Turns out, every year, for the last several years, and right around this time, I’ve done a post on the subject of deterioration in psychotherapy. In June 2014, I was responding to yet another attention-grabbing story published in The Guardian, one of the U.K.’s largest daily newspapers. “Misjudged counselling and therapy can be harmful,” the headline boldly asserted, citing results from “a major new analysis of outcomes.” The article was long on warnings to the public, but short on details about the study. In fact, there wasn’t anything about the size, scope, or design. Emails to the researchers were never answered. As of today, no results have appeared in print.
One year later, I was at it again—this time after seeing the biopic Love & Mercy, a film about the relationship between psychologist Eugene Landy and his famous client, Beach Boy Brian Wilson. In a word, it was disturbing. The psychologist did “24-hour-a-day” therapy, as he termed it, living full time with the singer-songwriter, keeping Wilson isolated from family and friends, and on a steady dose of psychotropic drugs while simultaneously taking ownership of Wilson’s songs, and charging $430,000 in fees annually. Eventually, the State of California intervened, forcing the psychologist to surrender his license to practice. As egregious as the behavior of this practitioner was, the problem of deterioration in psychotherapy goes beyond the field’s “bad apples.”
Do some people in therapy get worse? The answer is, most assuredly, “Yes.” Research dating back several decades puts the figure at about 10% (Lambert, 2010). Said another way, at termination, roughly one out of ten people are functioning more poorly than they were at the beginning of treatment. Despite claims to the contrary (e.g., Lilenfeld, 2007), no psychotherapy approach tested in a clinical trial has ever been shown to reliably lead to or increase the chances of deterioration. NONE. Scary stories about dangerous psychological treatments are limited to a handful of fringe therapies–approaches that have been never vetted scientifically and which all practitioners, but a few, avoid.
So, what is the chief cause of deterioration in treatment? Norwegian psychologist Jørgen A. Flor just completed a study on the subject. We’ve been corresponding for a number of year as he worked on the project. Given the limited information available, I was interested.
What he found may surprise you. Click here to read his entire report (in Norwegian), or a google-translated summary below, or watch the video. Be sure and leave a comment!
Until next time,
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence