Does therapy work?

Short answer: Yes.

Research consistently shows that therapy works. But, what do we mean by "works"? In research terms, it generally means that there is measurable improvement in the symptoms or concerns that brought someone to therapy. The measures vary, and the research is not perfect, but the results are pretty consistent that therapy helps people achieve meaningful changes in their lives.

What can be surprising is that the type of therapy (often called the “modality”) doesn't really matter. Specific techniques or theoretical orientations don’t really matter when it comes to creating changes. This finding, sometimes called the Dodo bird verdict, is one of the most replicated but also most debated findings in psychotherapy research. For some specific conditions, particularly OCD, eating disorders, and certain trauma presentations, modality does appear to matter. But across the broad range of concerns that bring people to therapy, no single approach consistently outperforms the others.

Therapy seems to work because the therapist and the client form a relationship, one devoted entirely to the client's objectives for therapy. It is not a facsimile for friendship, or a replacement for other relationships. It is a trusting, private, and personal space where a client can explore their thoughts, emotions, behaviors, desires, history, goals - really whatever they want - with an objective partner invested in their wellbeing.

Therapy has plenty of critics and skeptics. In 1952, psychologist Hans Eysenck published one of the first comprehensive reviews of psychotherapy research. His conclusion was damning: the data failed to prove that psychotherapy facilitated the recovery of neurotic patients. He argued that people got better at roughly the same rate whether they had therapy or not.

It took 25 years for research to offer a convincing counter. A landmark 1977 meta-analysis pooled 400 controlled trials involving around 50,000 patients and found that the average person receiving therapy was better off than 75% of untreated controls. Eysenck's original research was later found to have significant flaws. Reanalysis found that people in therapy generally saw change within two months, while those without therapy needed two years to see the same improvement. In 2019, King's College London conducted an inquiry into Eysenck's work and found numerous instances of questionable research practices and data manipulation. Eysenck is not the only problematic chapter in psychology's research history (we’ll examine these more closely in a future post).

So if therapy works, what makes it work? This turns out to be a harder question than it sounds. Bruce Wampold, one of the foremost researchers on psychotherapy outcomes, has spent his career trying to answer it. His conclusions, laid out in The Great Psychotherapy Debate, challenge most assumptions about what therapy actually is.

His work supports my earlier statement that the type of therapy doesn’t matter. Cognitive behavioral therapy, psychodynamic therapy, humanistic therapy, EMDR — the research consistently shows that no single modality outperforms the others in any meaningful way. What predicts outcome, across every modality studied, is the quality of the relationship between therapist and client. The alliance, as researchers call it. The degree to which the client feels heard, understood, and that the therapist is genuinely invested in their wellbeing.

It is worth noting that the relationship between alliance and outcome is correlational. Some researchers argue that people who are already improving form better alliances, rather than the alliance itself driving improvement. The evidence suggests the relationship is likely reciprocal. The debate continues. Practically, this means if therapy does not feel like it is working, the first step is to say so in the room with your therapist. That conversation is itself part of the process. The relationship is built on honesty and communication. If your therapist doesn’t respond well to feedback or if you feel you can’t be honest with them, then finding a different therapist is the right call.

Therapy works because honest, open, shame-free human connections can be healing. If you have read my earlier posts here and here, none of this will surprise you. But maybe therapy didn’t work for you or someone you know. That happens for a wide variety of reasons. We will discuss that more in a future post.

But therapy does “work”. It is one of the most consistently supported findings in all of behavioral science.

The time investment is small relative to what it can return. Most people who sit on the fence do so because of fear of the unknown, which we talked about at the start of this series. But now you may know a little more about what to expect. You know it is active, not passive. You know the relationship is the engine that drives change. You know you don't need to arrive with a clear goal or a diagnosis or the right words.

If you are considering it, that is enough. Trust the research. Trust the process. Trust yourself.

Mike O'Rourke is a Licensed Clinical Social Worker Candidate in Montana, available for in-person and telehealth therapy. Book a session or consultation.