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A Welcome Message from Dr. Bruce Wampold, Chief Scientist
Posted on August 11, 2016 by Dr. Bruce Wampold
I have been a psychologist and psychotherapy researcher for over 35 years. During that time I have learned much about the effectiveness of psychotherapy and about how it works. As a field, we’ve made enormous strides in our understanding of what really matters in therapy, and more importantly, what therapists can do to improve outcomes for their clients.
This is why I’m so excited about my involvement with Theravue. We’re building a system that leverages all that we know - and continue to learn - about therapeutic outcomes and how to improve them.
Yet, as I discuss below, improving the quality of psychotherapy services is difficult to accomplish—there are some structural barriers to improvement. Let’s briefly review the good news and news that is a cause for concern.
- Psychotherapy is remarkably effective. It is as effective or more effective than most well-accepted medical procedures in cardiology, pulmonary medicine, communicable diseases (e.g., influenza vaccines). It is as effective as medications for mental disorders e.g., for depression and anxiety), but without side effects. As well, psychotherapy is longer lasting than medications (i.e., lower relapse rates after treatment is discontinued) and is less resistant to additional courses of treatment.
- Therapists in clinical practice produce benefits that are comparable to what is achieved in clinical trials. Therapists seem to achieve the same outcomes as therapists in trials, but is a shorter period of time.
- When clients can use as much therapy as they want, there is evidence that they use only the amount needed to improve so that they are functioning in the normal range or close to it—this typically is achieved in 7 to 9 sessions. Of course, some clients improve more slowly than others and some—those with more severe disorders—need more intensive services for longer periods of time.
- Treatments that have a cogent rationale, are provided skillfully by therapists, and are accepted by clients (i.e., the clients believe that participating in the therapeutic work will be helpful) are about equally effective. Factors, such as the working alliance, empathy, expectations, psychoeducation about the disorder, and other so-called “common factors” are robustly related to outcome.
- Therapists vary in their effectiveness. That is, some therapists consistently achieve better outcomes with their clients, regardless of the disorder being treated or characteristics of the clients, than other therapists. Moreover, and importantly, therapists who can form an alliance with a range of patients, have a sophisticated set of facilitative interpersonal skills, worry about their effectiveness, and make deliberate efforts to improve are the therapists who achieve better outcomes.
- Accessibility is the major barrier in our mental health system. Most people with DSM diagnosable disorders do not have access to quality mental health services.
- It appears that “treatments” with no structure are less effective than treatments that have deliberate actions focused on the client’s problems. Therapists delivering non-structured treatments are not able to provide the client an explanation for his or her distress nor explain how the work the client does in therapy will help the client with his or problems, two aspects of therapy that seem to be important for producing benefits.
- Therapists do not improve over time or with greater experience. In fact,research indicates that therapists achieve better outcomes early in their careers (even as interns or beginning professionals) than they do later in their careers—that is, their performance seems to deteriorate over time.
- Continuing education, as it occurs in most states (workshops, classes, on-line classes), does not lead to improved performance as a therapist.
What are the barriers to improvement?
- Isolation. In the United States and many other countries (but not all!) once you are licensed or certified, supervision and consultation is no longer required. Providing psychotherapy is a lonely pursuit—therapists need support and encouragement of colleagues.
- Lack of coach/consultants. The literature on expertise emphasizes the importance of having a coach or consultants. Even the best tennis players in the world have someone who assists them to improve. It is very difficult to improve without colleagues to consult, particularly for difficult clients.
- Lack of opportunities to practice. Experts in all fields spend time practicing their craft. And this practice must be outside of performance (for example, the expert musician spends time, usually with a coach or consultant, practicing apart from performing concerts).
Theravue is designed to address these core barriers to improvement. We’ve built a system that combines internet technology with human-to-human interaction in a way that leverages the best aspects of both. We’re proud of what we build, and excited about the many features and benefits that are soon to come.
About the Author
Dr. Wampold is the Patricia L. Wolleat Emeritus Professor of Counseling Psychology at the University of Wisconsin—Madison and Director of the Research Institute at Modum Bad Psychiatric Center in Vikersund, Norway. He is a Fellow of the American Psychological Association, Board Certified in Counseling Psychology by the American Board of Professional Psychology, and is the recipient of the 2007 Distinguished Professional Contributions to Applied Research Award. His current work is summarized in The Great Psychotherapy Debate (with Z. Imel, Routledge, 2015).