What Makes Therapy Work?

! Earlier this year I stumbled across a thoughtful article

appearing in The New York Times written by a professor of
psychiatry at Weill Cornell Medical College in Manhattan.  Dr.
Richard Friedman's piece entitled "When Self-Knowledge Is Only
the Beginning" got me thinking: What makes therapy work? 

! In the article Dr. Friedman discusses the case of a young

man in his 30s who came to him feeling sad and anxious due to a
breakup with his girlfriend.  Through therapy this man had
traced his feelings of anxiety and sadness back to an earlier
trauma of being separated from his mother at the age of 4.  All
of this sounds probable enough, however, what use is such self-
awareness if it fails to alleviate this man's psychological
distress?  I'm reminded of what my own clients sometimes say
after arriving at their own meaningful insights during therapy:
"Well, that's great, but what do I do about it?

! I practice a form of psychotherapy derived from Freudian

psychoanalysis and work on helping my clients become self-aware
and insightful about their internal lives.  Such an approach to
therapy is in keeping with the Socratic mantra that "The
unexamined life is not worth living."  However, as much as I
would like to believe this, my clinical experience has also
taught me that insight only gets you so far. It is what you do
with that insight that really determines whether you are able to
live a healthier and happier existence.

! Freud believed that the key to curing neuroses lay within

the unconscious.  Through careful examination of his patients'
unconscious processes, Freud believed he could relieve their
suffering. From personal experience, however, I can tell you
that such palliative effects rarely follow directly from
insight, no matter how profound. We all need encouragement, if
not guidance, in translating our own personal insights into
concrete behavioral changes.  This is where therapy becomes more
of an art form than a hard science.

! Researchers such as the late Lester Luborsky, Ph.D. (2002)

have shown that when different types of therapies are compared
to one another, there really isn't much difference in outcome.
These researchers have focused instead on the common factor of
the strength of the therapeutic alliance.  This is in keeping
with what I have seen in my own practice. It is the relationship

ⓒ Tyger Latham, Psy.D.

between patient and therapist and the insight derived there from
that ultimately brings about true change.

About Dr. Tyger Latham

Dr. Tyger Latham is a clinical psychologist with a private practice in

Washington, DC. He frequently works with individuals struggling with
issues surrounding trauma, sexuality, and gender. He also counsels
couples and helps them address issues related to differing styles of
communication, sexual problems, and navigating work and family. He
maintains a weekly blog entitled “Therapy Matters,” where he enjoys
reflecting on his work as a psychotherapist. You can visit his blog
at www.psychologytoday.com/blog/therapy-matters or his website at
www.DupontTherapy.com.

ⓒ Tyger Latham, Psy.D.