First of all, does psychotherapy really work?

I can imagine it might be difficult for you to invest your time and energy in receiving psychotherapy without a clear answer about this question.  I would be skeptical too.  Since psychotherapy is a service, you don’t receive anything tangible from me such as medications or surgery.  When you come to my office for therapy, you might wonder whether you will feel better afterwards. 

Many studies have been conducted to assess the effectiveness of psychotherapy since the inception of the field. The good news is that, indeed, psychotherapy is significantly effective according to this 2017 meta-analysis (1) in comparison to no-therapy control groups.  This study reports when people receive psychotherapy services, there is a 80% chance one would feel better in comparison to those who did not receive psychotherapy. 

Then, you might wonder what would determine the effectiveness of psychotherapy?  Would it be the experience of the therapist, types of therapy (e.g., CBT, DBT, psychodynamic), etc.? There have been decades of scientific studies conducted on this inquiry, which reached the same conclusion: in general, no single type of psychotherapy is more effective than another.  (Wampold and Imel, 2015) (2)

According to Wampold and Imel (2015) (2), the psychotherapy approach is different from the medical model that identifies a particular treatment model for specific diagnoses such as treatment A for disorder Z.  (Exception to this, there are a few psychotherapy modalities that are a better match for a handful of particular mental health illnesses. For example, DBT is effective for treating Borderline Personality Disorder). This means, when you look for a therapist for treating mental illnesses such as depression, anxiety, and panic attacks the type of therapy modality would not influence the effectiveness and outcome of your therapy.  So, you don’t need to worry too much about choosing the right type of therapy modality such as CBT, Narrative, Psychodynamic, etc.  Rather, you could choose any type of therapy that speaks to you and that you feel comfortable with. 

That’s the reason why I don’t use one type of therapy modality for all my clients’ situations. Rather, I offer different therapy modalities for my clients to choose from depending on their issues in that moment.  So, in one session, I might be using different interventions from CBT, Narrative, and Solution-focused therapy, etc. Therefore, what I offer is personalized therapy based upon your needs and utilizing cutting-edge science. Your care is not constrained by the type of therapy modality.

Do psychotherapists improve with time and experience?

You might wonder if it would be better to see a therapist with a lot of experience in order to achieve better therapeutic outcomes.  Interestingly, there have been many studies conducted on this topic and resulted in the same conclusion:  there is no superior outcome for more experienced clinicians compared to trainees or less experienced clinicians. (Goldberg et al., 2016) (3) Goldberg’s longitudinal study stated that therapists on the whole become slightly less effective over time. Furthermore, therapists over 15 years of experience tend to overestimate their effectiveness and often fail to recognize failing cases. 

After learning about this information, I felt humbled and therefore will remind myself not to overestimate the effectiveness of my therapy as I gain more experience. I plan to continue to seek regular consultation, and to invest in my training and continual growth while also aiming to bring the best care that I can offer to my clients. Most importantly, I will frequently check in with you, my client, to see how you feel about your therapy and adjust it accordingly.  

What ultimately influences the outcome of therapy? 

If a certain type of therapy, or the number of years of the therapist’s experience don’t make much of a difference in terms of the effectiveness of the therapy outcome, you might wonder what you could use as a basis for choosing a therapist? 

In 2018, the American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness conducted a meta-analytic study including 96,000 clients (4). They found  these factors below which have demonstrably effectiveness over successful therapy outcomes:

  • Alliance (most influential factor) – Building an effective relationship with you the client
  • Goal consensus – Fostering agreement on the goal(s) and expectations of therapy
  • Collecting and delivering client feedback – Using client’s feedback to measure how therapy is working for the client and to tailor treatment accordingly
  • Positive regard/affirmation – Being your cheerleader 
  • Collaboration – Working together with the client on the treatment process 
  • Therapist’s Empathy – Sensitive understanding of the client’s feelings and struggles; seeing things from the client’s point of view

Based upon this large-scale research, I have incorporated those factors into my therapy approach in order to maximize the chance of successful therapy outcomes for my clients.  Together with my client, we create goals and agree on the treatment approach. I frequently check in with my clients to see how the therapy is going and what I need to change (if anything). In this way, clients can let me know what their bottlenecks are, how much progress they have made, and what else they would like to work on. So, each client is indeed in charge of her/his/their own healing journey.  Also, this approach seems to help my clients determine for themselves when to graduate from therapy, since they know best when they have achieved their goals. 

When you are choosing a new therapist, take advantage of a free initial consultation that most therapists offer.  Listen to yourself to assess whether you feel comfortable with the therapist, and the therapist seems to work collaboratively with you.  You could ask questions about their therapy approach, as well as how it would look like when the therapist would help you with your particular issue. 

It takes time to find the right fit.  So, you might want to interview several therapists.  Even after starting a few sessions with a new therapist, if you don’t feel comfortable, it’s ok to change your therapist.  Therapists are very understanding of this, and you don’t need to worry about saying no to your therapist. It’s better for you to find the right therapist for your needs.

Please remember that the type of therapy modality and length of the therapist’s experience do not determine the successful outcome of your therapy.  The biggest determining factor is the quality of your relationship with your therapist. So please trust your intuition! 

I hope I will have a chance to meet with you during the 30-minute free consultation.  

Best wishes to you to find the right therapist for your healing journey. 

  1. Dragioti E, Karathanos V, Gerdle B, Evangelou E. Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials. Acta Psychiatr Scand. 2017 Sep;136(3):236-246. doi: 10.1111/acps.12713. Epub 2017 Feb 27. PMID: 28240781.
  2. A Wampold, B. E., & Imel, Z. E. (2015). Counseling and psychotherapy.The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge/Taylor & Francis Group.
  3. Goldberg SB, Rousmaniere T, Miller SD, Whipple J, Nielsen SL, Hoyt WT, Wampold BE. Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. J Couns Psychol. 2016 Jan;63(1):1-11. doi: 10.1037/cou0000131. PMID: 26751152.
  4. Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315. http://dx.doi.org/10.1037/pst0000193

Neuroscience and Epigenetics

In this post, I would like to shed a light on this topic from neuroscience and epigenetic perspectives.

You may have heard that therapy helps you feel better, see things from different angles, or improve your interpersonal skills. However, you might not realize how much impact you have over your own well-being. Thus, it will be beneficial to explain what’s happening underneath the hood. The psychotherapy that you receive could indeed create neurologic and epigenetic changes.

This infographic created by the National Institute for the Clinical Application of Behavioral Medicine helps you visualize and understand the information provided in this post.

Prior to discovering epigenetics, it was thought that people who inherited “bad genes” were destined to develop illness and there was nothing much they could do. However, as we discover more about epigenetics and neuroplasticity, we’ve realized that each one of us could have quite a large impact over the way our genes are expressed. 

Neuroplasticity refers to how flexible our neurons are in the terms of  our neurons’ ability to rewire their connections. In the past, people thought that once we became adults, our brains couldn’t change any more.  However, new research shows that our neurons have plasticity, meaning they are susceptive to change and that we can develop new neural pathways at any age.  If you don’t use a particular connection, you will lose it as it weakens over time.  That’s why it’s important to create positive connections through therapy.

Since our genes are expressed or suppressed in response to how we live and practice self-care, psychotherapy is one of those influencing factors that could change gene expression by promoting behavioral change.  My clients state that learning about this mechanism gives them hope and a sense of control over their lives.  They said that they can visualize how their small efforts accumulate over time and create longer lasting changes, which in turn motivates my clients to try something new.

Since my therapeutic approach applies this knowledge, my sessions entail more than just me passively listening to my clients’ stories. In addition to that, we review my clients’ lifestyles and identify which of their behaviors that might hinder their personal growth. During each weekly session, my client and I explore together what kinds of changes they would like to try.  For example, they can make changes to their diet, adjusting their exercise routine, or improving their quality of sleep.

Additionally, my clients can try reducing their stress levels by saying “No” to unrealistic requests from other people or reduce the inner critical voices in their minds. In fact, it’s important not to engage with the inner critical voice, since it causes neurons to fire together, which makes the neural pathway stronger and solidifies the negative connections.  For this reason, I teach my clients to leave the inner critical voice aside and instead say something like, “I can take care of myself, so I no longer need your help” to the inner critical voice.  Over time, my clients have been impressed with how effective this strategy is to eliminate the inner critical voice. (Please note: there are additional small steps that clients go through, which would vary on a case by case basis.)

Before graduating from therapy, my clients sometimes ask me if they would forget the things they learned.  It is reassuring for them to hear that those new neural pathways and new epigenetic modifications they have created will stay with them, especially if they continue practicing those changes.  Furthermore, these changes become so ingrained that we can pass down some of our epigenetic changes to our children.  Therefore, through receiving therapy and making changes to your life, you are actually changing the way your genes are expressed and creating new connections between your neurons. 

Arden, J. B. (2019). Norton series on interpersonal neurobiology. Mind-brain-gene: Toward psychotherapy integration.  (pp. 59-89) W. W. Norton & Company