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How does therapy help and/or work? The patient perspective.

In prior posts I've written about how researchers thinks therapy works. One approach emphasizes how the quality of the relationship between therapist and patient affects treatment success. And another approach emphasizes evaluating specific treatments (e.g., Cognitive-Behavioral Therapy) for specific diagnoses (e.g., Major Depression). In this post I chose to explore how patients think therapy works.

The patient perspective on how therapy works

One way of learning about patients' experiences in therapy is to look to qualitative research. This type of research uses methods like observations, focus groups, and interviews to collect information that is rich in detail about individual patients and their experiences. Quantitative research, on the other hand, aims to collect numerical data (e.g., answers on a questionnaire; physiological measurements) that can be used in statistical analyses).

While exploring different research articles about patients' experiences in therapy, I found a study (Levitt et al., 2016) that aimed to systematically summarize relevant qualitative research. Specifically, they reviewed over 100 studies in which clients discussed their experiences of therapy, and the researchers summarized what patients found helpful and useful during therapy. Here are some of the findings:

  1. Many patients experience therapy as a process of identifying and understanding unhelpful personal patterns in thoughts, feelings, behaviors, or relationships, and then making relevant changes (e.g., challenging assumptions and considering new perspectives; learning to experience, instead of avoid emotions; changing behaviors and habits; and trying new interpersonal behaviors).

  2. Feeling understood, validated, and cared for by the therapist allows many patients to speak honestly and openly and reflect on their patterns non-defensively.

  3. The structure of therapy and the professional expertise of the therapist enhances many patients' "buy-in" and engagement.

  4. Many patients found it helpful to collaborate and explicitly discuss differences between patient and therapist - including differences in the perceived role of the patient and therapist, as well as differences in identity (e.g., race; class; gender, etc.).

  5. Many patients liked being able to take the lead in therapy and to draw connections on their own, while also receiving guidance from the therapist when things started to feel stuck or were being avoided.

  6. Finally, the researchers described a core, overarching theme in patients experiences, which was using therapy to identifying their unrecognized, vulnerable needs.

Identifying and understanding helpful and unhelpful patterns is a core process in therapy
Identifying and understanding helpful and unhelpful patterns is a core process in therapy

How understanding patients' perspectives can help you in therapy

There are several ways these research findings could help you in therapy. For folks who have never participated in therapy - or who have had unproductive experiences - the research highlights how many clients do benefit - in a many ways - from therapy. The research can also give you a sense of what to expect in therapy. For instance, it's likely that you'll work with the therapist to identify unhelpful patterns in thinking, feeling, behaving, or relating. Understanding this research can also help you assess how well therapy is working for you. You might, for example, reflect on if you're feeling validated and cared for by your therapist and if that's empowering you to speak honestly and openly. Additionally, you might consider if you're therapist is open to receiving feedback and to collaborating on how to structure therapy.

While this research summarizes some of many ways patients benefit from therapy, it by no means is an exhaustive list of the potential benefits. I'm often surprised by what patients found most meaningful or helpful when we end working together, and what you find meaningful or helpful may be unique to you.

How understanding patient's perspectives can help therapists

As a licensed psychologist, reading this research reminded me of how important the patient's perspective is in therapy. While I have expertise in clinical psychology, patients have expertise on their lives, histories, cultures, and problems. Success in therapy differs greatly from many medical procedures, where the procedure can be applied to a passive patient (e.g., taking a pill; undergoing a surgery). Successful therapy, in contrast, comes from collaborating and co-creating a caring, curious relationship that promotes healing and growth. Therapist and patient do this together. So therapists, myself included, need to ensure that we're working with the patient and providing support and guidance, when needed, while also allowing the patient to take the lead when it'd be helpful to do so.

As always, feel free to contact me if you have any questions or would like to learn about working together, as I offer evidence-based online therapy in Georgia for anxiety, OCD, depression, and many other concerns.


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