Question by Tabbitha: What are the implications for psychotherapy of Quay’s work on family recollections?

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Answer by GirlsAreStupid!ThrowRocksAtThem!
Within the psychotherapeutic community there has been some discussion of empirically-based psychotherapy, e.g.[13]

Virtually no comparisons of different psychotherapies with long follow-up times have been carried out.[14] The Helsinki Psychotherapy Study[15] is a randomized clinical trial, in which patients are monitored for 12 months after the onset of study treatments, of which each lasted approximately 6 months. The assessments are to be completed at the baseline examination and during the follow-up after 3, 7, and 9 months and 1, 1.5, 2, 3, 4, 5, 6, and 7 years. The final results of this trial are yet to be published since follow-up evaluations will continue up to 2009.

There is considerable controversy over which form of psychotherapy is most effective, and more specifically, which types of therapy are optimal for treating which sorts of problems.[16]

The dropout level is quite high; one meta-analysis of 125 studies concluded that the mean dropout rate was 46.86%.[17] The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy.

Psychotherapy outcome research—in which the effectiveness of psychotherapy is measured by questionnaires given to patients before, during, and after treatment—has had difficulty distinguishing between the success or failure of the different approaches to therapy. Those who stay with their therapist for longer periods are more likely to report positively on what develops into a longer-term relationship. This suggests that some “treatment” may be open-ended with concerns associated with ongoing financial costs.

As early as 1952, in one of the earliest studies of psychotherapy treatment, Hans Eysenck reported that two thirds of therapy patients improved significantly or recovered on their own within two years, whether or not they received psychotherapy.[18]

Many psychotherapists believe that the nuances of psychotherapy cannot be captured by questionnaire-style observation, and prefer to rely on their own clinical experiences and conceptual arguments to support the type of treatment they practice.

In 2001 Bruce Wampold of the University of Wisconsin published “The Great Psychotherapy Debate”[19]. In it Wampold, a former statistician who went on to train as a counseling psychologist, reported that

1. psychotherapy is indeed effective,
2. the type of treatment is not a factor,
3. the theoretical bases of the techniques used as well as the strictness of adherence to those techniques are both not factors,
4. the therapist’s strength of belief in the efficacy of the technique is a factor,
5. the therapist as a person is a large factor,
6. the alliance between the patience and the therapist (meaning affectionate and trusting feelings toward the therapist, motivation and collaboration of the client, and empathic response of the therapist) is a key factor.

Wanpold therefore concludes that “we do not know why psychotherapy works”.

Although the Great Psychotherapy Debate dealt primarily with data on depressed patients, subsequent articles have made similar findings for post-traumatic stress disorder[20] and youth disorders.[21]

Some report that by attempting to program or manualize treatment psychotherapists may actually be reducing efficacy, although the unstructured approach of many psychotherapists cannot appeal to patients motived to solve their difficulties through the application of specific techniques different from their past “mistakes.”

Critics of psychotherapy are skeptical of the healing power of a psychotherapeutic relationship.[22] Since any intervention takes time, critics note that the passage of time alone, without therapeutic intervention, often results in psycho-social healing.[23] Social contact with others is universally seen as beneficial for all humans and regularly scheduled visits with anyone would be likely to diminish both mild and severe emotional difficulty.

Many resources available to a person experiencing emotional distress—the friendly support of friends, peers, family members, clergy contacts, personal reading, research, and independent coping—-present considerable value. Critics note that humans have been dealing with crises, navigating severe social problems and finding solutions to life problems long before the advent of psychotherapy.[24] Of course, it may well be something in the patient that does not develop these “natural” supports that requires therapy.

Further critiques have emerged from feminist, constructionist and discursive sources. Key to these is the issue of power. In this regard there is a concern that clients are persuaded—both inside and outside of the consulting room—to understand themselves and their difficulties in ways that are consistent with therapeutic ideas. This means that alternative ideas (e.g., feminist, economic, spiritual) are sometimes implicitly undermined. Critics suggest that we idealise the situation when we think of

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