Editing Psychotherapy (section)

== Effects ==

=== Efficacy ===
There is considerable controversy about whether, or when, psychotherapy efficacy is best evaluated by [[randomized controlled trials]] or more individualized [[idiographic]] methods.<ref>{{cite news |url= https://www.nytimes.com/2004/08/10/science/for-psychotherapy-s-claims-skeptics-demand-proof.html |title= For psychotherapy's claims, skeptics demand proof |first= Benedict |last= Carey |newspaper= [[The New York Times]] |date= 10 August 2004 |access-date= 25 December 2016 |url-status= live |archive-url= https://web.archive.org/web/20160419175005/http://www.nytimes.com/2004/08/10/science/for-psychotherapy-s-claims-skeptics-demand-proof.html |archive-date= 19 April 2016 |df= dmy-all }}</ref>

One issue with trials is what to use as a [[placebo]] treatment group or non-treatment [[control group]]. Often, this group includes patients on a waiting list, or those receiving some kind of regular non-specific contact or support. Researchers must consider how best to match the use of inert tablets or sham treatments in [[Placebo-controlled study|placebo-controlled studies]] in pharmaceutical trials. Several interpretations and differing assumptions and language remain.<ref>[https://books.google.com/books?id=SPPr7HN7yugC Talking Cures and Placebo Effects] {{webarchive|url=https://web.archive.org/web/20150723051735/https://books.google.co.uk/books?id=SPPr7HN7yugC |date=23 July 2015 }} David A. Jopling OUP Oxford, 29 May 2008</ref> Another issue is the attempt to standardize and manualize therapies and link them to specific symptoms of diagnostic categories, making them more amenable to research. Some report that this may reduce efficacy or gloss over individual needs. Fonagy and Roth's opinion is that the benefits of the evidence-based approach outweighs the difficulties.<ref>Roth A., and Fonagy P. (2005) What Works for Whom: A critical review of psychotherapy research. Second Edition. The Guildford Press</ref>

There are several formal frameworks for evaluating whether a psychotherapist is a good fit for a patient. One example is the Scarsdale Psychotherapy Self-Evaluation (SPSE).<ref>{{cite web|url=http://howtherapyworks.com/the-scarsdale-psychotherapy-self-evaluation-spse/|title=The Scarsdale Psychotherapy Self-Evaluation (SPSE)|work=Integrative Psycotherapy |url-status=live|archive-url=https://web.archive.org/web/20180414233901/http://howtherapyworks.com/the-scarsdale-psychotherapy-self-evaluation-spse/|archive-date=14 April 2018}}</ref> However, some scales, such as the SPS, elicit information specific to certain schools of psychotherapy alone (e.g. the superego).

Many psychotherapists believe that the nuances of psychotherapy cannot be captured by questionnaire-style observation, and prefer to rely on their own clinical experiences and conceptual arguments to support the type of treatment they practice. Psychodynamic therapists increasingly believe that evidence-based approaches are appropriate to their methods and assumptions, and have increasingly accepted the challenge to implement evidence-based approaches in their methods.<ref>{{Cite journal |last= Silverman |first= Doris K. |title= What Works in Psychotherapy and How Do We Know?: What Evidence-Based Practice Has to Offer |journal= [[Psychoanalytic Psychology (journal)|Psychoanalytic Psychology]] |volume= 22 |issue= 2 |year= 2005 |pages= 306–12 |doi= 10.1037/0736-9735.22.2.306}}</ref>

A pioneer in investigating the results of different psychological therapies was psychologist [[Hans Eysenck]], who argued that psychotherapy does not produce any improvement in patients. He held that [[behavior therapy]] is the only effective one. However, it was revealed that Eysenck (who died in 1997) falsified data in his studies about this subject, fabricating data that would indicate that behavioral therapy enables achievements that are impossible to believe. Fourteen of his papers were retracted by journals in 2020, and journals issued 64 statements of concern about publications by him. Rod Buchanan, a biographer of Eysenck, has argued that 87 publications by Eysenck should be retracted.<ref>Eysenck, H. J. & Grossarth-Maticek, R. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: II. Effects of treatment. ''Behaviour Research and Therapy, 29'', 1, 17–31. https://doi.org/10.1016/S0005-7967(09)80003-X</ref><ref>King's College London (May 2019). King's College London enquiry into publications authored by Professor Hans Eysenck with Professor Ronald Grossarth-Maticek. https://retractionwatch.com/wp-content/uploads/2019/10/HE-Enquiry.pdf</ref><ref>Marks, D. F. (2019). The Hans Eysenck affair: Time to correct the scientific record. ''Journal of Health Psychology'', 1–12.</ref><ref>Marks, D. F. & Buchanan, R. D. (2020). King's College London's enquiry into Hans J. Eysenck's 'unsafe' publications must be properly completed. ''Journal of Health Psychology, 25'', 1, 3–6.</ref><ref>O'Grady, C. (15 July 2020). Misconduct allegations push psychology hero off his pedestal. Science Mag. https://www.science.org/content/article/misconduct-allegations-push-psychology-hero-his-pedestal</ref><ref>Pelosi, A. J. (2019). Personality and fatal diseases: Revisiting a scientific scandal. ''Journal of Health Psychology, 24'', 4, 421–439.</ref><ref>Rolls, G. (2015). ''Classic case studies in psychology''. Routledge Taylor & Francis.</ref>

The [[Clinical endpoint#Response rates|response rate]] of psychotherapy varies, no reliable changes due to psychotherapy can be found in up to 33% of patients.<ref name="d810">{{cite journal | last=Wolpert | first=Miranda | title=Failure is an option | journal=The Lancet Psychiatry | volume=3 | issue=6 | date=2016 | doi=10.1016/S2215-0366(16)30075-X | pages=510–512}}</ref>

==== Comparison with other treatments ====
Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for numerous conditions.<ref name=resolution/><ref name=Woelbert/> A 2022 [[umbrella review]] of 102 [[meta-analysis|meta-analyses]] found that most [[effect size]]s reported for both psychotherapies and pharmacotherapies, compared to treatment-as-usual or placebo, were small for most disorders and treatments, and concluded that a "paradigm shift in research" was needed to advance the field and improve treatment strategies for mental disorders.<ref>{{cite journal |last1=Leichsenring |first1=Falk |last2=Steinert |first2=Christiane |last3=Rabung |first3=Sven |last4=Ioannidis |first4=John P. A. |author-link4=John Ioannidis |date=February 2022 |title=The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses |journal=[[World Psychiatry]] |volume=21 |issue=1 |pages=133–145 |pmid=35015359 |pmc=8751557 |doi=10.1002/wps.20941 |doi-access=free}}</ref>

One line of research consistently found that supposedly different forms of psychotherapy show similar effectiveness. According to the 2008 edition of ''The Handbook of Counseling Psychology'': "Meta-analyses of psychotherapy studies have consistently demonstrated that there are no substantial differences in outcomes among treatments".<ref name=Handbook2008/> The handbook stated that "little evidence suggests that any one treatment consistently outperforms any other for any specific psychological disorders".<ref name=Handbook2008>{{cite book|url=https://archive.org/details/isbn_9780470096222/page/250|url-access=registration|title=Handbook of Counseling Psychology|edition=4th|editor-first1=Steven D.|editor-last1=Brown|editor-first2=Robert W.|editor-last2=Lent|date=2008|location=Hoboken, NJ|publisher=John Wiley & Sons|isbn=978-0-470-09622-2|page=[https://archive.org/details/isbn_9780470096222/page/250 250]}}</ref> This is sometimes called the [[Dodo bird verdict]] after a scene/section in Alice in Wonderland where every competitor in a race was called a winner and is given prizes.

Further analyses seek to identify the factors that the psychotherapies have in common that seem to account for this, known as [[common factors theory]]; for example the quality of the therapeutic relationship, interpretation of problem, and the confrontation of painful emotions.<ref>{{cite book|last1=Nolen-Hoeksema|first1=Susan|title=Abnormal Psychology|date=2014|publisher=McGraw-Hill Higher Education|location=University in New Haven, Connecticut|isbn=978-0077349165|pages=53–54|edition=Sixth}}</ref><ref name=GreatDebate>{{cite book |title=The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work |first1=Bruce E. |last1=Wampold |author-link1=Bruce Wampold |last2=Imel |first2=Zac E. |year=2015 |orig-year=2001 |edition=2nd |location=New York |publisher=Routledge |isbn=9780805857085 |oclc=227918397 |doi=10.4324/9780203582015|s2cid=202248258 }}</ref><ref>{{cite journal |last1=Benish |first1=Steven G. |last2=Imel |first2=Zac E. |last3=Wampold |first3=Bruce E. |author-link3=Bruce Wampold |year=2008 |title=The relative efficacy of bona fide psychotherapies for treating posttraumatic stress disorder: A meta-analysis of direct comparisons |journal=[[Clinical Psychology Review]] |volume=28 |issue=6 |pages=746–58 |doi=10.1016/j.cpr.2007.10.005 |pmid=18055080}}</ref><ref>{{cite journal |last1= Miller |first1= Scott D. |last2= Wampold |first2= Bruce E. |author-link2= Bruce Wampold |last3= Varhely |first3= Katelyn |year= 2008 |title= Direct comparisons of treatment modalities for youth disorders: A meta-analysis |url= http://scottdmiller.com/wp-content/uploads/Direct%20Comparisons%20%28Journal%20Copy%29.pdf |journal= [[Psychotherapy Research]] |volume= 18 |issue= 1 |pages= 5–14 |pmid= 18815962 |doi= 10.1080/10503300701472131 |s2cid= 13004118 |url-status= live |archive-url= https://web.archive.org/web/20140109200806/http://scottdmiller.com/wp-content/uploads/Direct%20Comparisons%20%28Journal%20Copy%29.pdf |archive-date= 9 January 2014 |df= dmy-all }}</ref>

Outcome studies have been critiqued for being too removed from real-world practice in that they use carefully selected therapists who have been extensively trained and monitored, and patients who may be non-representative of typical patients by virtue of strict inclusionary/exclusionary criteria. Such concerns impact the [[Replication crisis|replication]] of research results and the ability to generalize from them to practicing therapists.<ref name=GreatDebate/><ref>{{cite journal | vauthors = Leichsenring F, Abbass A, Hilsenroth MJ, Leweke F, Luyten P, Keefe JR, Midgley N, Rabung S, Salzer S, Steinert C | title = Biases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research | journal = Psychological Medicine | volume = 47 | issue = 6 | pages = 1000–1011 | date = April 2017 | pmid = 27955715 | doi = 10.1017/s003329171600324x | s2cid = 1872762 | df = dmy-all | url = http://discovery.ucl.ac.uk/1532689/1/Replicability%2033%20Psychological%20Medicine.pdf }}</ref>

However, specific therapies have been tested for use with specific disorders,<ref>Norcross, J.C. (Ed.). (2002). Psychotherapy relationships that work. OUP.</ref> and regulatory organizations in both the UK and US make recommendations for different conditions.<ref>{{cite web|url=http://www.nice.org.uk/guidancemenu/conditions-and-diseases/mental-health-and-behavioural-conditions|title=Mental health and behavioural conditions – Guidance and guideline topic – NICE|website=www.nice.org.uk|url-status=live|archive-url=https://web.archive.org/web/20150730130920/http://www.nice.org.uk/guidancemenu/conditions-and-diseases/mental-health-and-behavioural-conditions|archive-date=30 July 2015}}</ref><ref>{{cite web|url=http://www.apa.org/about/offices/directorates/guidelines/clinical-practice.aspx|title=APA Clinical Practice Guideline Development|website=apa.org|url-status=live|archive-url=https://web.archive.org/web/20151003204648/http://www.apa.org/about/offices/directorates/guidelines/clinical-practice.aspx|archive-date=3 October 2015}}</ref><ref>{{cite web|url=http://psychiatryonline.org/guidelines|title=American Psychiatric Association Practice Guidelines|website=psychiatryonline.org}}</ref>

The Helsinki Psychotherapy Study was one of several large long-term clinical trials of psychotherapies that have taken place. Anxious and depressed patients in two short-term therapies (solution-focused and brief psychodynamic) improved faster, but five years long-term psychotherapy and psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability for different psychotherapies.<ref>{{cite journal | vauthors = Knekt P, Lindfors O, Sares-Jäske L, Virtala E, Härkänen T | title = Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up | journal = Nordic Journal of Psychiatry | volume = 67 | issue = 1 | pages = 59–68 | date = February 2013 | pmid = 22563790 | doi = 10.3109/08039488.2012.680910 | s2cid = 30877764 | url = https://www.thl.fi/en/web/thlfi-en/research-and-expertwork/projects-and-programmes/helsinki-psychotherapy-study/results }}</ref>

Meta-analyses have established that [[cognitive behavioural therapy]] (CBT) and [[psychodynamic psychotherapy]] are equally effective in treating depression.<ref>{{cite web|url=http://alert.psychnews.org/2017/05/psychodynamic-psychotherapy-is.html|title=Psychodynamic Therapy Is Equivalent to CBT, Meta-Analysis Finds|website=alert.psychnews.org|url-status=live|archive-url=https://web.archive.org/web/20180413185813/http://alert.psychnews.org/2017/05/psychodynamic-psychotherapy-is.html|archive-date=13 April 2018}}</ref>

A 2014 meta analysis over 11,000 patients reveals that Interpersonal Psychotherapy (IPT) is of comparable effectiveness to CBT for depression but is inferior to the latter for eating disorders.<ref>{{cite journal|title=Interpersonal psychotherapy for mental health problems: A comprehensive meta-analysis|first1=Pim|last1=Cuijpers|first2=Tara|last2=Donker|first3=Myrna M.|last3=Weissman|first4=Paula|last4=Ravitz|first5=Ioana A.|last5=Cristea|date=1 July 2016|journal=The American Journal of Psychiatry|volume=173|issue=7|pages=680–687|doi=10.1176/appi.ajp.2015.15091141|pmid=27032627|doi-access=free|hdl=1871.1/e5f03ebe-ef61-42c8-af16-0a6e951d6d92|hdl-access=free}}</ref> For children and adolescents, interpersonal psychotherapy and CBT are the best methods according to a 2014 meta analysis of almost 4000 patients.<ref>{{cite journal | vauthors = Zhou X, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, Cohen D, Del Giovane C, Liu Y, Michael KD, Zhang Y, Weisz JR, Xie P | title = Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis | journal = World Psychiatry | volume = 14 | issue = 2 | pages = 207–22 | date = June 2015 | pmid = 26043339 | pmc = 4471978 | doi = 10.1002/wps.20217 }}</ref>

=== Adverse effects ===
Research on [[adverse effect]]s of psychotherapy has been limited, yet worsening of symptoms may be expected to occur in 3% to 15% of patients, with variability across patient and therapist characteristics.<ref>{{cite journal |last1=Hardy |first1=Gillian E. |last2=Bishop-Edwards |first2=Lindsey |last3=Chambers |first3=Eleni |last4=Connell |first4=Janice |last5=Dent-Brown |first5=Kim |last6=Kothari |first6=Gemma |last7=O'hara |first7=Rachel |last8=Parry |first8=Glenys D. |date=April 2019 |title=Risk factors for negative experiences during psychotherapy |journal=[[Psychotherapy Research]] |volume=29 |issue=3 |pages=403–414 |pmid=29078740 |doi=10.1080/10503307.2017.1393575 |s2cid=22336500 |url=http://eprints.whiterose.ac.uk/123234/3/NegTherapyExperiences%20Accepted%20version%20.pdf |quote=Estimates of 'unwanted effects,' including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area.}}</ref><ref name=Farquharson>{{cite book |last=Farquharson |first=Lorna |date=2020 |chapter=Adverse effects of psychological therapies |editor1-last=Tribe |editor1-first=Rachel |editor2-last=Morrissey |editor2-first=Jean |title=The handbook of professional, ethical and research practice for psychologists, counsellors, psychotherapists and psychiatrists |edition=3rd |location=Abingdon; New York |publisher=[[Routledge]] |pages=129–140 |isbn=9781138352070 |oclc=1130376524 |doi=10.4324/9780429428838-11 |s2cid=216525848 |chapter-url=https://repository.uel.ac.uk/item/8897x |quote=5–10% of all clients experience adverse effects of therapy (Crawford et al., 2016; Lambert, 2013; Hatfield et al, 2010; Hannan et al., 2005). However, there can be considerable variability across therapists (Saxon et al., 2017; Mohr, 1995) and according to client characteristics (Saxon et al., 2017; Crawford et al., 2016; Mohr, 1995).}}</ref><ref>{{cite news |last=Jarrett |first=Christian |date=10 March 2016 |title=How often does psychotherapy make people feel worse? |url=https://digest.bps.org.uk/2016/03/10/how-often-does-psychotherapy-make-people-feel-worse/ |newspaper=Research Digest |publisher=[[British Psychological Society]] |access-date=30 October 2021 |quote=Data is thin on the ground, but best estimates suggest that between 5 to 10 per cent of therapy clients experience a worsening of their symptoms.}}</ref> Potential problems include deterioration of symptoms or developing new symptoms, strains in other relationships, [[social stigma]], and therapy dependence.<ref name=Linden/> Some techniques or therapists may carry more risks than others, and some client characteristics may make them more vulnerable.<ref name=Farquharson/> Side-effects from properly conducted therapy should be distinguished from harms caused by malpractice.<ref name=Linden>{{cite journal | last1 = Linden | first1 = Michael | last2 = Schermuly-Haupt | first2 = Marie-Luise | title = Definition, assessment and rate of psychotherapy side effects | journal = World Psychiatry | volume = 13 | issue = 3 | pages = 306–9 | date = October 2014 | pmid = 25273304 | pmc = 4219072 | doi = 10.1002/wps.20153 }}</ref>

=== Adherence ===
Patient [[Compliance (medicine)|adherence]] to a course of psychotherapy—continuing to attend sessions or complete tasks—is a major issue.

The dropout level—early termination—ranges from around 30% to 60%, depending partly on how it is defined. The range is lower for research settings for various reasons, such as the selection of clients and how they are inducted. Early termination is associated on average with various demographic and clinical characteristics of clients, therapists and treatment interactions.<ref name=adherence>Jennifer L. Strauss, Vito S. Guerra, Christine E. Marx, A. Meade Eggleston Ph.D, Patrick S. Calhoun Ph.D [https://books.google.com/books?id=uiuXxI6wBSQC&pg=PA215 Chapter 9: Improving Patient Treatment Adherence: A Clinician's Guide] {{webarchive|url=https://web.archive.org/web/20160416081953/https://books.google.co.uk/books?id=uiuXxI6wBSQC&pg=PA215 |date=16 April 2016 }} In: Improving Patient Treatment Adherence: A Clinician's Guide. Edited by Hayden Bosworth. Springer Science & Business Media, 3 July 2010</ref><ref>{{Cite journal |last1= Wierzbicki |first1= Michael |last2= Pekarik |first2= Gene |title= A meta-analysis of psychotherapy dropout |journal= [[Professional Psychology: Research and Practice]] |volume= 24 |issue= 2 |pages= 190–5 |year= 1993 |doi= 10.1037/0735-7028.24.2.190}}</ref> The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy.<ref>{{cite journal |last= Egan |first= Jonathan |title= Dropout and related factors in therapy |url= http://www.lenus.ie/hse/bitstream/10147/121474/1/DropoutRelatedfactorsPSI.pdf |journal= The Irish Psychologist |year= 2005 |volume= 32 |issue= 2 |pages= 27–30 |url-status= live |archive-url= https://web.archive.org/web/20110721125420/http://www.lenus.ie/hse/bitstream/10147/121474/1/DropoutRelatedfactorsPSI.pdf |archive-date= 21 July 2011 |df= dmy-all }}</ref>

Most psychologists use between-session tasks in their general therapy work, and cognitive behavioral therapies in particular use and see them as an "active ingredient". It is not clear how often clients do not complete them, but it is thought to be a pervasive phenomenon.<ref name=adherence/>

From the other side, the adherence of therapists to therapy protocols and techniques—known as "treatment integrity" or "fidelity"—has also been studied, with complex mixed results.<ref>{{cite book |author1= Dinger Ulrike |author2= Zilcha-Mano Sigal |author3= Dillon Justina |author4= Barber Jacques P |year= 2015 |title = Therapist Adherence and Competence in Psychotherapy Research |journal= The Encyclopedia of Clinical Psychology |pages= 1–5|doi= 10.1002/9781118625392.wbecp340 |isbn= 9781118625392 }}</ref> In general, however, it is a hallmark of evidence-based psychotherapy to use fidelity monitoring as part of therapy outcome trials and ongoing quality assurance in clinical implementation.

=== Mechanisms of change ===
It is not yet understood how psychotherapies can succeed in treating mental illnesses.<ref>{{Cite journal|last1=Cuijpers|first1=Pim|last2=Reijnders|first2=Mirjam|last3=Huibers|first3=Marcus J.H.|date=7 May 2019|title=The Role of Common Factors in Psychotherapy Outcomes|journal=Annual Review of Clinical Psychology|volume=15|issue=1|pages=207–231|doi=10.1146/annurev-clinpsy-050718-095424|pmid=30550721|issn=1548-5943|doi-access=free|hdl=1871.1/fc5d7d73-48fb-40f3-9c56-05a7995d9888|hdl-access=free}}</ref> Different therapeutic approaches may be associated with particular theories about what needs to change in a person for a successful therapeutic outcome.

In general, processes of [[Arousal|emotional arousal]] and [[memory]] have long been held to play an important role. One theory combining these aspects proposes that permanent change occurs to the extent that the neuropsychological mechanism of [[memory reconsolidation]] is triggered and is able to incorporate new emotional experiences.<ref>{{cite journal |last1=Centonze |first1=Diego |last2=Siracusano |first2=Alberto |last3=Calabresi |first3=Paolo |last4=Bernardi |first4=Giorgio |date=October 2005 |title=Removing pathogenic memories: a neurobiology of psychotherapy |journal=[[Molecular Neurobiology]] |volume=32 |issue=2 |pages=123–132 |doi=10.1385/MN:32:2:123 |pmid=16215277|s2cid=20176022 }}</ref><ref>{{cite book |last1=Ecker |first1=Bruce |last2=Ticic |first2=Robin |last3=Hulley |first3=Laurel |date=2012 |title=Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation |location=New York |publisher=[[Routledge]] |isbn=9780415897167 |oclc=772112300 |url=https://books.google.com/books?id=fQpd13K0gHUC}} But for a more hesitant view of the role of memory reconsolidation in psychotherapy that criticizes some of the claims of Ecker et al., see: {{cite journal |last=Alberini |first=Cristina M. |author-link1=Cristina Alberini |date=April 2015 |title=Commentary on Tuch |journal=[[Journal of the American Psychoanalytic Association]] |volume=63 |issue=2 |pages=317–330 |doi=10.1177/0003065115579720 |pmid=25922379|s2cid=207597244 }}</ref><ref>{{cite journal |last=Welling |first=Hans |date=June 2012 |title=Transformative emotional sequence: towards a common principle of change |journal=[[Journal of Psychotherapy Integration]] |volume=22 |issue=2 |pages=109–136 |doi=10.1037/a0027786 |url=http://www.integra.pt/textos/tes.pdf |url-status=live |archive-url=https://web.archive.org/web/20150924035355/http://www.integra.pt/textos/tes.pdf |archive-date=24 September 2015 |citeseerx=10.1.1.1004.236 }}</ref><ref>For a more hesitant view of the role of memory reconsolidation in psychotherapy, see the objections in some of the invited comments in: {{cite journal |last1=Lane |first1=Richard D. |last2=Ryan |first2=Lee |last3=Nadel |first3=Lynn |author-link3=Lynn Nadel |last4=Greenberg |first4=Leslie S. |author-link4=Les Greenberg |date=2015 |title=Memory reconsolidation, emotional arousal and the process of change in psychotherapy: new insights from brain science |journal=[[Behavioral and Brain Sciences]] |volume=38 |pages=e1 |doi=10.1017/S0140525X14000041 |url=http://www.coherencetherapy.org/files/Ecker-etal_2015_Minding-the-Findings.pdf |pmid=24827452 |url-status=live |archive-url=https://web.archive.org/web/20151117022253/http://www.coherencetherapy.org/files/Ecker-etal_2015_Minding-the-Findings.pdf |archive-date=17 November 2015 }}</ref>

=== General critiques <!--This section is linked from multiple articles: do not rename without including an anchor to previous name ([[MOS:HEAD]])-->===
Some critics are skeptical of the healing power of psychotherapeutic relationships.<ref>{{cite book |last=Masson |first=Jeffrey M. |author-link=Jeffrey Moussaieff Masson |year=1988 |title=Against therapy: emotional tyranny and the myth of psychological healing |location=New York |publisher=Atheneum |isbn=978-0689119293 |oclc=17618782|title-link=Against Therapy }}</ref><ref name="Epstein1995">{{cite book |last=Epstein |first=William M. |date=1995 |title=The illusion of psychotherapy |location=New Brunswick, NJ |publisher=[[Transaction Publishers]] |isbn=978-1560002154 |oclc=32086626}}</ref><ref>{{cite book |editor-last=Feltham |editor-first=Colin |date=1999 |title=Controversies in psychotherapy and counselling |location=London; Thousand Oaks, CA |publisher=[[SAGE Publications]] |isbn=978-0761956402 |oclc=45002563}}</ref> Some dismiss psychotherapy altogether in the sense of a scientific discipline requiring professional practitioners,<ref name="Dawes">{{cite book |last=Dawes |first=Robyn M. |author-link=Robyn Dawes |date=1994 |title=House of cards: psychology and psychotherapy built on myth |location=New York |publisher=[[Free Press (publisher)|Free Press]] |isbn=978-0029072059 |oclc=28675086 |url-access=registration |url=https://archive.org/details/houseofcardspsyc00dawerich }}</ref> instead favoring either nonprofessional help<ref name="Dawes"/> or biomedical treatments.<ref name="WattersOfshe1999">{{cite book |last1=Watters |first1=Ethan |last2=Ofshe |first2=Richard |date=1999 |title=Therapy's delusions, the myth of the unconscious and the exploitation of today's walking worried |location=New York |publisher=[[Charles Scribner's Sons|Scribner]] |isbn=9780684835846 |oclc=40467398 |url=https://archive.org/details/therapysdelusion00etha_0 }}</ref> Others have pointed out ways in which the values and techniques of therapists can be harmful as well as helpful to clients (or indirectly to other people in a client's life).<ref>{{multiref2 | {{cite journal |title=Special section on negative effects from psychological treatments |date=January 2010 |journal=[[American Psychologist]] |volume=65 |issue=1 |pages=13–49 |doi=10.1037/a0015643 |pmid=20063906 |last1=Barlow |first1=D. H. }} | {{cite book |last=Dorpat |first=Theodore L. |date=1996 |title=Gaslighting, the double whammy, interrogation, and other methods of covert control in psychotherapy and psychoanalysis |location=Northvale, NJ |publisher=[[Jason Aronson]] |isbn=978-1568218281 |oclc=34548677}} | {{cite journal |last=Basseches |first=Michael |date=April 1997 |title=A developmental perspective on psychotherapy process, psychotherapists' expertise, and 'meaning-making conflict' within therapeutic relationships: part II |journal=Journal of Adult Development |volume=4 |issue=2 |pages=85–106 |doi=10.1007/BF02510083|s2cid=143991100 }} Basseches coined the term "theoretical abuse" as a parallel to "sexual abuse" in psychotherapy. }}</ref>

Many resources available to a person experiencing emotional distress—the friendly support of friends, peers, family members, clergy contacts, personal reading, healthy exercise, research, and independent coping—all present considerable value. Critics note that humans have been dealing with crises, navigating severe social problems and finding solutions to life problems long before the advent of psychotherapy.<ref>{{cite book |first=Frank |last=Furedi |author-link=Frank Furedi |year=2004 |edition=Reprint |title=Therapy culture: cultivating vulnerability in an uncertain age |publisher=[[Psychology Press]] |isbn=9780415321600 |oclc=52166272}}</ref>

On the other hand, some argue psychotherapy is under-utilized and under-researched by contemporary psychiatry despite offering more promise than stagnant medication development. In 2015, the US [[National Institute of Mental Health]] allocated only 5.4% of its budget to new clinical trials of psychotherapies (medication trials are largely funded by [[pharmaceutical companies]]), despite plentiful evidence they can work and that patients are more likely to prefer them.<ref>{{cite news |last=Friedman |first=Richard A. |date=19 July 2015 |title=Psychiatry's identity crisis |newspaper=[[The New York Times]] |page=SR5 |url=https://www.nytimes.com/2015/07/19/opinion/psychiatrys-identity-crisis.html |url-status=live |archive-url=https://web.archive.org/web/20161231043810/http://www.nytimes.com/2015/07/19/opinion/psychiatrys-identity-crisis.html |archive-date=31 December 2016 }}</ref>

Further critiques have emerged from [[feminist]], [[Social constructionism|constructionist]] and [[Discourse analysis|discourse-analytical]] sources.<ref>{{cite book |last=Cushman |first=Philip |date=1995 |title=Constructing the self, constructing America: a cultural history of psychotherapy |location=Boston |publisher=[[Addison-Wesley]] |isbn=978-0201626438 |oclc=30976460 |url=https://archive.org/details/constructingself00cush }}</ref><ref name="Rose">{{cite book |last=Rose |first=Nikolas S. |author-link=Nikolas Rose |date=1996 |title=Inventing our selves: psychology, power, and personhood |series=Cambridge studies in the history of psychology |location=Cambridge, UK; New York |publisher=[[Cambridge University Press]] |isbn=978-0521434140 |oclc=33440952 |doi=10.1017/CBO9780511752179}}</ref><ref>{{cite book |editor-last=Loewenthal |editor-first=Del |date=2015 |title=Critical psychotherapy, psychoanalysis and counselling: implications for practice |location=Houndmills, Hampshire; New York |publisher=[[Palgrave Macmillan]] |isbn=9781137460578 |oclc=898925104 |doi=10.1057/9781137460585}}</ref> Key to these is the issue of [[Power (social and political)|power]].<ref name="Rose"/><ref>{{cite journal |last=House |first=Richard |date=June 2012 |title=Psychotherapy, politics and the 'common factor' of power |journal=Psychotherapy and Politics International |volume=10 |issue=2 |pages=157–160 |doi=10.1002/ppi.1260}}</ref> In this regard there is a concern that clients are persuaded—both inside and outside the consulting room—to understand themselves and their difficulties in ways that are consistent with therapeutic ideas.<ref name="Epstein1995"/><ref name="Rose"/> This means that alternative ideas (e.g., feminist,<ref>{{cite journal |last=McLellan |first=Betty |date=August 1999 |title=The prostitution of psychotherapy: a feminist critique |journal=British Journal of Guidance & Counselling |volume=27 |issue=3 |pages=325–337 |doi=10.1080/03069889908256274}}</ref> economic,<ref>{{cite journal |last=Pavón-Cuéllar |first=David |date=October 2014 |title=The Freudo-Marxist tradition and the critique of psychotherapeutic ideology |journal=Psychotherapy and Politics International |volume=12 |issue=3 |pages=208–219 |doi=10.1002/ppi.1336}}</ref> spiritual<ref>{{cite book |last1=Moodley |first1=Roy |last2=West |first2=William |date=2005 |title=Integrating traditional healing practices into counseling and psychotherapy |series=Multicultural aspects of counseling and psychotherapy |volume=22 |location=Thousand Oaks, CA |publisher=[[SAGE Publications]] |isbn=978-0761930464 |oclc=57283684}}</ref>) are sometimes implicitly undermined.<ref>{{cite journal |last=House |first=Richard |date=August 1999 |title='Limits to therapy and counselling': deconstructing a professional ideology |journal=British Journal of Guidance & Counselling |volume=27 |issue=3 |pages=377–392 |doi=10.1080/03069889908256278}}</ref> Critics suggest that we idealize the situation when we think of therapy only as a helping relationship—arguing instead that it is fundamentally a political practice, in that some cultural ideas and practices are supported while others are undermined or disqualified, and that while it is seldom intended, the therapist–client relationship always participates in society's power relations and political dynamics.<ref name="Epstein1995"/><ref>{{cite book |last=Epstein |first=William M. |date=2006 |title=Psychotherapy as religion: the civil divine in America |location=Reno, NV |publisher=[[University of Nevada Press]] |isbn=978-0874176780 |oclc=62889079}}</ref><ref>{{cite book |last=Throop |first=Elizabeth A. |date=2009 |title=Psychotherapy, American culture, and social policy: immoral individualism |series=Culture, mind, and society |location=New York |publisher=[[Palgrave Macmillan]] |isbn=978-0230609457 |oclc=226357146 |doi=10.1057/9780230618350}}</ref> A noted academic who espoused this criticism was [[Michel Foucault]].<ref>{{multiref2 | {{cite journal |last=Marks |first=Sarah |date=April 2017 |title=Psychotherapy in historical perspective |journal=[[History of the Human Sciences]] |volume=30 |issue=2 |pages=3–16 |doi=10.1177/0952695117703243 |pmid=28690369 |pmc=5484460 |quote=Michel Foucault, in what has perhaps become the most well-known critique of psychiatric and therapeutic interventions, identified a shift in the way western society conceptualized madness with the establishment of 'moral treatment' at the end of the 18th century... }} | {{cite journal |last=Guilfoyle |first=Michael |date=February 2005 |title=From therapeutic power to resistance? Therapy and cultural hegemony |journal=[[Theory & Psychology]] |volume=15 |issue=1 |pages=101–124 |doi=10.1177/0959354305049748 |s2cid=145491324 |quote=Foucault's views have been used to highlight problems of power in a variety of 'mental health' fields: in nursing (e.g. Clinton & Hazelton, 2002), social work (e.g. Foote & Frank, 1999), psychiatry (e.g. Ali, 2002), and in the cross-disciplinary practices of psychotherapy (most notably in narrative therapy—e.g. Flaskas & Humphreys, 1993; Swann, 1999; White & Epston, 1990). However, there is no single 'Foucauldian' approach to power, or indeed to therapy, and his ideas are used, as he intended, more in the manner of a 'tool kit' of ideas than as a coherent theoretical account.}} | {{cite book |last1=Isack |first1=Sharonne |last2=Hook |first2=Derek |chapter=The psychological imperialism of psychotherapy |date=20 October 1995 |title=1st Annual South African Qualitative Methods Conference: "A spanner in the works of the factory of truth" |url=http://www.criticalmethods.org/spanner.htm |publisher=Critical Methods Society |chapter-url=http://www.criticalmethods.org/hook.htm |location=Johannesburg, South Africa |url-status=live |archive-url=https://web.archive.org/web/20140419043338/http://www.criticalmethods.org/spanner.htm |archive-date=19 April 2014 }} }}</ref>