Does Therapy Work?

Increasing numbers of people in the United Kingdom are turning to therapy to help improve their mental health, but does therapy actually work?

This topic was explored in a recent podcast with Journalist Horatio Clare and Psychiatrist Femi Oyebode.

The focus was mainly on the use of psychotherapy to combat more serious mental health issues such as schizophrenia, bipolar disorder and post traumatic stress disorders, and the overwhelming consensus was that therapy can help and the podcast explores why, as well as what makes for effective therapy.

What is psychotherapy?

Psychotherapy is the use of words as a means of treating another human being

Both psychiatrists and psychotherapists use talking therapy as part of their work, but a psychiatrist is someone who has had medical training, so is qualified to prescribe drug treatments to patients, whereas a psychotherapist doesn’t have prior medical training and so is limited to only do talking therapy with clients.

On misconception about the difference between the two is that psychotherapy focus on dealing with the causes of mental illness whereas psychoanalysis only deals with the symptoms, there is in fact more blurring between the two disciplines.

Types of psychotherapy

The British Council of Counselling and Psychotherapy lists over 30 types of therapy. Three of the main types of psychotherapy are:

  • Psychoanalysis, developed by Freud, is built on the theory that experiences in early childhood have a deep impact on the formation of adult personalities. Dynamic psychotherapy is a modern version of this.
  • Behavioural Therapy believes that patterns of behaviour such as OCD or anxiety arise because of conditioned behaviour, abnormalities of learning which developed either in childhood or adulthood.
  • Cognitive Behavioural Therapy, invented by Aaron Beck was a further development of behavioural therapy theorises that our emotions are dependent on our thinking, so the intent is to alter our thinking so our emotional state changes.

Psychotherapy to treat Schizophrenia

The podcast introduces as a case study one individual who used a combination of medication and talking therapy to ease his symptoms of schizophrenia.

His symptoms were serious, including hearing voices, delusions (having the wrong perception of reality), depression and paranoia which in turn created a number of severe negative emotions such as frustration, hopelessness, disappointment and an overwhelming lack of self-worth, or very low self-esteem.

Talking therapy helped him because his schizophrenia meant he only listened to himself, only heard from himself, having other people’s opinions helped him see from another perspective.

An example of how this can help is if you imagine walking into a room of people who are talking but stop when you enter, you might think ‘they must have been talking about me’ but a different perspective is that maybe they were just talking about something private and confidential.

Cognitive Behavioural Therapy can help calm the symptoms of schizophrenia in two ways.

  • Firstly it can help reduce hallucinations and delusions that may not have responded to drug treatment
  • Secondly it can help a patient deal with the low self-esteem and worthlessness that it causes.

It was suggested to him that family therapy may help, since in psychoanalytic theory childhood experiences may have contributed to his schizophrenia, but his parents refused to take part.

The concept of over-resilience was used to to describe his family’s reluctance to take up family therapy: his parents thought the family was fine as an emotional unit and had no need of therapeutic input.

Over-resilience is very common in ethnic minority families and it builds up over generations. Fathers especially want to be the family rock and so don’t want their partners or children to see them crying or stressed, and so children grow up thinking they also need to hide and not talk about negative emotional states, vulnerabilities and weaknesses.

However for some people this builds up and leads to a mental health crisis, or a breakdown as it did with the case study here.

Psychotherapy and bipolar

One guest, Katie Mason, argued that therapy can also help treat bipolar disorder.

In such cases it can help prevent relapse, addresses symptoms that occur in depression and reduce guilt and shame after someone has had a manic episode. It can also help people accept their condition, which can prevent relapse as they recognise when they are getting unwell again and get early intervention.

Eye Movement Desensitisation and Reprocessing

Another guest, Dr Logi, outlined how a relatively new type of therapy called eye movement desensitisation reprocessing can help patients process previous traumatic events and thus help with Post Traumatic Stress Disorder.

The process is roughly as follows:

  1. The patient thinks about a key even that is causing them to have negative feeling and events, for example a road traffic accident.
  2. They identify what emotions these memories trigger and where in the body they are located.
  3. Then they do something which encourages rapid eye movement while the patient thinks about those memories and feelings.

The theory is that rapid eye movements distract the clients, keeping them in the here and now while they are revisiting the past, thus enabling them to process negative emotional states caused by past events more easily.

EMDR also works with people with depression, phobias and OCD.

Effective Psychotherapy

The most effective thing about therapy is the relationship with the therapist, they work as well as each other!

A good psychotherapist needs to have cultural competence: they need to recognise that their own cultural context and narrative is not superior to that of the patient.

There are some people who believe that a psychotherapist needs to come from the same cultural background to be effective, arguing that positive results are more likely if a therapist is from the same ethnic group as the patient, but Oyebode doesn’t subscribe to this theory.

The most important qualities of a good series of psychotherapy sessions are that they are well structured and allow time for the patient to focus on themselves.

The system also needs broader structures in place to ensure that patients who need medication can find that kind of support which psychiatry doesn’t offer.

Psychiatrists need more time to spend with their patients so they can can tailor therapy more effectively. They are pushed to medicated while therapy is more of a longer game – there are times when it’s more appropriate than others.

There is very little availability of therapy in in-patient services. The average in patient stay in the U.K. is 21 to 28 days and it is not possible to do effective psychotherapy with the patient in an extremely disturbed state and in such a short period of time.

Signposting and Sources

While this material isn’t directly relevant to any of the standard A-level sociology modules I thought it was of sufficient interest given the amount of young people with poor mental health and the fact that therapy is becoming increasingly normal!

Radio 4 (February 2023) Is Psychiatry Working?: Episode 5: Therapy.

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