From the substantial research evidence gathered, we have proven that psychotherapy works overall and we have a better understanding of why it works. The basic facts to know are:

1. Psychotherapy is significantly more effective than a placebo (dummy) treatment, and its effects are generally lasting. However, there is a wide variation in individual results and improvement cannot always be guaranteed.
2. The effectiveness of therapists varies considerably, regardless of their professional background or specialty.
3. The therapist needs to enthusiastically believe that their therapy will help you. Good therapy gives you a sense of hope and expectation of change for the better. It also helps you to develop practical ways forward.
4. Your perception of having a good working relationship with the therapist is very important to success. You need to feel comfortable both with the therapist as a person and with their methods of therapy.
5. Success also depends greatly on your active participation in therapy and your openness and readiness to change. It is helpful to have some idea of tangible goals and how you might like to use therapy to achieve them.
6. Good therapy is sensitive to your viewpoint and adapts its methods to your individual circumstances rather than imposing an approach's "right" way. Primarily it helps to utilize and develop your own abilities and resources.
7. The contribution to success of specific therapeutic models and techniques is relatively small compared to the aspects noted above. No one type of therapy has been shown to be consistently superior to others. Therapeutic models and techniques are helpful in structuring therapy when they fit your views of the situation and how it might be helped.
8. Psychotherapy is not like a medical procedure: success does not depend on diagnosis of the problem or adherence to a prescribed treatment. Psychotherapy is at least as effective as medication for most common psychological problems, has fewer side effects, and makes you less prone to relapse.
9. The eventual outcome is very likely to be successful if you perceive some improvement within the first few sessions. But the longer therapy goes on without any progress, the less the likelihood of eventual success.
10. Valid methods exist to assess your perceptions of the way therapy is conducted and its effectiveness. These can provide valuable feedback to improve the therapy.

There are some key questions to be asked when you first contact a prospective therapist. In addition to enquiring about practical details (times, duration, location, cost and so on), ask them:

1. What is your philosophy of therapy?
2. How do you think change happens?
3. How important will my contribution to therapy be?
4. Will we collaborate on deciding what we do?
5. How and when will we assess progress?
6. How many sessions do you average per client?
7. How easy will it be to end therapy or spread out sessions as I progress?
8. What do you think of medical diagnoses and drug treatments?
9. Can I seek other means of help at the same time?

Compare the answers you receive with your own views and the research findings. Find a therapist that is a good fit with them. Remember that successful therapy builds on your abilities and resources, and depends much less on the therapist's pet approach or assessment of the problem.

Your perceptions of the working relationship with the therapist and the anticipation of improvement are very important to success. Seriously consider finding or requesting another therapist if:

1. You do not like or trust your therapist.
2. You think that your therapist does not like you, understand you, or is insensitive to your point of view.
3. You think that the therapist's agenda is different from yours.
4. You think that your therapist is pessimistic about helping you.
5. The therapist discounts other sources of help which you have found beneficial.
6. You feel uncomfortable with the therapist's theories or techniques.
7. You are not getting sufficient opportunities to provide feedback and influence the course of therapy.
8. The therapist sticks to their approach regardless of your opinions or suggestions.
9. You do not feel any benefit within a handful of sessions, even after talking to your therapist about discomfort or lack of progress.
10. You have doubts about medication and it is recommended early on by your therapist. Consider more than just medical and drug companies' information, and don't be fobbed off by vague (and generally unproven) explanations such as "biochemical imbalances in the brain". Make sure you understand the limitations, probable side effects and likely duration of medication even if you believe it is the right choice for you.

• Wampold, B E (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. New Jersey: Lawrence Erlbaum.
• Duncan, B L, & Miller, S D (2000). The Heroic Client: Doing Client-Directed, Outcome-Informed Therapy. San Francisco: Jossey-Bass Wiley.
• Bohart, A C, & Tallman, K (1999). How Clients Make Therapy Work: The Process of Active Self-Healing. Washington DC: American Psychological Association.
• Hubble, M A, Duncan, B L, & Miller, S D (Eds) (1999). The Heart and Soul of Change: What Works in Therapy. Washington DC: American Psychological Association.

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Last updated 26 May 2005