Why do some people benefit from therapy while others don't?

[Earthcircle]

I think I may know the answer to this question. I've queried in other sites as to why I didn't benefit from psychotherapy, and I'm usually told it was my fault. I struggled to get better in therapy, but my failure means that I unconsciously didn't want to succeed. Now I think I know the real reason. Here it is:

Psychotherapy is actually placebo:

The Placebo Is Powerful: Estimating Placebo Effects
in Medicine and Psychotherapy From Randomized
Clinical Trials

Bruce E. Wampold, Takuya Minami, Sandra Callen Tierney, Thomas W. Baskin, and Kuldhir S. Bhati
J Clin Psychol 61: 835–854, 2005

Here is a key passage: "In psychotherapy, it has been claimed that treatments produce effects that are roughly twice as large as placebo effects (Lambert & Ogles, 2004; Wampold, 2001b). However, when psychotherapy placebos are well designed, the placebo effect approaches the treatment effect, a result consistent with pharmacological treatments of psychological disorders."

The placebo effect is genetically variable:

Placebo Effect May Be In the Genes | LiveScience

Putting these two together: psychotherapy is a placebo which, for genetic reasons, will only help some people.

Now before people accuse me of being a troll for posting this, let me tell you that I am trying to make sense of the experience of myself and of many others. Further, the topic deserves a discussion, especially among those who are likely to be in therapy and hence paying for it.

 

[Solitudes_Grace]

I've never had psychotherapy myself, so I cannot draw on any personal experiences. That said, your argument seems to make sense to me.

 

[surewhynot]

I think that stating that Psychotherapy is just a placebo effect is pretty much undermining a huge scientific field of study based on tons of studies. There is no way that it is just a placebo effect. It is not some kind of pseudoscience that only works because you think that it works, like astrology. Psychodynamics are supported by the scientific community as actually valide, meaning that its methods have been proven as benefical.

Now, why would some people benefit more than others? Well, there are obviously many factors that play a role into this. One of them is, as you stated, the placebo effect. Surely someone who has faith in the therapy will benefit more. Another important factor is that psychotherapy can take a lot of time to find the source of someone's issues. By that I mean it can take years, depending on the gravity of the problem. Then you also have the quality of the therapist, etc. It's really not that black or white, like most things in life.

 

[Earthcircle]

I think that stating that Psychotherapy is just a placebo effect is pretty much undermining a huge scientific field of study based on tons of studies. There is no way that it is just a placebo effect. It is not some kind of pseudoscience that only works because you think that it works, like astrology. Psychodynamics are supported by the scientific community as actually valide, meaning that its methods have been proven as benefical.

Now, why would some people benefit more than others? Well, there are obviously many factors that play a role into this. One of them is, as you stated, the placebo effect. Surely someone who has faith in the therapy will benefit more. Another important factor is that psychotherapy can take a lot of time to find the source of someone's issues. By that I mean it can take years, depending on the gravity of the problem. Then you also have the quality of the therapist, etc. It's really not that black or white, like most things in life.

There are many studies apparently indicating the efficacy of therapy, but they appear to be subject to publication bias. Please check out this link.

]Efficacy of cognitive

 

[OceanMist]

This is definitely true. Any kind of therapy will help some people and won't help other people.

I think a lot of it has to do with who you are (yes, genetics are important with that) and how much anxiety you have.

No matter what you do, a person who has terrible anxiety will always be inhibited to a certain extent.

Medication and therapy can be quite petty for some people. For some, it can make conditions worse. Arguing with a non-understanding therapist can stress you out. Most therapists have no clue what it's like to have SAD.

 

[MikeyC]

Everybody is different.

Therefore therapy is not for everybody.

 

[kihira]

For therapy to be beneficial I think the individual has to want to change, plus have the belief that change is possible and recognise that the change has to happen from within themselves. In a sense, this ties in with a placebo effect as its to do with belief and thought processes, but you still have to walk that path of change, which takes effort over time. Getting the right therapist is a major factor, too.

 

[bcsr]

You get out what you put in. Fear and anxiety are learned behaviors, and they can definitely be unlearned.

 

[OceanMist]

People mention wanting to change. When someone has bad SA, it's impossible to want to totally change. Anxiety isn't always a learned behavior, it's often something that is nature, ie passed down through genetics.

It's who you are as a person if you are very shy. You can't argue with nature.

sure there are things you can do to improve, but there are many people that....by nature.....don't want to socialize. Therapy and meds can't help that. Nothing can. It's just who they are.

 

[Earthcircle]

Here is one part of the article on genetics that really struck me:

"Patients with the high-dopamine version of the gene felt slightly better after seeing the curt, all-business health-care provider that gave placebo acupuncture. But they were six times as likely to say their symptoms improved with a caring practitioner as those with the low-dopamine gene, who didn't improve much in any group. ... People with the high-dopamine allele of the gene may do well on the placebo with the nurturing treatment because they are generally more attuned to their environments, said University of Michigan psychiatrist Jon-Kar Zubieta, who was not involved in the study."

There is a genetic variant which results in a person being very attuned to their environment and responding well to a very caring provider. Now wouldn't these be the same people who respond strongly to psychotherapy? Note that this is genetic. If you don't got it, you don't got it.

This is important for several reasons. One shouldn't have to pay for placebo, unless perhaps one is only paying a tiny amount. This is true for anyone. But it is especially disturbing that people who are genetically inclined not to respond to placebo are also paying huge amounts for psychotherapy. It is also troubling that they themselves are blamed for failing to improve in therapy. Ironically, I once had a friend who swore to me that he improved in therapy because he didn't try very hard. I, by contrast, tried extremely hard for over a decade and got nothing out of it.

 

[bcsr]

People mention wanting to change. When someone has bad SA, it's impossible to want to totally change. Anxiety isn't always a learned behavior, it's often something that is nature, ie passed down through genetics.

It's who you are as a person if you are very shy. You can't argue with nature.

sure there are things you can do to improve, but there are many people that....by nature.....don't want to socialize. Therapy and meds can't help that. Nothing can. It's just who they are.

Not wanting to socialize and being unable/afraid to are completely different things. Those fears and anxieties are learned, and they can be unlearned.

 

[Earthcircle]

I should add: I was helped by Edna Foa's book Stop Obsessing, but that only helped my OCD. It didn't address SA. And St. John's wort seems to lift my spirits, even if I'm not susceptible to the placebo effect. I'm not suggesting that there is no treatment for anything at all.