Does Therapy Really Work?: Honest Answers from a Therapist

Does therapy work?: It depends on what you’re trying to do

A common question we hear from patients just starting their search for therapy is: Does therapy really work? The truth is, well, the research is actually mixed. Most people find most therapists helpful for a short period of time. It is useful to have space to talk through what’s happening in our lives and to feel heard and received. In this sense, therapy “works”—it helps people feel somewhat better. Beyond that? It depends on what you’re trying to do.

Treating symptoms versus treating symptoms and creating deep, lasting change

Having someone to speak to, particularly someone who is kind, empathetic, and nonjudgmental, works, especially in the short term, at lowering symptoms that may accompany a difficult moment in life. Many people who see a therapist for just a few sessions might rate this as helpful. Insurance companies would be thrilled; it suggests that so-called “brief” therapies are plenty effective. If someone is unfamiliar with therapy (or worse, has absorbed a cynical view of therapy), they might see this as the best that therapy can do.

It's not. In fact, a good friend can be relied upon to do the same. Good therapy can do better.

The best therapists provide strong leadership around discovering lasting relief

Therapists should be ambitious—providing people with more than perhaps they’re asking for, realize they need, or even know is possible. Many people don’t see the patterns they seek help with piecemeal. They don’t have that insight or it’s simply never been offered to them that our troubles tend to follow a pattern, that those patterns often repeat, and that clues (and ultimately, relief) can lie in looking at these issues as a part of a broader context, including a historical one.

For example, a patient finds herself in a relationship that’s falling apart but is unable to end it. Seeking treatment after a particularly difficult patch, she finds a therapist who listens to her struggles and holds space for her ambivalence about the relationship while also being encouraging of her desire to end it. And she does. A few weeks later, weary from the drama, she also feels an intense relief. That was bad; the therapist was a stable platform and understanding ear. She might rate the work as a success and move on.

But, what is missing? Perhaps this is all she needed. The relationship was unfortunate, but she moved on and has likely learned some things from the experience. But what if there is more to work on here? What about an exploration of her history of dating difficult men? How might that pattern come to light? And if it does, what’s involved in truly helping this to change?

Therapy works when a therapist is able to ask: What are the possibilities of what we might do together? And how might we do this together?

When does therapy not work?: It usually has to do with the fit

The success of a therapeutic relationship is often dependent on the fit between a patient and therapist. Ideally, a therapist adjusts their offerings based on the particulars of the person they’re attempting to help. Not every therapist is right for each patient, but each therapist should also be flexible. When this doesn’t happen, it’s usually related to two things: 1. A lack of deep rigorous training on the part of more and more therapists entering the field and 2. an overreliance on tools and technique to the exclusion of co-creating therapy based on flexibility (see the former for the primary reason for this overreliance).

Learning technique is challenging; much harder is learning how to develop new approaches for each treatment. Harder still is co-developing approaches with a patient. Even harder than that is teaching a patient to do it for themselves. This reveals a chicken-or-the-egg problem in therapy training. A becoming-therapist wants to learn technique before practicing and yet, one benefits from having practiced before learning technique. There’s no easy solution here. The real answer is both, meaning therapists need to be continually learning and relearning technique while practicing so that the therapy works.