16 May 2011

When Does Talk Therapy Work?

Some mental health conditions are utterly unresponsive to sessions spent talking with a psychologist or counselor, but very responsive to drugs.  For some conditions for some people, drugs and talk therapy support each other.  Others people with particular conditions are responsive to talking with someone, but the mere fact of having a conversation with someone who cares matters more than the content of the talk, the talking to a professional may not be the most cost effective solution.  How is one to make sense of what works and doesn't work in talk therapy for mental health issues?

A good place to start is an index of resources accompanying one of today's National Public Radio stories. 

For example, it includes a registry of 193 different interventions whose effectiveness is supported by scientific evidence.  For example, there are dozens of interventions proven to be effective in treating substance abuse problems of various types that are evidence based.  Others deal with issues connected to parenting, eldercare, PTSD, suicide prevention, general juvenile delinquency, aggression, ODC, workplace stress, and depression.

One common and basic deficiency in the status quo is a failure to know that there are approaches that have been proven to work with a condition or situation.  When there is good news, it needs to be spread far and wide.

While any list of evidence based talk therapies is necessarily driven by the funding and institutions incentives of programs to have their approaches validated with scientific research, it is also a good starting place to get a sense of what kinds of issues there is evidence to support benefits from this kind of treatment, and by inference, what issues there is no solid evidence at this time that this kind of treatment is effective in treating.  Thus, lists like these are a logical empirically driven starting point to a larger widely available resource for determing how best to deal with mental condition or emotionally difficult situations.  Moreover, as one puts together these lists, one ends up with a more practically relevant classification scheme for dealing with these conditions and situations than one that is more focused on cause and classification than in the availablity of treatment.

Also worth noting from the list is that many effective approaches take a group or community orientation rather than an individual psychotheraputic one.  Some issues are not best dealt with in a self-referring patient medical model and can look more like generalized character education.

There is probably a siginificant residual of conditions (for example, Alzheimer's disease) for which the answer is that there are no evidence based treatments, talk based or drug based, available.  Knowing that, too, has value as well, both in counseling skepticism towards unrealistic claims about proposed treatments and fostering inquiry about a broad range of treatment modalities to see if any look like a promising source of a future evidence based intervention.  Knowing this also favors an inquiry approach that focuses on minimizing harm and side effects, given that positive benefits aren't well established.

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