Does Therapy Work?

Therapy "Doesn't Improve Behavior"

I’ve been told by a psychology professor whom I respect greatly that a considerable number of studies have shown that counseling is not effective in improving a person’s behavior. And since improving our behavior is, presumably, one of the things we hope to accomplish through therapy, we might then wonder if therapy is worthwhile at all. If it doesn’t benefit our behavior, what does it do? I will once again cite my anonymous professor, who said that it has been shown that psychology “increases self-awareness”. Studies have shown that rather conclusively. Well, besides the issue of what “self-awareness” really entails, what good does it do us to become more self-aware if that does not improve our behavior?

Test All Things

If a study shows that therapy has no significant effect on behavior, does this mean that therapy cannot improve any individual's behavior? I doubt it. One thing you learn when studying psychology is to be skeptical of any research. Don’t believe anything supposedly shown by research until you know how the research was conducted, what precautionary measures were taken, what kind of sample (group of people to be studied) was used, what the statistical significance was, and what, if any, effect size or practical significance this might entail. And these are only a few of the things one must consider when judging the results of any research in psychology. To put it simply: the average person is not trained to know whether, when something is passed off as being “shown” by psychological research, anything of importance has actually been shown at all. Researchers know this, as do publishers. But when it comes to publishing, unfortunately the main thrust is to publish, and to keep an audience. So a great deal of questionable “research” gets published, its “findings” are accepted by any number of the general population, and then some years later, after considerable damage may have been done to the public opinion already, new research shows up which conclusively shows something absolutely contrary to the old research. This is how pop-psychology myths are propagated and then stick in the collective mind. It is hard to uproot a misplaced public opinion once it has been embedded for years.

Good Stuff. Everyone Gets Paid.

Let’s say we are studying a group of thirty people (a sample), to determine whether or not therapy improves behavior. So we choose or create a few variables that we examine as measures of “behavior improvement”. For example, we might decide that the most important areas of behavior are those involving one’s social life and one’s occupation. So for one of our variables, we might use a measure like “ability to obtain mentor support on the job”, since we know this is positively associated with career success. And for another measure we’ll choose something like “stability in interpersonal relationships”, which we will further define with a number of variables such as “self-reported satisfaction with one’s personal relationships”. You get the picture.

So we interview or test or otherwise observe everyone in our study group to determine how they measure up on our variables. For our group, we have selected only people who had made a decision to get psychotherapy for one reason or another. So six months later, we bring each of our subjects back in and measure them on our variables once more, to see if there has been any improvement after six months of therapy. What we find is that for some people, there is no significant change at all. For others, there is a slight improvement. For some, there is considerable improvement. But much to our surprise, some of them seem to fare slightly worse than they did before therapy, and others are behaving considerably worse! In fact, when we average out the results for the group as a whole, the improvement in some people almost perfectly balances out the backsliding of the others. So we conclude that, overall, therapy does not improve behavior. In one sense, we are right. As a whole, the group’s behavior has not improved. So we give our study a catchy title, like, "Does Therapy Work? Science Says, 'No!'". We find a publisher eager to obtain such a damning report against the psychotherapy industry, and the publisher in turn finds an audience more than eager to gloat over the downfall of psychology as an entire discipline. It’s good stuff. Everyone gets paid.

Therapy Can Make Sociopaths Worse

But there’s more to it, isn’t there? Otherwise I’d have nothing to write about. Now I’m going to tell you something I learned from both my therapist, a giant of an intellect, and the same professor I mentioned earlier: for sociopaths (sometimes called “psychopaths“), psychotherapy often increases the patient’s level of harmful behavior, rather than increasing his/her adaptive behavior! Sociopaths are those who are characterized by a conspicuous lack of “conscience”. That is, they simply feel no guilt or remorse about lying, cheating, stealing, abusing, and using others. The worst of such cases are the people we hear about in the news, who have, say, tortured a whole family to death for no apparent reason, and then stand there in the courtroom looking perfectly serene and undisturbed. They can see nothing wrong with what they’ve done.

The Killer in Me is the Killer in You

But most sociopathic personalities are not quite that extreme. At least, they don’t act out to such extremes. The fact is, sociopathic personality traits (otherwise known as “antisocial personality traits”) are in everyone, to whatever small extent. For example, almost everyone is able to tell a small lie sometimes, and feel little or no remorse over it. Other people go a bit further, feeling no guilt about shoplifting from big stores, although they wouldn’t steal from their own friends. Then you have people who would steal from their own friends, but wouldn’t, for example, rape someone.

What you should see from this is that sociopathy falls on a continuum, like most psychological traits. That is, for almost any measure in psychology (such as “anxiety”, “mood instability”, “IQ” etc.), people do not fall into either/or categories. You are not either completely free of all anxiety, or hospitalized from debilitating OCD. You are not either a super-genius, or a person who lacks the IQ to take care of his own basic daily upkeep. There is a wide continuum for all these traits, and people fall all along this continuum. That is the only reason good psychotherapy is even possible. In order for a therapist to treat a patient for something, she must first be capable of understanding what she is treating. And you do not obtain such understanding from a textbook. You get it by looking within yourself, where you’ll find those same latent pathological traits, only (hopefully) to a much lesser extreme than the person you are trying to treat. This is why some of the best psychologists are those who have dealt with considerable mental problems of their own. It creates the ability to understand. To empathize. This is why one does not get “therapy” from a book or a website. Sure, a book can tell you what’s wrong with you, and how you might try to treat it. But a book can neither understand you nor care about you. You need a person for that.

Standard format of a normal curve
Standard format of a normal curve

The Bell Curve

So psychological traits fall on continua. In fact, most of them fall on a sort of continua that can be plotted (graphed) in a very recognizable way: the normal curve (also called a “bell curve”). The trait that is most famously associated with the normal curve is probably IQ, but the fact is that most traits follow this curve, not just IQ. In fact, a great number of variables in nature, from the height of oak trees to the weight of newborn chimps, follow the normal curve. Rather than try to fully explain a normal curve, I’ll simply say that it is used to graph a variable which is distributed on a continuum, such that all the individual values of the variable fall around the average of all those values in a predictable way (which is why the normal curve always has the same, general “bell” shape). What this means is that, generally speaking, for everyone who’s IQ is ten points above the average IQ for all people, there is someone who’s IQ is ten points below this average. I propose that sociopathy could be measured and described in exactly the same way. That is, there is an “average” when it comes to the extent of personal sociopathic traits, and for everyone who exceeds the average by a certain distance, there is someone who falls short of the average by that very distance. I propose that sociopathy (antisocial personality) follows a normal curve.

"Know Thyself" is a Two-Way Street

Now back to the fact that therapy often makes behavior worse in sociopaths. Why might this be? I think it has something to do with those studies which have shown that therapy increases self-awareness. Self-awareness alone, it would seem, has a neutral effect on behavior. It depends on the degree of antisocial personality trait’s a person has. Why is this? It is because the more we understand how our own minds work, the better we understand how other people’s minds work. For a person who cares about other people, this might result in an enhanced ability to interact with others in a mutually beneficial way--recall my discussion of why a therapist must look within herself in order to effectively help her patients. But how will this enhanced understanding of the human mind affect someone who does not care about other people, but only thinks of them in terms of how he might use them to his own advantage, without regard for how it may hurt them? For such a person, a greater understanding of other people will only lead to a greater ability to manipulate them and use them. Thus, their behavior will not improve. It will get worse. My professor agreed with me on this.

The End of the Matter

So back to our hypothetical study of whether or not therapy improves behavior. Remember, the researchers concluded that it does not. The behavior of some people worsened, while for others it improved, so for the group the behavior change averaged out to something insignificant. But what if there is a very strong direct correlation between antisocial personality traits and the effect of therapy on behavior, such that to whatever proportion antisocial traits increase, behavior improvement decreases, and to whatever degree antisocial traits decrease, behavior improvement increases? And if antisocial personality traits in the population at large do, in fact, follow the normal curve, as I suggested earlier, then what might be the implications for any study that attempts to show how therapy affects behavior? If the study uses a random sample of test subjects, we would expect as many test subjects to have stronger than average antisocial traits as have weaker than average antisocial traits. And so the effects of therapy in the study would work equally in both directions, positive and negative, resulting in a net effect of essentially nothing.

So the answer to the question, “does therapy work?”, would be: “Yes, but it works in positive ways only for people lower on the antisocial continuum, and in negative ways for people higher on that continuum.” So if you are not particularly sociopathic, and you think you might need therapy for some reason, I say go for it! Personally, I feel that I benefited tremendously from the 2-3 years of therapy I underwent myself. Maybe that because I’m just such a nice guy.

As I warned you earlier, this article is far from being well-researched. I am relying mostly on what I’ve heard from my psychology professors and my therapist. But I hope I’ve at least provided some worthwhile food for thought to the average reader. For the professional reader, trained to do research in psychology, I would encourage you to do what I am too lazy to do: properly research the thesis of this article. If I have entertained and informed some people, while perhaps stimulating additional research into an area that I consider rather important, I will consider this article to have been worth writing.

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