Research on Counseling Effectiveness

A Disclaimer: I have been providing counseling to individuals and couples since 1975, so I obviously have a positive bias. I would like to think that I am aware of some of legitimate scientific questions about mental health counseling, as I do keep myself informed of the research studies. In fact, I have contributed to the research on counseling effectiveness while I was on the faculty at the University of Maryland, and later, as a research associate at the National Institutes of Health.

Can you expect to be helped? Obviously, every marital fight or bad mood does not send people into treatment. Normally, people bounce back and start feeling better, personally and in their relationships. Emotional change without treatment can, and does, occur. This is called "spontaneous remission" in the studies. We believe several factors may be involved, including talking to non-professionals like friends and or a member of the clergy, learning to be resilient, making a change, or having some good luck.

Unfortunately, some persons stay stuck in negative emotions for a prolonged period of time and need professional help. It is very common to make the call not feeling well and somewhat demoralized by your problems in living. And it is also common to be wondering, "Will it help?".

Fortunately, we have clear and convincing answers to this question. We know that most people can expect to be helped from counseling. The numbers show that improvement rates among those who received counseling far exceeded spontaneous remission rates that were observed in "no treatment control groups" (see Wampold, The Great Psychotherapy Debate, 2001).

What do mental health consumers think? The Consumer Reports study, published in November 1995, asked patients about their counseling experience. Their survey found that treatment by a mental health professional usually worked. Of the 426 people in the survey who were feeling " very poor" when they began counseling, 87% were feeling very good, good or at least so-so when they were surveyed. Of the 786 people who were feeling "fairly poor" emotionally when they began, the improvement rate was 92%. Their conclusion: "some people probably would have gotten better without treatment, but the vast majority specifically said that therapy helped" (page 735, Consumer Reports). It is interesting to note that these improvement rates are similar to what Wampold found in his review of the studies.

Other interesting findings from the CR survey were:

• Satisfaction with the help, and amount of progress, were similar for all three mental health professional providers: psychiatrists, psychologists and social workers.
• The longer people stayed in counseling, the more they improved. People in counseling more than six months reported the most progress.
• Talking therapy worked as well as combining talk with medications like Prozac. Of the people who took drugs, they felt medicine helped but many reported side effects.

While this is a weakness of any consumer satisfaction survey, the strength of the survey was its applicability to the real world of office practice. Controlled studies typically exclude 2/3rds of those interested in treatment because only patients with a very narrowly defined disorder are studied. Consumer Reports studied persons who have diverse problems. In controlled studies, only one procedure is used whether or not the patient is making a positive response. In reality, the majority of psychologists use several approaches until something works.

What Works Best? When I was starting off my career in 1975, I read an excellent study by Sloane and his colleagues comparing the effectiveness of more traditional psychotherapy with newer, more directive methods used in behavior therapy. I had interests in both kinds of treatment, and wanted to know which method would be more effective for my patients. The study found that both methods were equally effective, which wasn't what I wanted to read. Now, after many years of practice, the results are completely understandable to me.

What we know from the research studies is that there is no support for one method being more effective than another method. In the CR survey, no specific counseling method, like cognitive behavioral counseling, did any better than any other method. Comprehensive reviews of many studies also show that treatment methods do not differ from one another in terms of their effectiveness (see Wampold, 2001). The general consensus: Many psychological disorders can be helped by more than one kind of counseling method.

PostScript. Since the mid-1990's, psychological science has attempted to identify "Empirically Supported Treatments". This effort is designed to influence practice patterns, and promote the use of counseling methods that have been shown to be effective. The highest form of scientific evidence are methods that have two studies, conducted by independent research teams, that are superior to alternative and comparable methods of treatment. Other methods may be effective, because they are better than no treatment control groups; however, these methods are not better than comparable methods of treatment. My own opinion is that this effort will help the consumer avoid being treated by "fringe therapies" that have very little empirical support.