Start Here True Stories Test Your Therapy Newsgroup
What's New Myths False Memory Syndrome "Experts" Debunked
Info for You Essays Reform Legislation The Courage to Heal
Site Map Audio How You Can Help Articles, Links & Resources

What is "Good Therapy?"

Therapists and members of the public sometimes email and ask "What is good therapy?" or "What therapies are good?" or "What therapies do you think are good?"

The term "good" is really too vague to be meaningful. By contrast, the criterion of "tested and found to be safe and effective" is precise, meaningful, objective, and independently verifiable. And before we call a therapy "good," we really need to test it for safety and effectiveness. After all, if a therapy hasn't been tested for safety, it may be harming people by making them suicidal or causing them to self-mutilate, as so-called memory recovery therapy does. Clearly, a therapy that harms the client is not "good." Likewise, if a therapy hasn't been tested for effectiveness, we don't know whether it delivers the results it claims to. It may have no effect at all (besides wasting the client's time and money, which is harmful), or it may be less effective than other available therapies. A therapy that is ineffective or less effective than available alternatives is also not "good."

When considering effectiveness, the question "effective for what purpose?" inevitably arises. That question becomes the basis for forming a hypothesis that will be tested in a clinical trial. Every therapy either explicitly or implicitly claims to be beneficial in one or more ways for one or more problems. So, in evaluating effectiveness, we need to consider three things:

1) What condition does this therapy claims to treat?
2) What benefits does the therapy claim to provide?
3) Among a group of people with the condition, when the outcomes of clients treated with the therapy are compared with control subjects, does this therapy show a statistically significant benefit in the way that it claims?

Personal opinions prove nothing because of the problem of personal bias and the lack of independent review of an individual's thinking. "Clinical experience" without control subjects also proves nothing because of problems like a therapist's bias towards believing that their client is improving and the lack of control subjects to establish whether the improvement is a mere coincidence, the result of the "placebo effect," or actually the result of the therapy.

Scientific, technological, medical, and therapeutic progress occurs as a result of applying the scientific method by doing four things in sequence:

1) Defining a testable, falsifiable hypothesis.
2) Defining an experiment that tests the hypothesis.
3) Performing the experiment.
4) Documenting the results of the experiment and the testing methodology used so that others can critique the methodology as well as reproduce the tests and confirm the results for themselves if they wish.

Rigorous, sustained, consistent application of the scientific method is ultimately the source of all the spectacular progress in science, technology, and medicine during the 20th century. By contrast, the widespread failure to apply the scientific method is the reason that the mental health industry as a whole made little progress during the 20th century and indeed remains in the same anarchic state that medicine was at the start of the 20th century. As a whole, the mental health industry simply isn't doing much testing to find out what works and what doesn't, so we aren't learning much, so the state of the art in the industry isn't improving much over time.

There are exceptions of course such as the researchers and clinicians doing the studies cited in  Therapies Tested and Found to Be Safe and Effective, and indeed it is these researchers and clinicians who applied the scientific method that are responsible for most of the progress in psychotherapy that was made during the 20th century. The problem is that only a small fraction of the therapies in use today have been tested, and even where therapies have been tested, practicing therapists are often ignorant of the results or, if aware, do not conform their practice to them.

So, any therapy will claim to be useful (i.e. effective) for some purpose. The questions are:

1) Has that therapy been tested and found to be safe? (i.e. Do clients get no worse on average as a result of undergoing it, when compared to control subjects?)
2) Has that therapy been tested and found to be effective, providing the benefit it claims for the condition it claims to treat? (i.e. Do clients show significantly more improvement on average as a result of undergoing this therapy than do control subjects who receive no therapy or alternative therapies?)

A therapy that has been tested and found to be safe and effective can be considered a "good" therapy. If a therapy hasn't been tested, we simply don't know whether it's helpful, harmful, or if it has no effect at all. Of course, it's important to remember that knowingly administering an ineffective therapy to a client is in fact harmful and unethical because doing so wastes the client's time, depriving him or her of the opportunity to receive other, effective therapies instead during the same time period, and it wastes the client's money, squandering limited financial resources that could have been spent on other, effective therapies.

If you are a practicing therapist, it is your moral, professional, ethical, and (increasingly) legal responsibility to investigate the scientific proof for safety and effectiveness for each and every therapy technique you use. It is also your moral, professional, and ethical responsibility to inform clients about the known risks, benefits, and alternatives to a proposed therapy before treatment begins and to get the client's informed consent. Finally, you need to give yourself a look in the mirror and ask "What have I done to solve the epidemic problems in the industry of which I'm a part?"

If you are a client in therapy or if you are considering therapy, you must protect yourself by asking therapists what therapy techniques they propose to use and whether these therapy techniques have been tested for safety and effectiveness. Ask the therapist to "show you the money" before you pay your own by providing references to controlled clinical studies demonstrating safety and effectiveness for the proposed therapy. If a therapist isn't informed enough to provide those citations when asked, you're probably better off searching for a better-informed therapist. If a therapist is so irresponsible and unethical as to use therapies that have not been tested for safety and effectiveness, then you are probably better off searching for a therapist who cares enough about clients to test therapies before exposing vulnerable clients to possibly harmful treatments. If you are already in therapy, you may wish to read the page on this site entitled Evaluate Your Therapy.

Testing for safety and effectiveness is not easy. It's much easier for irresponsible therapists if the mental health industry continues to languish in its quagmire of ignorance about effectiveness and indifference about the problems this creates. So long as this situation persists, irresponsible therapists will remain free to do virtually whatever they wish to any of their clients. Without testing for safety and effectiveness, there is no basis for defining standards of care. Without defining standards of care, there is no basis for accountability or disciplinary action against therapists who harm their clients by applying substandard or outright harmful therapies.

In the end, the questions determining the future of the mental health industry are very simple. Are there enough "good therapists" who care enough about their clients to find out which therapies do and don't work? Will these therapists be able to overcome the well-paid indifference of their irresponsible colleagues and reform the industry from within? Or will enough clients and families devastated by untested, unsafe, and ineffective therapies bring pressure to force industry reforms from outside? Until the answer to these questions is "yes" and "good therapy" that's been tested for safety and effectiveness becomes the standard of care, clients and their families will continue to be devastated by so-called memory recovery therapy and future equally harmful fads.

top of page