||The examples and perspective in this article may not represent a worldwide view of the subject. (November 2010)|
Talking therapies is the generic name for the range of psychotherapies and is a derivative of the talking cure. Although less related to one therapy alone, it is a term that does cover psychoanalysis, cognitive behavioural therapy, and counseling or counseling psychology approaches.
In the UK
Since the mid-1990s, under increasing financial pressures that emphasize functioning over quality-of-life, the UK has started to follow the United States example of manualising approaches to therapy, as some therapeutic approaches are claimed to have been "proven" to be significantly more "effective" than others. This is often claimed to be especially true of Cognitive Behavioral Therapy (CBT). However, virtually no comparisons of different psychotherapies with long follow-up times have been done. The Helsinki Psychotherapy Study is a randomized clinical trial, in which patients were monitored for 10 years after the onset of short-term (6 months) psychodynamic or solution-focused, or long-term (3 years) psychodynamic study treatments. The effectiveness, suitability and sufficiency of the therapies were compared also with that of psychoanalysis (5 years), within a quasi-experimental design. The assessments were completed at the baseline and 14 times thereafter during the follow-up. The results of the 3- and 5-year follow-up indicate that the length of therapy is important when predicting the outcome of therapy. Patients in the two short-term therapies improved faster, but in the long run long-term psychotherapy and psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability for different psychotherapies. Follow-up evaluations of this study will continue up to 2014.
Therapy by disorder
In the UK, there have been extensive reviews of research, which has led to specific ways of working with specific problems. Because the development of protocols is sometimes misunderstood as a prescription of solution, some individuals object to this approach. However, the advantages of this method have been stated elsewhere, and it is commonly used in the treatment of mental health problems. Finagy and Roth's opinion is that the benefits of the evidence based approach outweighs the difficulties in the categories used.
Although the relationship in therapy is often considered to be generally beneficial, specific therapies have been tested for use against specific disorders.
In the UK reviews of evidence have shown that CBT has a great deal of evidence to support its use. The National Institute for Health and Clinical Excellence has developed and recommended clear guidelines for a number of conditions. These include the treatment of anxiety disorders, depression, Post-traumatic stress disorder, and bipolar disorder, as well as the less ‘diagnosable’ problems, all of which advocate the use of CBT.
The strength of the evidence has led its substantial roll out under the Improving Access to Psychological Therapies initiative, which aims to effectively put in place therapists to delivery the above NICE guidelines. Parallel to this initiative, more detailed clinical guidelines and competencies for CBT have been produced, as well as for the other therapies with good evidence.
The weight of evidence for CBT has had an effect of shift to clients wanting CBT has also been seen in private organisations. The National Health Service, in the UK, and private specialists around the world provide a range of talking therapies.
- What works for whom?: a critical review of psychotherapy research.
- Härkänen, T.; Knekt, P.; Virtala, E.; Lindfors, O. (2005). "A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements". Statistics in Medicine 24 (24): 3773–87. doi:10.1002/sim.2409. PMID 16320283.
- "Helsinki Psychotherapy Study". National Institute for Health and Welfare (Finland).
- Roth A., and Fonagy P. (2005) What Works for Whom: A critical review of psychotherapy research. Second Edition. The Guildford Press
- Norcross, J.C. ( Ed.). (2002). Psychotherapy relationships that work. OUP.