Alan Carr. 2007
This report, commissioned by the Irish Council for Psychotherapy (ICP), consists of a preface by Dr. Brion Sweeney Chairperson of ICP, an executive summary and six chapters, demonstrates conclusively that psychotherapy in its many forms is effective in the treatment of a myriad of psychological and medical problems experienced by both adults and children. Because this document is a review of a review of psychotherapy research, the latter is referred to as a report throughout this review for the sake of clarity.
The first chapter gives a brief history of the origins of psychotherapy, particularly its emergence in Ireland in the 1940s. The narrative then provides a description of the five different psychotherapeutic approaches most commonly used in Ireland. This section is followed by: a definition of psychotherapy, the roles played by both therapist and client; the training of psychotherapists; ethics; statutory registration; and the difference between psychotherapy and counselling.
In order to judge the effectiveness of psychotherapy the report describes in great and very useful detail the hierarchy of evidence which can be used to evaluate the effectiveness of psychotherapy from basic narrative accounts through to sophisticated meta-analyses of controlled outcome studies. “Meta-analysis is a systematic and quantitative approach to reviewing evidence from multiple treatment outcome studies which aims to overcome the impact of reviewer bias on the review process” (Carr, 2007: 13). This is a long and wide-ranging chapter, packed with information of value to the psychotherapist and other professionals alike and provides a firm foundation for the following chapters.
The second chapter examines the overall effectiveness of psychotherapy for adults and children and explains why studies in the 1950s showed psychotherapy was not effective. These earlier studies were flawed because they did not use classical experimental designs comparing treatment and control groups (i.e. members which did not receive treatment). Later more sophisticated and controlled approaches, including meta-analyses demonstrated conclusively the effectiveness of psychotherapy. Findings from meta-analyses of scientific studies showed that: long-term treatment was more efficacious than short term; less improvement occurred when length of therapy and choice of therapist was constrained (i.e., by health insurance companies). However, the use of psychotropic medication during treatment, theoretical orientation of the therapy (e.g., psychoanalytic, humanistic, cognitive-behavioural, etc.) and profession of the psychotherapist (e.g., psychologist, psychiatrist, social worker, etc.) had no significant impact on improvement following psychotherapy.
The report queries if psychotherapeutic interventions are any better than medical /surgical treatments? The results of research comparing both interventions (psychological vs. medical / surgical) show the effectiveness of psychotherapy to be similar to or slightly better than, medical / surgical treatments alone. However, it should be noted that one in ten clients deteriorate following therapy, especially those who drop out.
In Chapter 3 the role of factors common to all forms of effective psychotherapy are examined. Guided by a large body of research, three categories of common factors were identified these are: the therapy context; therapist; and client.
In the therapy context the most important factor is the therapeutic alliance. Thirty-eight per cent of the positive effects of psychotherapy are attributed to this factor. Another factor of note is dose – that is the amount of therapy clients receive. The most important therapist factors are training and experience. Factors for clients which lead to successful treatment outcomes are: high personal distress; low symptom severity; well-functioning families; low levels of life stress; and high levels of social support.
The next two chapters consist of an exhaustive literature review on the effectiveness of psychotherapy in adult and child populations with many different presenting problems. For some conditions a multimodal approach is recommended, For example approaches in which psychotherapy and psychotropic medications are combined. In others psychotherapy alone is the treatment of choice because of its effectiveness, especially in the long term and additionally, because many medications can become addictive.
The final chapter contains conclusions and recommendations, the latter mostly concerning the need for the availability of psychotherapy for all who require it as a stand alone treatment or as part of a multi-modal treatment programme and the need for financial resources to provide it/them, the training of psychotherapists and the practice of psychotherapy.
We can now ask: ‘is this report worth reading’? The answer is an unequivocal: ‘yes’. It is an invaluable resource and should be read not only by psychotherapists but by the providers of many services in this country – HSE personnel, specialists in medical practice, GPs, psychologists, social workers and other adult and childcare service providers who encounter people experiencing psychological, psychosocial and certain medical problems. This having been said, this reviewer had considerable difficulty in obtaining a copy of the report. It is unfortunate that its availability seems to be limited. The report deserves to be showcased rather than hidden away. Finally, some sort of a ‘potted’ version which would be available in doctors surgeries, pharmacies and even perhaps, in Citizens’ Information centres would be very worthwhile to inform the general public about the benefits of psychotherapy for anyone experiencing or knowing someone experiencing problems in their lives.
Francesca Lundström, Ph.D. is a Research Consultant.