What is it about?
This study uses data from a meta-analysis of youth psychotherapy during the past 50 years. It simulates the "maximum" (99.9th percentile) of therapy quality, and estimates that therapy's effectiveness. Results suggest that even at maximum quality, psychotherapy can only do so much. This makes some intuitive sense, given that psychotherapy typically involves 1-2 hours out of 110+ waking hours a week.
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Why is it important?
A great deal of time, money, and research expertise has gone into creating high-quality therapies. Much was well spent—we now have empirically supported treatments for a variety of mental illnesses. However, it now may be time to change our priorities. Our analyses indicate that expending additional effort to improve the quality of therapy as currently structured may offer diminishing returns in terms of the efficacy we are able to produce. Expanding effort on other priority areas may provide benefits that have not yet been maximized. Of course, there is no guarantee that alternative areas of exploration will yield greater benefits; they may have equally prohibitive limitations. Still, they likely merit further exploration. Examples might include (a) dissemination of existing empirically supported psychotherapies to expand the number of lives impacted, (b) alternative modes of psychotherapy delivery that may outperform current models, (c) greater focus on understudied indicators of psychotherapy quality that have shown relatively stronger association with outcome than most indicators (e.g., facilitative interpersonal skills training for therapists), and (d) complementing therapy with strategies that address personal and environmental factors that influence outcome (e.g., expert case management to help clients address real-life events and challenges that stand in the way of good adjustment and functioning).
Perspectives
This project started in Dr. John Weisz's "psychotherapy research" graduate course. He showed his research that youth psychotherapy hasn't really improved over the past decades. One possibility, he offered, was that we have already nearly reached the "upper limit" of effectiveness that can be achieved with traditional psychotherapy. That is, there are a lot of factors that influence mental illness. Some of these factors are incredibly hard to change. A couple hours a week of talking to a person can presumably only do so much. Improving the quality of psychotherapy may only go so far. We used meta-analytic data to create a model incorporating psychotherapy quality (things the therapist controls that may make therapy better) and psychotherapy outcome (actual improvement in the pt). We then set the model to 99.9% quality. The outcomes are...disappointing. The projected effect size is g = 0.87. That's not bad, but it's not stellar either. So what is the takeaway? Well, it seems investing millions of dollars into (only) Package 1 vs. Package 2 psychotherapy trials might yield diminishing returns. Clinical scientists might consider expending more effort into understudied areas like (1) dissemination of existing EBTs (2) scalable interventions (3) understudied aspects of therapy "quality" (like therapist interpersonal skill) (4) addressing real-life challenges. There are also conclusions that do not follow. The study does not show that psychotherapy is ineffective or that it is inferior to other options. Psychotherapy is incredibly effective for certain problems (e.g., panic). It does not predict the future. It is based on existing data, so it cannot predict someone coming up with some entirely new and amazing technique that no one has thought of before. But overall, it seems we are reaching a tipping point when it comes to treating mental illness. The moment may have arrived where we must change our existing strategies if we want to avoid ever-diminishing returns.
Payton Jones
Harvard University
Read the Original
This page is a summary of: An Upper Limit to Youth Psychotherapy Benefit? A Meta-Analytic Copula Approach to Psychotherapy Outcomes, Clinical Psychological Science, August 2019, SAGE Publications,
DOI: 10.1177/2167702619858424.
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