By Dr. Paul Kelly, Updated September 3, 2023
Not All Therapists are Effective, But There is Hope
Did you already have a clue that not all therapists are effective? I grew up in a little village in Northern Ontario and I was clueless about therapists until I packed a couple of suitcases and went to university.
I got my first clue from a police officer in a morgue.
When I was a student I worked weekends as a pathologist’s assistant. One Saturday morning a police officer came to witness the autopsy of a woman who had been murdered by her husband. The officer was early and we got to talking while we waited for the pathologist. When I told him I was studying Psychology he told me about his one and only psychotherapy session. He shook his head and said “I went to see a Psychiatrist once. He was sitting behind a big desk. I sat down. He didn’t say anything so I didn’t say anything. That went on for an hour, and then he stood up and said the session was over. After that I was done with shrinks.”
I got my second clue when I first tried psychotherapy for myself.
That same year I saw a psychologist at my school’s counseling centre. Unlike the police officer’s psychiatrist my therapist did talk with me but he refused to give me any advice or recommendations about anything. All he ever did was listen kindly, nod, and reflect my feelings. I went about 20 times but nothing changed. His approach was not right for me. By the end of it I was doubting whether my problems were fixable or whether “I would be stuck with my screwed up self for the rest of my life.” (Don’t worry – things did eventually get better for me. Later on I benefited greatly from work with an excellent therapist.)
My third clue came when I had to interview patients about their therapy.
Over the years after I became a psychologist I have interviewed thousands of people who have received psychotherapy or counseling. They weren’t my patients. I met with them because an insurance company wanted to know if they needed more therapy or if the therapy they had been receiving was helping. Here are a couple of the stories I heard.
A teacher told me “I saw a Social Worker because I had a car accident and I was anxious about driving. She told me I had to talk about my childhood. My childhood wasn’t great. I focused on my childhood because she told me to. I started to get really depressed and the problem I wanted help for, driving anxiety, didn’t get any better.” A banker told me: “I saw a psychologist because I started to have panic attacks about making presentations at work. I saw her for 6 months and paid her a lot of money. I finally stopped going because I was feeling worse, not better.”
My fourth clue was the research evidence.
You might be wondering by now if things are really that bad in the world of psychotherapy. Maybe my memory is biased. Maybe I am just a grumpy old guy. Here is what the research tells us. When patients get psychotherapy in the community usually about 33% of them significantly improve or fully recover. Some estimates put the percentage a bit higher, but it is clear that a lot of therapists are not very effective at helping people feel better and live better.
Reasons for Hope
Psychotherapy can be very helpful if you work with an effective therapist, and it is possible to find one!
Who your therapist is makes a huge difference in whether or not therapy is likely to be helpful for you. The most effective therapists have 50% better outcomes and 50% fewer dropouts. Some therapists are consistently more effective at helping patients feel better and live better. The success rate for psychotherapy can be in the range of 65% to 80%, for patients who get to work with an effective therapist. Here are some tips that can help you identify an effective therapist.
