by Shamma B S

Created on: May 20, 2007   Last Updated: May 21, 2007

Psychotherapy has often been criticized as unscientific and unverifiable. The evidence on which it is based comes from case studies of individual clients. These studies rely heavily on the therapist's interpretations, which are often to bias. They are largely based on information acquired retrospectively - adults recalling their early years. Memories of childhood experiences are often partial and selective - and they can be false. There is plenty of evidence that false memories exist, and that they can be implemented by suggestion and leading questions.

Since many of the processes analyzed by therapists occur at an unconscious level, it is difficult, if not impossible, to determine if they exists at all. For example, are internal conflicts real? Does repression actually occur?

Take the case of insight. It is largely based on the interpretations of the therapist. And these interpretations tend to very depending, among other things, on the theoretical background of the therapist. For example, Freudians tend to based their interpretations on psychosexual conflicts, object relation theorists tend to base them on problems with social relationships in childhood. Which of these interpretations, if any, is correct? And are clients developing insight on the basis of objective data or are they simply accepting the interpretations of their therapist? Some researchers argue that the development of insight is a social conversion process whereby the client is gradually converted to the views and beliefs of their therapist.

But do the above criticism matter? Surely the most important question is: Does psychotherapy work and does it have any advantages? How can the effectiveness of therapy be measured? One answer is to ask the client.This raises a number of problems. For example, 'a small improvement' for one client might be 'a large improvement' for another. At what point should the client be asked? Ideally, at the end of treatment. However, psychoterapy may take years. In some cases, clients are asked to assess their progress during the treatment, in others when the treatment has ended. These two forms of assessment are not directly comparable.

If clients have improved during or after therapy, is this due to the therapy? There are many cases of spontaneous remission - improvement without any professional treatment. One way of assessing the effect of therapy is to compare two groups of people diagnosed with the same disorder. The first group receives treatment, the other does not. If the improvement of the treatment group is significantly greater than that of the non-treatment group, then it can be argued that therapy is effective. However, there are still problems. Are we comparing like with like? For instance, is the severity of the disorder the same for members of each group?

In terms of these and other methodological problems, it is not surprising that there is little agreement about the effectiveness and advantages of psychotherapy. At one extreme, Hans Eyseneck (1952) argues that it appears to be less effective and has less advantages than no treatment at all. At the other extreme, a survey of 475 studies concluded that a wide range of therapies, including psychotherapy, were significanly more effective than no treatment at all. The researchers concluded that, 'The average person who receives therapy is better off at the end of it than 80% of persons who do not' (Smith et al., 1980).

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