Psychotherapy was more effective than "psychotherapeutic placebo" (the encounter between therapist and patient where systematic psychotherapeutic work using one out of the three main psychotherapeutic approaches is experimentally prevented), which in turn was more effective than wait-list or non-treatment groups; 5. Psychotherapeutic maintenance of one session a month was effective in preventing relapse; 6. Experienced psychotherapists are more effective than beginners; 7. Empathy, the ability to identify the central thread of the session, and encouragement of the patient to reflect were found to be the key factors in techniques most associated with therapeutic success.