Does the therapy really work? Let’s unpack that.

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Over the decades, and especially since the pandemic, the stigma of therapy has faded. It has come to be perceived as an important form of self-care, almost like a gym membership, normalized as a routine, a healthy commitment, and clearly worth the many hours and considerable amounts of money invested. In 2021, 42 million adults in the United States sought mental health care one way or another, until 27 million in 2002. Increasingly, Americans have embraced the idea that therapy is one way they can reliably and significantly improve their lives.

As I recently considered entering therapy once again, this time to adjust to some major life transitions, I tried to identify exactly how it had helped (or not) me in the past. That train of thought led me to wonder what the research really reveals about how effective talk therapy is in improving mental health.

From time to time I tried to bring up the question with friends who were also in therapy, but often they seemed intent on changing the subject or even responded with a bit of hostility. I felt that simply bringing up the topic of the research findings seemed threatening or irrelevant to them. What did a little study matter in the face of the intangibles that improved their lives: a flash of insight, a new understanding of irrational anger, a new recognition of another person’s point of view? I, too, have no doubt that therapy can change people’s lives, and yet I still wanted to know how reliably it offers real relief from suffering. Does the therapy resolve the symptoms that cause so much pain: the feeling of fear in people dealing with anxiety or insomnia in depressed people? Does talking actually heal? And if it does, how well?

Sigmund Freud, the brilliant, if dogmatic, father of psychoanalysis, was famously disinterested in submitting his innovation to formal investigation, which he seemed to regard as a mere bean bean in the face of his cerebral excavations of the unconscious. When presented with some encouraging research that emerged, Freud responded that he “did not place much value in these confirmations because the large number of reliable observations on which these claims are based make them independent of experimental verification.” Some skepticism about the scientific method could be found in psychoanalytic circles well into the 20th century, says Andrew Gerber, president and medical director of a psychiatric treatment center in New Canaan, Conn., who pursued the use of neuroimaging to investigate the therapy efficacy. “When I graduated from psychoanalytic training, a supervising analyst told me: ‘Your analysis will cure you of the need to investigate.'”

Over time, formal psychoanalysis has largely given way to less libido-focused talking therapies, including psychodynamic therapy, a short-term practice that also targets habits and defenses developed earlier in life, and cognitive behavioral therapy, which helps people learn. replace negative thought patterns with more positive ones. Hundreds of clinical trials have been conducted on various forms of talk therapy, and overall, the vast amount of research is pretty clear: talk therapy works, which means that people who undergo therapy are more likely to to improve their mental health. health than those who do not.