Speaking of Psychology: Making psychotherapy work for you, with Bruce Wampold, PhD

Research has shown that psychotherapy is an effective tool for people who are dealing with a wide range of mental and behavioral health issues, yet people are still hesitant to visit a therapist for treatment. In this episode, we talk with psychologist and researcher Bruce Wampold, PhD, about why psychotherapy works and can often be a better alternative to medications.

Bruce Wampold is the Patricia L. Wolleat professor of counseling psychologyopens in new window at the University of Wisconsin–Madison and director of the Research Institute at Modum Bad Psychiatric Center in Norway. He served on the American Psychological Association’s Presidential Task Force on Evidence-Based Practice in Psychology and his research on psychotherapy and methodology has been published in several APA journals, including Psychological Bulletin,American Psychologist   and the Journal of Consulting and Clinical Psychology. He is also author of the book “The Great Psychotherapy Debateopens in new window.”

Audrey Hamilton: Psychotherapy is a personal process for many people. What works for me may not work for you. But in other healthcare settings, there is research that has offered some guidance to people looking for the right therapist and the right treatment. In this episode, we talk with psychologist and researcher Bruce Wampold about how to make psychotherapy effective and long-lasting. I’m Audrey Hamilton and this is “Speaking of Psychology. “

Bruce Wampold is the Patricia L. Wolleat professor of counseling psychology at the University of Wisconsin-Madison. He’s also director of the Research Institute at Modum Bad Psychiatric Center in Norway. He served on the American Psychological Association’s Presidential Task Force on Evidence-Based Practice in Psychology and his research on psychotherapy and methodology has been published in several APA journals, including Psychological Bulletin, American Psychologist and the Journal of Consulting and Clinical Psychology. He is author of the book “The Great Psychotherapy Debate,” which is a synthesis of empirical research on psychotherapy and provides a model for understanding how psychotherapy works. Welcome, Dr. Wampold.

Bruce Wampold: Thank you.

Audrey Hamilton: Psychotherapy is tremendously effective for many people. But is it correct to say that psychotherapy works differently for different people?

Bruce Wampold: Well, there’s many approaches to psychotherapy and many people come with different kinds of problems, different styles. So yes it does work differently for different people. But in the core, it’s probably more similar than it is different.

Audrey Hamilton: So, if I were a client seeking therapy, how would I know I’m getting the best treatment? And like you said, I know that we’re all different. We all have our different issues. But there’s got to be a way to determine what’s working for you.

Bruce Wampold: Well, psychotherapy’s a very personal process. You have a therapist delivering a particular kind of treatment. The most important thing is that you have faith in the therapist and the treatment method the therapist is using with you. And this is something you should discuss with your therapist. So, if you feel like you’re not making progress, and most patients make relatively significant progress in the first five or six sessions, then you should discuss that with your therapist and discuss the progress you’re making and how therapy is progressing.

Audrey Hamilton: So what you’re saying is every therapist is different and has their own style. But, what qualities do all effective therapists have and, you know, how can a patient select some of those qualities to treat their specific issues?

Bruce Wampold: Well, it is true. Therapists have a lot of different styles and there are very successful therapists who are very different than others who are also successful. But there is a common core we know now of characteristics and actions of effective therapists. So, effective therapists have a very sophisticated set of interpersonal skills that are focused on helping the patient. Successful therapists or effective therapists are able to form a working relationship with a variety of patients. And effective therapists seem to be those who are reflective and practice deliberately to get better.

So for the patient it’s really difficult to assess whether the therapist has these qualities. But again, this is something that should be discussed with a therapist in terms of do you feel like you are making adequate progress in the therapeutic endeavor.

Audrey Hamilton: How long should that progress take? Are we talking weeks, months, years?

Bruce Wampold: Well, it really depends on the problem people bring. Many problems that people bring to therapy are really amenable to treatment of five or six or 10 sessions make significant progress. Therapy’s something you don’t just do once in life and you’re cured. You might feel quite satisfied for several years and then there’s another stressor in your life or something happens, and you want to go back. And that’s a perfectly ordinarily.

There are some disorders – severe disorders – in which it’s more like a chronic disease, like diabetes, and you might require more intensive care for longer periods of time.

Audrey Hamilton: Is this something you should be discussing with your therapist at the start of your treatment? How long should you be going before you see some benefits?

Bruce Wampold: Absolutely. This is something the therapist should assess and discuss with you and you should get an idea about what is the conditions of the therapy, both in terms of its length, but the activities you’re going to do and your prognosis and these kinds of things.

Audrey Hamilton: We know now that therapy can be as effective as medication for some of these disorders. Clinical trials have been done on this. Yet, many doctors prescribe psychotropic medications without even recommending therapy. Why is that? When are medications appropriate?

Bruce Wampold: Well, it’s a complex question. I can say, you know, that every clinician practices within their discipline. So, physicians are medical doctors. So, the first thing they think of is prescribing a medication. So, it’s not surprising that that would be frequently used. But we do know, as you mentioned, that psychotherapy is as effective as medications for many of the disorders, mental disorders. And it’s more enduring.

Audrey Hamilton: Right.

Bruce Wampold: So when you discontinue medication, some of which have some pretty significant side effects, people relapse. Whereas with psychotherapy, you learn some skills and ways to overcome or accept your difficulties that are longer lasting.

Audrey Hamilton: Do you find that more people are looking toward psychotherapy because of this very reason, like you mentioned, the side effects, etc., and the fact they’re being able to do it more naturally?

Bruce Wampold: Well, I think there’s a lot of people who really naturally believe in psychotherapy and that would be their first choice. There’s others who are skeptical of psychotherapy and maybe would benefit from other practices. Although psychotherapists are really good at working with people even if they’re resistant. So I wouldn’t say if you don’t believe in psychotherapy, it’s not going to be helpful. That’s not really true. But again, so much of it is determined by the person who’s treating you. So if you talk about your depression or anxiety with a physician, you’re more likely to get medication. That’s kind of a natural consequence, although there’s many physicians who recognize the importance of psychotherapy.

Audrey Hamilton: Are there are some situations where medication and therapy can work together?

Bruce Wampold: There’s some research to indicate that the combination is beneficial. But again, it’s a case by case basis. And the advantage of duel care, like medication and psychotherapy, over psychotherapy by itself is small.

Audrey Hamilton: There is a lot of research out there on different kinds of psychotherapies and not just necessarily the therapist, but the therapies themselves, you know, some of which you published and studied. Can we say what makes one type of therapy more effective than another?

Bruce Wampold: Well, the research literature really indicates that there isn’t one treatment, one kind of psychotherapy that is demonstrably better than any other. So, they all work differently. The activities that are involved in the treatments are different. And what seems to be important is that the patient believes and has faith in this particular method. What works best for them. Some people want a more concrete structured treatment, like cognitive behavioral therapy. Other people find more exploratory and interpretive treatments, like dynamic treatments more acceptable. So, there’s a variety of treatments. There’s a variety of people and it’s important to find one that seems to fit for you and works.

Audrey Hamilton: Where do people research this type of therapy? If I’m not sure what I would fit best with. How do people kind of look into the types of therapies that are out there?

Bruce Wampold: Well, that’s a difficult thing to do because some therapists will advertise this is the kind of therapy I do. Some therapists will wait until they understand the patient’s problems and the context before they decide how they’re going to work together. But it’s really difficult for somebody in the public to say well, I want brand X.

Audrey Hamilton: Right.

Bruce Wampold: Although, if you want cognitive behavioral therapy there’s organizations which will refer you to cognitive behavioral therapists saying what dynamic therapists and so forth. So that is possible. But again, what I advise people to do is to go to a therapist who is recommended to them and see if this fits. See how it works.

Audrey Hamilton: Much like a medical doctor. You kind of don’t know until you get in the room and see what…

Bruce Wampold: That’s right. And what’s really interesting is that somebody might recommend therapist X because they had a really good experience and you might not find that style compatible with you at all. 

Audrey Hamilton: Yeah. Well, thank you Dr. Wampold so much for joining us today.

Bruce Wampold: You’re welcome. Thanks very much.

Audrey Hamilton: You can find more information on psychotherapy effectiveness on our website . With the American Psychological Association’s “Speaking of Psychology,” I’m Audrey Hamilton.