Self-help Articles

Dr. Bruce E. Wampold Ph.D.

In a published interview, APA spoke to Dr. Wampold about how psychotherapy works and what the research tells us about different types of treatment, including psychiatric drugs. Bruce E. Wampold Ph.D. is chair and professor of counseling psychology and clinical professor of psychiatry. He is also a groundbreaking researcher and theoretician. Dr. Wampold has published more than 100 scientific articles and is the author of the acclaimed book, “The Great Psychotherapy Debate,” which is a synthesis of empirical research on psychotherapy using sophisticated methods that are situated in a historical and anthropological context.

Q. How exactly does psychotherapy help people?

A. Patients often come to psychotherapy with explanations for their difficulties that leave them feeling that the distress will continue indefinitely. Every treatment provides an explanation for the distress that is adaptive — that is, the patient understands that he or she can do something to improve his or her situation. This leads the patient into healthy actions in that the psychotherapy improves some aspect of their lives, whether it is thinking more positive thoughts, creating better relationships, more appropriately expressing emotions, or enacting other positive changes. The critical aspect is not which treatment a person receives but rather that the patient believes this particular treatment is effective and works collaboratively with the therapist.

Q. What makes psychotherapy work, and what might make one type of psychotherapy more effective than another?

There are common elements of effective psychotherapies. For example, there are hundreds of studies that show that a purposeful collaborative relationship between a therapist and the patient – what we call the therapeutic alliance – is related to therapeutic progress. This relationship holds for all types of therapy. The therapeutic alliance is critical even in medication treatments for mental disorders. The most important aspect of effective therapy is that the patient and the therapist work together to help the patient reach their goals in therapy.

Q. Why is it that so many people are prescribed drugs first and psychotherapy second, if at all, despite its effectiveness?

A. The reason is that first, the pharmaceutical industry spends an inordinate amount of money advertising psychiatric medications to physicians and to the public, resulting in a perception that mental disorders are due to “chemical imbalances in the brain” that can be remediated easily by medications.

Second, increasing numbers of mental disorders are being treated in primary care settings and primary care physicians are not trained in or aware of effective psychotherapies, but they are trained to prescribe drugs. Third, psychotropic medications suggest that the problem is biological, which relieves the patient of responsibility for his or her actions. It is simpler to take a pill and go on with one’s life than to accept that changing involves intentional and purposeful work.

Q. How does a psychotherapist determine when psychiatric drugs are the correct course of action for a given patient?

A. There are instances in which psychiatric medication is an appropriate adjunct to psychotherapy -- for example, in the treatment of severe and persistent depression, bipolar disorder and some anxiety disorders. There is evidence that effective psychotherapists are often the best judges of when their patients can benefit from a pharmaceutical treatment program and work collaboratively with the patient to get the best response to the medication. From my perspective, behavioral interventions should be the first line of treatment and medications used only when response to the behavioral interventions are not sufficient.

Q. How would I know if someone is an effective caregiver and is offering appropriate treatment? How long should I be in treatment?

A. As a starting point, a patient should ascertain that the psychologist he or she is considering is licensed by the state where he/she practices and that he has evidence that the therapist is effective. But because this evidence is rarely available, consumers often rely on word of mouth or testimonials of previous patients.

After therapy begins, the best cue is the patient’s experience: Does this therapist understand me? Does the treatment plan make sense to me? Do I believe this therapist will help me? And most important — am I making progress? If a patient is not making noticeable progress in several sessions, the patient should discuss this with the therapist.

Treatment length depends on the problems or disorder, patient goals, patient history and characteristics, events occurring outside of therapy (e.g., divorce, change in employment status), and therapeutic progress. Therapy typically terminates when the patient is functioning adequately. Commonly, psychotherapy lasts six to 12 sessions, with more complex difficulties benefiting from longer treatment.