Does Talk Therapy Really Work for YOU, for Anyone?

Last week I introduced you to some questions like, does talk therapy work? What kind of talk therapy works? What are the best approaches for therapists.

The lead question and the follow ups here are much bigger questions than you might guess.

I want you to know what you can know about things that might make you better or feel better. And I want you to know what you can’t know but maybe can guess at.

The Most Effective Psychotherapy?

The fact is no one knows what the best therapy approach is for each therapist/client relationship.

Let’s start with something simple, so it’s super easy to see why no one knows.

If you take a pill because you have a headache, any pill, there is about a 50% chance you’ll feel better in 3 – 7 hours. It could be a randomly selected people out of your medicine cabinet.

Let’s say it is a vitamin but you don’t know it. You tell your girlfriend, “hey that pill did the trick. Can I get a few for my upcoming trip to NewYork.”

“Sure thing Babe.”

“She grabs a handful of vitamins, throws them in a baggie.”

He goes on his trip, pops the vitamins when he has a headache and feels better every single time.

And the first thing YOU are going to say is well, “Kev it’s the placebo effect. And you know that more than anyone because you’ve written a lot about placebo and nocebo effects and have researched the heck out of this.”

Is it the Placebo Effect?

Yeah, but in this case it may not be the placebo effect.

It’s very likely your headache would have gone away any way. Maybe you didn’t have your caffeine hit this morning.

(Did you know caffeine is a key ingredient in many over the counter pain killers? Did you know that the SSRI’s like Zoloft, Celexa, Lexapro and on and on are all good pain killers too?)

There’s other things that make headaches go away every day after you take your advil, placebo or nothing.

Coffee, tea, a walk in the park, swimming, talking to a friend all can make headaches vanish. No placebo effect.

“But Kev there are plenty of days I do all those things and my headaches do NOT go away. So those things like caffeine, swimming and talking don’t really work.”

or

“But Kev, placebos don’t work with me. My headache never goes away when my girlfriend gives me the sugar pill. We tried it out. No go.”

The reason people believe this kind of thinking is they are used to processing information this way and damn near everyone thinks this way, and it is completely incorrect.

Does it Mean Therapy is Working if You Feel Better?

Just because you take a pill, any pill, and your headache didn’t go away means almost nothing in real life.

What people NEVER ask is, most of the time you took the pill did you get worse? Did you just get a teeny weeny bit better?

Here’s why you ask the question:

You don’t know if you wouldn’t have gotten worse (or better) had you not taken the pill.

In other words the pill could have saved you from major agony.

People tend to be unable to think clearly about what events REALLY mean.

The pill MAY have saved your life because you didn’t get worse and yet it’s likely you tell the world, “it didn’t work.”  Yet of course in this case, it very well might have.

The fact is you never know until you’ve tested these things on yourself 100 times and tracked what happened after that.

Kevin Hogan’s Therapy Model Is Best

Except it’s not…probably.

This by the way is part of The Hogan Therapeutic Model.

Most psychologists aren’t logicians. They don’t have the capacity to calculate what interventions are working because they don’t have their clients track what happens.

What do psychologists do? What do most doctors do?

They Ask the BIG Question Whose Answer Means Almost Nothing.

I don’t like the phrase “fake news” but….when They ask, “How have you been feeling this week since our last appointment?” …well the fact is it elicits. Good therapists don’t ask questions like that.

Great Therapists Ask REAL Questions that Mean Something

They ask, have you been tracking your progress every day? Are you doing your homework every day? Have you started implementing the new tools we talked about last week

Any well trained MD already knows that patients filter who they have been feeling with how they feel NOW. Patients remember through the lens of THIS MOMENT they are speaking.

I will return to this shortly.

Back to the pill.

Because we don’t know what made the person not get worse that day he took the pill, we can’t ascribe it to the pill or any of the other things that happened today.

Aside from the withdrawal from antidepressants which is quite a nasty experience for most, the AD’s seem to do their job more than half the time, over time.

But we don’t know for sure.

Why?

When a drug is released on the market you can find the online drug vs. placebo (control group) data.

Why What You Read Online is Generally Wrong about Both Drugs and Therapy

You’ll see two basic combinations of information pushed by the drug companies which is similar to what psychologists promote as well.

Here’s the Secret No one Knows About

In the group of people that took the actual drug in the trials, like Zoloft, for example, what you don’t see is how many people DROPPED OUT of the STUDY in each group. In the case of Zoloft about HALF of the zoloft group of participants QUIT THE STUDY, and 13% quit in the placebo group.

(Say WOW!)

Thank you…

Now: Understand the second simple statistic No One Knows

Zoloft has side effects. One study (all studies are very different in these drug studies) reported 35% of people reported side effects. The placebo group reported 22% of side effects.

You think the fact that 22% of people reporting side effects in the placebo group is bad. It’s terrible but it means the placebo IS WORKING.

That person’s brain is convinced they are taking Zoloft so they tolerate these very real side effects because their depression is lifting.

How do we know? They didn’t drop out of the group.

People who are taking a pill for depression more often than not improve, if they can tolerate the side effects. Placebos of course do NOT have side effects. But…

Brains create side effects.

“I wasn’t doing well on the medication so I stopped it.”

I recently told my doc this. It triggered (probably) the one side effect I don’t tolerate, tinnitus.

Did the drug REALLY trigger the tinnitus, after all I didn’t have those sounds and that volume of those new sounds before I took the drug.

The answer is there is a good chance the med triggered the side effect. But of course it is 100% impossible to be certain if it did or not.

Go online sometimes and check out the fact that the COLOR of placebo pills (help) predict how many people will have specific side effects.

For example. The studies on perceived action of colored drugs showed that red, yellow, and orange are associated with a stimulant effect, while blue and green are related to a tranquilizing effect. The trials that assessed the impact of the color of drugs on their effectiveness showed inconsistent differences between colors. The quality of the methods of these trials was all over the board.

Hypnotic, sedative, and anti-anxiety drugs were more likely than antidepressants to be green, blue, or purple. 

I’ve written extensively on the placebo effects in the past so will update you with this fascinating fact. Quite often when a drug is in trials some of the side effects of the placebo are greater than the drug itself.

How is THAT possible?

Because brains expect certain experiences and in a a lot of people those brains create experiences, often with the help of well intentioned dragons who want to tell you that you should/shouldn’t take that drug…

Truth? They don’t have a clue.

This idiotic advice is the same if you asked me, “Kev should I put 10W40 oil in my car?” …and then I gave you answer!

How could I POSSIBLY know???

“Worked for me!”

Welcome to how friends and family screw up your life. They give you advice on important life issues without being a studied student and expert of, in this case, therapy.

Just this thumbnail checklist of the placebo effect vs. a therapeutic pill of some kind (pain killer, anti-anxiety, anti-depressant) helps us understand the question of the day:

Does Talk Therapy Really Work for You?

That’s right…you don’t always do therapy in an office. In fact, there are MANY better settings.  A home, on a walk in private but beautiful outdoor space. How do we know? Because people do feel more at ease.

When I was training therapists to be better therapists it became abundantly clear that the best predictor of improvement in the client resulted from what I call the “Therapeutic Alliance.” It basically means the relationship of the client and therapist.

Why is this?

Psychotherapists are often the image of what a best friend should be because they are taught, quite often to have an unconditional positive regard for the client.

It’s really tough to not like going to the therapists office if you are going to spend an hour or 90 minutes being “liked!”

(If you are in for a 45 minute appointment, I am super skeptical from second one.)

The connection, the rapport between the two humans is critical.

What Else Matters in Finding an Outstanding Therapist?

What else is a good predictor of improvement in the client? The empathic skills of the practitioner.

Most people are terrible at this and this is why most therapists aren’t so great. It’s also why most therapists eventually reach for short term therapies. Clients in pain lead to burn out.

You can’t get great answers from psychological associations on how effective psychotherapy is. They’ll tell you 70% of people will improve with a therapist.

70% of People Get Better with Psychotherapy? Well….

And if we want to work with a number let’s start with that number. Every therapist has a favorite approach.

Here’s the truth, no one knows and no one can know and you can’t calculate the answer with statistical analysis.

I developed my own therapeutic modality and you can get the book if you ever want to learn it. It’s pretty simple and will help you be a much more effective therapists.

70% are better than drug therapies according to most therapist studies.

70% get better with psychotherapy right? That’s what both APA’s report. And they report an even better result when combined with meds.

Are they right?

Maybe, but you’ll never know. (I happen to think that the notion is true for very different reasons than the person who is giving you this information, and, like everyone else, I don’t know for certain either.)

Truth They Don’t Want You to Know

1/3 don’t get better from therapy. But maybe they would if they had better therapists!

For the moment let’s simply stick with 1/3 don’t get better after therapy. That is a pretty solid number.

And 1/3 get some measurable improvement after therapy.

And 1/3 of people get better on their own with or without therapy.

Why do many people get better on their own? Because life experience can change. The people they hang out with are more supportive, better friends than the old group. They are lucky enough to have good relationships with their spouse and/or friends.

1/3 improve somewhere between a little and a lot.

“I Read Cognitive Behavioral Therapy is Amazing…I Read Positive Psychology is Fantastic!”

Is the difference the therapeutic modality?

Not likely.

Yes it makes sense that some modalities should be more effective than others, but the research has generally shown for decades all therapies are about the same in effectiveness. (I have my own biases but prefer not to lay them out here as people will remember them, find a therapist that uses that tool box, and then the therapist is not great. Yuck.)

…but Here’s How You Can Guess if A Type of Therapy is Worth Your Time…or Not

Here’s the BIG secret.

Therapists that work as couples counselors (marriage counselors/relationship counselors) are on average better at what they do and get better reported results than therapists that work one on one.

Why?

Once again, rapport, unconditional positive regard and empathy. But far more important?

Homework.

You can’t get better without it.

There are 168 hours in a week. How many people are going to believe that one hour in anyone’s office each week is going to make them “better?”

But what about that same person doing their therapist-assigned homework (generally but definitely not always) with their spouse a few times each week. (Sometimes daily. I’ve always had clients monitor their experiences daily so they know what is going on in their own world.

Who’s the Best Therapist in the World?

John Gottman’s work is available at amazon. All of his books are absolutely excellent. I found the Science of Trust very valuable. (If you simply read his work and applied it with the simple homework where you actually interact with your spouse, your relationship, your LIFE, would improve.

Many of the principles (but not all) carry over to other family members, friends and office situations all that relate directly to YOU.

Teaching clients to put into practice the very simple and elegant “emotional bids” and “turning towards” the spouse (or really anyone in your life), can make that life much better.

Gottman’s work has been studied and studied because he’s been studying interactions for decades, with meticulous research which has not just been code but video recorded with the permission of those in therapy, and teaching his students to do the same.

Homework with your spouse. Every good therapist will give you homework. Homework can be as simple as watching your favorite show and discussing the dynamics of the main couple in the show. A little structure is all you need and all of a sudden you start to see how relationships go bad or turn better.

These things help you feel better. They help your spouse feel better as well. A good relationship with the people around you will help you feel less physical pain, better sleep, lower anxiety, lower depression levels. Longer life span.

If you don’t have a best friend that supports you with empathy and encouragement to make life better, that is something you’ll want to work on.

A relationship is about common goals, moving toward those outcomes and moving in step with your spouse/partner. And remember the principles of good therapy really do go from fair to very good by implementing the work of the best family and marriage therapists.

Does Talk Therapy Really Work for You?

I believe it can be a gold mine to have a great therapist and a road to hell if you have a poor therapist. Unfortunately, a license is not a symbol of quality.

Your therapist should make you feel comfortable and then assign uncomfortable tasks for you at the end of your session.

Uncomfortable because these are the things you aren’t doing in daily life that you need to be doing.

Its worth a gamble. You can always fire your therapist.

Part Three? Next Week.