After 45 years of doing therapy, I know one thing for sure, and that’s that I don’t know much for sure.
I used to think that we therapists knew, or would soon discover, the underlying causes of psychological and relational problems. Scratch that hope: we have as many explanatory models and inconclusive studies today as ever.
I also used to think that my favorite treatment model would become the silver bullet for thorny treatment issues—or at least clear the field of most competitors. But nope: we still have no evidence that any one treatment model is more effective than others for the vast majority of problems we see in therapy.
Okay, but at least most of us practitioners get a bit better with time and experience, right? Alas, available research shows that on average, therapists don’t have better client outcomes over time, even if we feel more confident in our work as we gain experience.
But I don’t despair, and neither should you. Even though we can be certain about so little, psychotherapy truly does work for a majority of clients. How does it do this? In part by creating a state of necessary, benign illusion.
To begin, we now have countless studies that show the biggest influence on outcomes—aside from client factors like prior functioning and motivation—is the relationship that we therapists…