Empirical Evidence Supporting the Benefits of Psychotherapy

Morgan Lacher

Loras College
 Lacher 2

Currently, a major controversy in both psychology and society as a whole is the debate

over the efficacy of psychotherapy through evidence of its scientific support and benefits.

Essentially, individuals are questioning if the practices of psychotherapy can be beneficial and if

those beneficial qualities are supported by the scientific psychology community. According to

the American Psychological Association (APA), psychotherapy can be effectively defined as

the informed and intentional application of clinical methods and interpersonal stances derived

from established psychological principles for the purpose of assisting people to modify their

behaviors, cognitions, emotions, and/or other personal characteristics in directions that the

participants deem desirable" (Norcross, 1990). Although there are multiple variations of

psychotherapy, including psychoanalysis, interpersonal psychotherapy, and cognitive behavioral

therapy, psychotherapists all strive to accomplish the same goal: alleviate the symptomology of

their patients by utilizing behavioral, cognitive, and interpersonal techniques.

Dr. Robert Berezin worked as a psychiatry professor at Harvard Medical School before

publishing his book, Psychotherapy of Character, in which he demonstrates the beneficial

relationship between psychotherapy and human identity. While comparing the mind to the

theatrical world, he asserts: Psychotherapy responsively addresses the cause of suffering and

symptoms and ameliorates them in exactly the way they were constructed in the first place.

Through boundaries and the context of genuine emotional holding, it allows for the mourning of

our problematic plays and fosters the writing of a new play grounded in authenticity and love

(Berezin, 2014). Psychotherapy not only seeks to identify the underlying issues causing the

emotional distress, but also works on combatting the symptomology of a multitude of mental

illnesses. Some of the numerous benefits of psychotherapy include the sustainability of the

practice and the ability to alleviate the symptoms of a variety of mental illnesses and conditions.
 Lacher 3

The practice of psychotherapy is not only supported by empirical scientific data, but it also

provides an immense amount of benefits for the patient.

Psychotherapy was first advocated for by English psychiatrist Walter Cooper Dendy in

1853, with Dendys desire to talk about emotional problems in therapeutic settings. Dendy

coined the term psycho-therapeia which has since then been altered to psychotherapy (Dendy,

1853). Following Dendy, Sigmund Freud introduced the concept of psychoanalysis in the late

1800s and early 1900s, which focused greatly on the understanding of the unconscious mind

(Haggerty, 2016).

Since the arrival of the twentieth century, psychotherapy has developed into what it is

today. Psychotherapy can be conducted in group and individual settings, the efficacy of

psychotherapy does not depend on the number of individuals in a session (Rinaldi, 1985).

Although many forms of psychotherapy are utilized today, cognitive behavioral therapy and

interpersonal therapy are the two most common practices currently.

Cognitive behavioral therapy (CBT) is arguably the most utilized form of psychotherapy

in the United States currently. Dr. Aaron Beck, a practicing psychiatrist at the University of

Pennsylvania, first pioneered the practice in 1960 in hopes of discovering a better way to treat

depression in his clients. Beck acknowledged that an underlying factor in the sustainability of

depressive symptoms were his patients autonomic thoughts, or cognitions that occurred

automatically. CBT works to identify and evaluate these autonomic thoughts in individuals in

order to create a change in cognition which inherently affects ones behavior (Beck, 2016).

In the time frame spanning 1977 to 2006, CBT and its effects on depression have been

tested in clinical trials over 75 times, demonstrating the empirical data supporting the

effectiveness of CBT (Butler et al., 2006). Also, CBT is not limited to solely treating depression;
 Lacher 4

rather, CBT has been found to effectively alleviate the symptomology of a multitude of disorders

categorized by the Diagnostic Statistical Manual V. In an extensive literature review organized in

2012, researchers analyzed over 269 meta-analytic studies and found empirical evidence and

scientific support that demonstrates CBTs efficacy when used to treat substance use disorders,

schizophrenia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders,

insomnia, and personality disorders (Hofman et al., 2012).

Interpersonal psychotherapy (IPT) was first developed in 1970 at Yale University by

psychologists Klerman, Weissman, and Paykel. IPT assumes that interpersonal distress is the

causation for psychological symptoms and works to alleviate the symptomology while utilizing

biopsychosocial, cultural, and spiritual models (Markowitz & Weissman, 2004). The

Interpersonal Triad, or the reasoning behind IPT, states that inadequate social support, acute

interpersonal crisis, and attachment vulnerabilities lead to psychological distress. Myrna

Weissman, developer of the IPT approach states, Social factors such as a patient's current

significant relationships and general social support provide the context in which the stress-

diathesis interaction occurs, and further modify the individual's ability to cope with his or her

distress (Weissman, 2017). Through techniques such as interpersonal incidents, communication

analysis, and role-playing, IPT provides a psychotherapeutic that focuses on the relationship with

the patient and others.

In regards to the APA Ethical Principles of Psychologists and Code of Conduct, Section

10 focuses predominantly on the practices of psychotherapy. According to Code 10.1, Informed

Consent to Psychotherapy, psychologists and those engaging in psychotherapy are to inform

their patients of the developing nature of the treatment, the potential risk involved, alternative

treatments that may be available, and the voluntary nature of their participation. Although
 Lacher 5

psychotherapy is a commonly utilized and well-documented practice, much debate and

skepticism has circulated the effectiveness and beneficial properties of psychotherapy in

alleviating mental health conditions and symptoms. In a resolution passed by the APA in August

2012 titled Recognition of Psychotherapy Effectiveness, APA and all of its members

acknowledge the effectiveness of psychotherapy as a psychological component through a

multitude of statements:

As a healing practice and professional service, psychotherapy is effective and highly

cost-effective. In controlled trials and in clinical practice, psychotherapy results in

benefits that markedly exceed those experienced by individuals who need mental health

services but do not receive psychotherapy. Consequently, psychotherapy should be

included in the health care system as an established evidence-based practice.

Be It Further Resolved that APA increase its efforts to educate the public about the

effectiveness of psychotherapy APA encourages continued and further research on the

comparative effectiveness and efficacy of psychotherapy (Recognition of psychotherapy

effectiveness, 2012).

Although the resolution was indeed passed, this issue regarding the effectiveness of

psychotherapy has been reoccurring in the psychology scientific debates for many years. Many

sub-committees and groups associated with the American Psychological Association created

over five drafts of the resolution before it was voted in including: the Board of Educational

Affairs, Board for the Advancement of Psychology in the Public Interest, Board of Scientific

Affairs, Policy and Planning Board, Committee for the Advancement of Professional Practice,

Committee on Aging, Committee on Children, Youth, and Families, Committee on Disability

Issues, Committee on Ethnic Minority Affairs, Committee on Legal Issues, Committee on

 Lacher 6

Lesbian, Gay, Committee for Bisexual and Transgender Concerns, Ad Hoc Committee on

Psychology and AIDS, Committee on Rural Health, Committee on Socioeconomic Status,

Committee on International Relations in Psychology, Committee on Psychological Tests and

Assessment, and the Committee on Women in Psychology (Campbell et al., 2013).

The wide range of interdisciplinary groups associated with the production of the

resolution is reflective of the efficacy and potential that psychotherapy has to impact the lives of

a multitude of people. Psychotherapy does not solely benefit one population of individuals;

rather, psychotherapy has the capacity to positively impact every aspect of society and all of its

diverse members (Gaudiano & Miller, 2013).

The magnitude of this decision and endorsement of psychotherapy by the APA affects

many multi-interest groups in the United States, not just the psychological community. In the

medical field, practitioners will desire to include psychotherapy services in health care billing

and insurance protocols and will include psychotherapy as an effective treatment option. More

research will be conducted on the federal level, as psychotherapy is now a qualifying criterion

for federal funding. The Department of Education regulations will adapt to include

psychotherapy effectiveness in training developments and accreditation standards, impacting the

United States education system greatly. In addition to other fields, the world of psychology will

forever be changed internally. According to the APA Council of Representatives, this resolution

elevates psychotherapy in prominence within the profession and provides further hope in

combatting mental illness. Unfortunately, in the past, there was much scrutiny regarding the

treatment of mental illnesses, but going forward, the field of psychology now has concrete ideals

and treatment plans. All psychologists will now advocate for federal policies involving

psychotherapy and continue gaining empirical support for the methods (Campbell et. al, 2013).
 Lacher 7

There are numerous, peer-reviewed studies that demonstrate the efficacy and benefits of

psychotherapy and the treatment of multiple mental illnesses. A study was conducted in 1982 in

order to examine the relationship between psychotherapy and the effectiveness of drug and

alcohol addiction relief. In the study, 742 drug and alcohol abusers were treated in six programs

that provided a combination of psychotherapeutic techniques and a follow-up was conducted six

months after the initial trials and a between-groups comparison was implemented. According to

the results, there was a statistically significant improvement in work performance, psychological

functioning, decreased alcohol and drug usage, and a decrease in criminal behavior,

demonstrating the effectiveness of psychotherapy for these clients (McClellan et al., 1982).

According to the American Center for Disease Control, approximately 11 to 20 percent of

women who give birth suffer from postpartum depression (PPD), accounting for an estimated

600,000 women suffering from PPD yearly. Although this statistic outnumbers new cases of

tuberculosis, leukemia, multiple sclerosis, Parkinsons disease, Alzheimers disease, lupus, and

epilepsy combined, only 15% of women with PPD receive therapy or medication for their mental

illness (The statistics, 2013). Fortunately, a number of studies have provided empirical,

scientific evidence that supports psychotherapeutic treatment of PPD and the alleviation of that

symptomology.

A psychoeducational group for women with PPD achieved a significant reduction in

depressive symptomatology, demonstrating the efficacy of psychotherapeutic approaches in

combatting major depressive symptoms (Morgan et al., 1997). Also, in an earlier study in 1989,

psychologists Holden, Sagovsky, and Cox found that nondirective counseling, cognitive

behavioral therapy, and psychodynamic psychotherapy are more effective than standard primary

care in reducing depressed mood in the postpartum period, demonstrating the efficacy of
 Lacher 8

psychotherapy in combatting PPD ailments (Clark, Tluczek, & Wenzel, 2003). Through a

multitude of scientific, clinic studies, one can easily detect the effectiveness of psychotherapy on

the treatment of mental illness in order to benefit the lives of the patients.

Psychiatry, not to be confused with psychology, is the branch of medicine focused on the

diagnosis, treatment and prevention of mental, emotional and behavioral disorders through the

usage of medication (What is psychiatry, 2017). Whereas psychologists treat mental illnesses

with psychotherapy and other evaluations, psychiatrists are trained physicians who focus on the

alleviation of symptomology through medication solely.

Many individuals against the practice of psychotherapy doubt the scientific evidence

supporting the efficacy of psychotherapy and are skeptical about their benefits. One critical

skeptic, Dr. Harriet Hall remarks: Amateurs get equal results. The benefits of psychotherapy

may be no better than the benefits of talking to a friend; in a sense, psychotherapists are paid to

act as friends, which could be considered a sort of prostitutionTherapy can do real harm and

can lead to suicide. It encourages dependence, false optimism, and externalized responsibility

(Hall, 2015). In reality, the therapeutic relationship between psychologist and patient is not a

sociable one, but rather a strictly professional relationship. Therefore, psychotherapists are not

viewed as friends, but rather close, professional confidants which debunks the myth that a client

solely pays for a friend to listen to them (What is therapy, 2014).

Other critics claim that psychotherapy actually harms the patient and that there are no

feasible benefits of the practice. Many skeptics believe that therapy opens up emotional wounds

and may trigger an event that is more psychological damaging to the patient than before starting

psychotherapy.
 Lacher 9

The statistics showcase the exact opposite: mental illnesses are more dangerous for the

individual if they are left untreated by any form of therapy. According to the National Alliance

on Mental Illness, approximately 90% of individuals who die by suicide have experienced

mental illness (Risk of suicide, 2017). An estimated 2-15 % of persons who have been diagnosed

with major depression, 3-20% of persons who have been diagnosed with bipolar disorder, 6-15%

of persons diagnosed with schizophrenia die by suicide yearly. In addition to those staggering

numbers, people with personality disorders are approximately three times more likely to die by

suicide than those without personality disorders (UW School of Social Work, 2017). Therefore,

the claim that psychotherapy is more harmful than helpful is invalid due to the copious amounts

of scientific research that prove its benefits and the potential risks that untreated mental illness

bring about for the individual.

According to the Monadnock Area Pastoral Counseling Service, some of the risks

associated with psychotherapy are intense self-reflection and acknowledgment of issues

regarding the patients feelings and relationships. Therapy, at times, can be a challenging process

to some individuals due to the need to confront realities and emotions, but the risks of not

receiving treatment are far greater (What is therapy and what are the potential risks and benefits,

2014). While there are still potentials harms involved with any form of therapy, the benefits of

psychotherapy greatly outnumber the potential risks of psychotherapy.

With the increasing prevalence of prescribed medication to treat the symptomology of

mental illnesses in American society, many claim that medication therefore must be the best

solution. According to the an article from the American Psychological Association, Mental

health problems lead to more than 150 million visits to doctors offices, clinics and hospital

outpatient departments each year, making it one of the top three reasons why Americans seek
 Lacher 10

medical treatment. Between 1996 and 2008, the number of prescriptions for antidepressants more

than doubled from 55.9 million to 154.7 million (Bossolo, 2012). Advocators for solely the use

of medication instead of psychotherapy or a combination of the two practices would state that the

rise of prescribed antidepressants (ADM) must correlate with the effectiveness of that particular

treatment. However, the National Institute of Mental Health Treatment of Depression

Collaborative Research Program found IPT, cognitive CBT, and ADM to be equally effective in

reducing depressive symptoms (Elkin et al., 1989).

According to the American Group Psychotherapy Association, many studies support and

advocate for the implementation of psychotherapy as a powerful alternative in treating clinical

depression (The benefits of psychotherapy, 2017). In regards to empirical data, Dr. Katherine

Nordal, executive director of professional practice of the APA, mentions that hundreds of studies

have found that psychotherapy is an effective way to help people make positive changes in their

lives. Psychotherapy, in comparison to prescribed medication, exhibits fewer side effects and

lower instances of mental illness relapse when discontinued (Brownawell & Wiggins, 2012).

While medications may work for most patients, all treatments have limits.

In addition to high rates of relapse, ADMs exhibit a multitude of harmful side effects,

including but not limited to: nausea, increased appetite and weight gain, a loss of sexual desire,

erectile dysfunction, decreased orgasm, fatigue, drowsiness, insomnia, dry mouth, blurred vision,

constipation, dizziness, agitation, irritability, and more anxiety (Allen, 2017). For these reasons,

psychotherapy can be very beneficial for the individual because it exhibits statistically lower

rates of relapse and lower risks associated with the practice (Markowitz & Weissman, 2004).

Individuals that solely pursue medication for treatment of mental illness suffer from

higher rates of relapse, proving this form of therapy to be less effective than users of
 Lacher 11

psychotherapy (Di Mascio et al., 1979). ADM remission is defined by the near absence of

symptoms. However, patients retain a high risk of relapse and consequently, patients who have

been treated with ADM are advised to continue treatment for at least six months. In a 2008 study

conducted by the Nature Review of Neuroscience, the long-lasting effects of ADM and CBT

were tested in a series of clinical trials. According to the data collected, These findings, which

are consistent with the pattern observed in previous studies, indicate that CBT has an enduring

effect that is not found with ADM. This suggests that, whereas the acute responses to CBT and

ADM might be due to changes in similar mechanisms (consistent with the similar rates of change

of different symptom clusters resulting from the two types of treatment), CBT can be assumed to

also produce changes that ADM does not (DeRubeis, Siegle, & Hollon, 2008). Psychotherapy

allows for long-lasting, beneficial changes for the individual and exhibits less amounts of

relapses than the sole use of antidepressant medication.

Ultimately, psychotherapy is a practice that is endorsed and advocated for by the APA

and consequentially all psychologists. According to the Center for Disease Control, published

studies as of 2011 reported that about 25% of all adults have a mental illness and that nearly 50%

of adults will develop at least one mental illness during their lifetime in the United States (Center

for Disease Control, 2011). Therefore, the benefits demonstrated by the psychotherapy methods,

especially CBT and IPT, can alleviate the symptomology of mental illnesses for numerous

Americans. Although critics and skeptics of psychotherapy claim that psychotherapy is less

effective than the use of medications to treat mental illnesses, scientific, valid studies

demonstrate that CBT, IPT, and ADM are all equally effective in the treatment of depression

(Elkin et al., 1989). Also, in regards to ADM, psychotherapy exhibits much less side effects and

potential risks and the data demonstrates that psychotherapy treatments are sustained after
 Lacher 12

treatment. There are numerous, peer-reviewed studies that demonstrate the efficacy and benefits

of psychotherapy with the treatment of multiple mental illnesses, including depression, anxiety

disorders, mood disorders, substance abuse, and others. The practice of psychotherapy is not

only supported by empirical scientific data and the APA, but it also provides an immense amount

of benefits for the patient, including extended sustainability of post-treatment benefits and less

potential risks and associated side-effects of the treatments.

References

Allen, A. (2017). Coping with side effects of depression treatment. Retrieved October 22,

2017, from https://www.webmd.com/depression/features/coping-with-side-effects-of-

depression-treatment.

Beck, A. (2016). History of cognitive behavior therapy. Retrieved October 12, 2017, from

https://www.beckinstitute.org/about-beck/our-history/history-of-cognitive-therapy/

Berezin, R. (2014, January 5). The Art, the science, the wisdom of psychotherapy. Retrieved

October 8, 2017, from https://www.psychologytoday.com/blog/the-theater-the-

brain/201401/the-art-the-science-the-wisdom-psychotherapy-i.

Bossolo, L. (2012). Psychotherapy works. American Psychological Association, 43(10), 16.

Brownawell, A., & Wiggins, K. (2012, September 24). Has psychotherapy taken a back seat to

medication? Retrieved October 9, 2017, from

http://www.apa.org/news/press/releases/2012/09/psychotherapy.aspx

Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The empirical status of cognitive-

behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 1731.

 Lacher 13

Campbell, L. F., Norcross, J. C., Vasquez, M. J. T., & Kaslow, N. J. (2013). Recognition of

psychotherapy effectiveness: The APA resolution. Psychotherapy, 50(1), 98101.

https://doi.org/http://dx.doi.org.ezproxy.loras.edu/10.1037/a0031817.

Clark, R., Tluczek, A., & Wenzel, A. (2003). Psychotherapy for postpartum depression: A

preliminary report. American Journal of Orthopsychiatry, 73(4), 441454.

https://doi.org/http://dx.doi.org.ezproxy.loras.edu/10.1037/0002-9432.73.4.441

Dendy, W. C. (1853). Psychotherapeia, or the remedial influence of mind. Journal of

Psychological Medicine and Mental Pathology (London, England: 1848), 6(22), 268

274.

DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy vs. medications for

depression: Treatment outcomes and neural mechanisms. Nature Reviews: Neuroscience,

9(10), 788796. https://doi.org/10.1038/nrn2345

Di Mascio, A., Weissman, M. M., Prusoff, B. A., et al. (1979). Differential symptom reduction

by drugs and psychotherapy in acute depression. Archives of General Psychiatry, 36,

14501456.

Elkin I., Shea M.T., Watkins J.T., et al. National Institute of Mental Health treatment of

depression collaborative research program: general effectiveness of treatments. Arch Gen

Psychiatry. 46: 971982.

Facts about mental illness and suicide - UW School of Social Work. (2017). Retrieved October

11, 2017, from http://depts.washington.edu/mhreport/facts_suicide.php

Gaudiano, B. A., & Miller, I. W. (2013). The evidence-based practice of psychotherapy: Facing

the challenges that lie ahead. Clinical Psychology Review, 33(7), 813824.

https://doi.org/10.1016/j.cpr.2013.04.004
 Lacher 14

Haggerty, J. (2016). History of psychotherapy. Retrieved October 9, 2017, from

https://psychcentral.com/lib/history-of-psychotherapy/

Hall, H. (2015). Psychology and psychotherapy: How much is evidence-based? Retrieved

October 11, 2017, from https://sciencebasedmedicine.org/psychology-and-

psychotherapy-how-much-is-evidence-based/

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of

cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and

Research, 36(5), 427440. https://doi.org/10.1007/s10608-012-9476-1

Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and

applications. World Psychiatry, 3(3), 136139.

McClellan, A. et al. (1982). Is treatment for substance abuse effective?

The Journal of the American Medical Association, 247, 14231428.

Mental illness surveillance among adults in the United States. (2011). Center for Disease

Control, Division of Health Informatics and Surveillance. Retrieved from

https://www.cdc.gov/mentalhealthsurveillance/fact_sheet.html

Morgan, M., Matthey, S., Barnett, B., & Richardson, C. (1997). A group programme for

postnatally depressed women and their partners. Journal of Advanced Nursing, 26, 913

920.

Norcross, J.C. (1990). An eclectic definition of psychotherapy. In J.K. Zeig & W.M. Munion

(Eds.), What is psychotherapy? Contemporary perspectives (218-220). San Francisco,

CA: Jossey-Bass.

Recognition of psychotherapy effectiveness. (2012). Retrieved October 9, 2017, from

http://www.apa.org/about/policy/resolution-psychotherapy.aspx
 Lacher 15

Rinaldi, R. C. (1985). Positive effects of psychosocial interventions on total health care: A

review of the literature. Family Systems Medicine, 3(4), 417426.

https://doi.org/http://dx.doi.org.ezproxy.loras.edu/10.1037/h0089677

Risk of suicide. (2017). Retrieved October 11, 2017, from https://www.nami.org/Learn-

More/Mental-Health-Conditions/Related-Conditions/Suicide.

Rubinstein, N. (2011, January 26). Psychotherapy and science go hand in hand. Retrieved

October 8, 2017, from https://www.goodtherapy.org/blog/psychotherapy-and-science-go-

hand-in-hand

The benefits of psychotherapy. (2017). Retrieved October 25, 2017, from

http://www.groupsinc.org/the-benefits-of-psychotherapy/

The statistics (2013, July 12). Retrieved October 9, 2017, from

http://postpartumprogress.org/the-facts-about-postpartum-depression/

Weissman, M. (2017). History of IPT. Retrieved October 9, 2017, from

https://iptinstitute.com/about-ipt/.

What is therapy and what are the potential risks and benefits? (2014). Retrieved October 11,

2017, from http://mapsnh.org/about/what-is-therapy/

What is psychiatry? (2017). Retrieved October 11, 2017, from

https://www.psychiatry.org/patients-families/what-is-psychiatry.