Upfront

Psychotherapy works, and the science and research are there to back it up, said Bruce E. Wampold, PhD, at the APA 2011 Annual Convention symposium, "Psychotherapy Effectiveness: What Makes it Work?"

Answering just what makes it work is complex, said Wampold, a professor of counseling psychology at the University of Wisconsin–Madison, but relationships and customized treatments play key roles.

So what makes a good therapist? According to research presented by Wampold, a good therapist:

  • Has a sophisticated set of interpersonal skills.
  • Builds trust, understanding and belief from the client.
  • Has an alliance with client.
  • Has an acceptable and adaptive explanation of the client's condition.
  • Has a treatment plan and allows it to be flexible.
  • Is influential, persuasive and convincing.
  • Monitors patient progress.
  • Offers hope and optimism (realistic optimism, not Pollyanna-ish).
  • Is aware of a client's characteristics in context.
  • Is reflective.
  • Relies on best research evidence.
  • Continually improves through professional development.

With an effective therapist, science shows that psychotherapy even works better in the long-term and is more enduring than medication. In fact, not only is it more cost-effective, but psychotherapy leads to fewer relapses of anxiety and mild to moderate depression than medication use alone—so much so that Norwegian Health Authorities have issued new guidelines concerning treatment of mild to moderate depression and anxiety, stating that psychological interventions, not medications, should be applied first.

So what's stopping psychotherapy for being the go-to treatment for nonpsychotic conditions? For one thing, major pharmaceutical companies heavily market their medications directly to the public and health professionals, said speaker Steven Hollon, PhD. While therapy is getting sharper, more effective, and more enduring, it is continuing to lose market share to medication.

But it doesn't have to be this way, said APA officials. There is an increased effort by psychologists and APA to change attitudes and make psychotherapy a first-line treatment. With evidence-based treatment guidelines under development, and the move for an official statement by APA on psychotherapy's effectiveness, one day medication may lose its market share to psychotherapy.

—A. Brownawell and K. Kelley