Psychotherapy Facts
The most famous psychotherapist is perhaps Sigmund Freud – and for good reason. Originally trained as a doctor and neurologist, Freud was first and foremost interested in how the brain worked. But leaving his experimental brain work behind, Freud focused instead on developing what he called the talking cure, what has become psychotherapy (note that psychotherapy is talk-therapy; the two terms mean the same thing).
Let us define psychotherapy broadly. Simply, it involves two people talking about emotions, thoughts, and behaviours - a process where two people discuss goals and how to implement useful strategies. Different psychotherapies may emphasise some parts over others, but all share the premise that listening and talking – that is, having a conversation - can be healing.
He couldn’t prove it back then, but Freud thought that this process of psychotherapy could alter the brain. Now it is one hundred years later. And Freud was right. In fact, since Dr Freud’s era, much has been discovered about psychotherapy, how it works, why, and for who. Here are three talking-therapy facts, at least according to ongoing (and ever changing) scientific research.
1. The relationship with your therapist probably matters more than the specific type of therapy that you do.
In research terms, the relationship with your therapist is called the therapeutic alliance. It matters because a strong therapeutic alliance seems to be the most important factor in the whole of talking therapy. This suggests that it’s important to:
Connect with your therapist on a human level.
If a solid connection doesn’t develop, then the therapeutic work is not likely to be effective, so finding a different therapist could be a good idea. Connection is not magic. Instead, let it emerge naturally, like a friendship.
Relationships develop, or they don’t. If you don’t connect with your therapist, this isn’t your fault. We cannot and do not get on with everyone. There are lots of kinds of psychotherapy. Hypnotherapy, cognitive behavioural, and so on. But the relationship with your therapist may matter more than the type of therapy that you do.
2. Good psychotherapy is linked to positive changes in your brain.
All mental processes are preceded by physical events in our brains. The mind is what the brain does. Specifically, the mind is what emerges from physical brain activity, which is similar to how individual ingredients like eggs, flour, and baking powder, mix together to form something greater than the sum of their parts. That is, a cake.
Through the mechanism of emergence, conversations in psychotherapy can change your brain. In fact, many studies have had the good fortune to measure this. Some of the findings are that psychotherapy can lead to brain changes like:
Improved emotional regulation, demonstrated through increased activity in the prefrontal cortex, the brain’s rational control centre, and reduced activity in the amygdala, the brain’s smoke detector and house of fear.
Improved neurotransmitter systems, like serotonin – which is often the target of medications like antidepressants.
Increased brain derived neurotropic factor, a protein that supports the survival of existing neurons and encourages the growth of new neurons and synapses.
Increased grey and white matter, which are associated with enhanced cognitive function, emotional regulation, and neuroplasticity.
Not all psychotherapy is equal; so not all psychotherapy will lead to these changes. But good psychotherapy, one where the client and the patient deeply connect, can change your brain for the better.
3. The talking cure can last a long time.
The talking cure is a good but misleading name. Because people with psychological difficulties, like anxiety and depression, are rarely cured – but they do often learn better ways to cope, view, and live with these difficult emotions. What’s great is that the benefits of talk therapy do not stop when you stop talking (and paying your therapist). Instead, the research suggests that the benefits of good psychotherapy extend far beyond the therapy room, and well into the future.
In particular, the research tends to find that:
75% of people who participate in talk therapy get some benefit.
When therapy ends, individuals who received therapy found that their mental health symptoms improved by 80% more than those who did not receive therapy.
Studies have found that the benefits of talk-therapy can extend up to 10 years in the future.
In good psychotherapy, a person learns something about how their brain and emotions work, about themselves, and about useful strategies that can be employed today or in the future. What works in the therapy room can work outside it, too. That’s why the benefits of good psychotherapy can and do last a long time.
I repeat here: not all psychotherapy is the same, and does not work the same for everybody. Some people have problems that are more difficult to work with than others, and talking therapy is more suited to dealing with some issues than others. Despite these positive findings discussed, it is entirely possible for people to engage with psychotherapy and not find it that helpful.
Education and experimentation are perhaps the two greatest avenues to learn about yourself and how to find out what therapeutic approaches are most likely to be helpful to your specific circumstances. Hypnosis, for instance, can be particularly helpful for reducing stress, anxiety, pain, and IBS, whereas it ,may not be as effective depression, eating disorders, or for PTSD.
General References
Rebuilding the brain with psychotherapy - PMC
Therapeutic Alliance:
Meta-Analytic Evidence:
A comprehensive meta-analysis of 295 studies involving over 30,000 patients found a robust positive correlation between the therapeutic alliance and treatment outcomes across various psychotherapy approaches and patient characteristics1. The overall effect size was significant, indicating that the quality of the alliance is a reliable predictor of positive clinical outcomes.
Consistency Across Modalities:
Studies have shown that the therapeutic alliance is a significant predictor of treatment success across different therapeutic modalities, including cognitive-behavioral therapy (CBT), psychodynamic therapy, and others2. This suggests that the alliance’s impact is not limited to a specific type of therapy but is a general factor contributing to effective treatment.
Patient Engagement and Retention:
The strength of the therapeutic alliance also plays a crucial role in keeping clients engaged in therapy. Clients who feel a strong bond with their therapist are more likely to remain committed to the treatment process, even during challenging phases3.
Specific Research Findings:
Changes to your brain
Functional and Structural Changes:
Studies using functional MRI (fMRI) and positron emission tomography (PET) have shown that psychotherapy can lead to changes in brain activity and structure. For example, cognitive-behavioral therapy (CBT) for depression has been associated with increased activity in the prefrontal cortex and decreased activity in the amygdala, which are areas involved in emotion regulation1.
Gray and White Matter Changes:
Research has indicated that psychotherapy can lead to changes in gray matter volume. For instance, a study found that patients with social anxiety disorder who underwent CBT showed increased gray matter volume in the prefrontal cortex2. Similarly, changes in white matter integrity have been observed, suggesting that psychotherapy can affect the brain’s structural connectivity3.
Neurotransmitter Systems:
Psychotherapy has been shown to influence neurotransmitter systems. For example, a study using PET imaging found that successful psychotherapy for depression was associated with changes in serotonin transporter binding in the brain4. This suggests that psychotherapy can affect the serotonergic system, which is crucial for mood regulation.
Brain-Derived Neurotrophic Factor (BDNF):
BDNF is a protein that supports the survival of existing neurons and encourages the growth of new neurons and synapses. Some studies have shown that psychotherapy can increase BDNF levels, which may contribute to its therapeutic effects5.
Specific Studies
https://www.psychiatry.org/patients-families/psychotherapy
https://psychcentral.com/blog/what-are-the-benefits-of-therapy#:~:text=Improvements%20in%20your%20health,who%20did%20not%20receive%20therapy.