As an attorney referring your client to therapy, or a judge considering ordering therapy, you may wonder if the client will really benefit from psychotherapy. Does psychotherapy work? If so, why does it work? How much can a person really change? And how does being ordered into therapy versus choosing it change the likelihood of change?
Does psychotherapy work? Empirical research has consistently shown that therapy is effective. That is, people who completed therapy sessions reported better outcomes than control groups who did not. Better outcomes are typically defined as feeling better, thinking more clearly, improved interpersonal relationships, and/or improved behaviors (reported by the client and others).
Why does psychotherapy work? Psychotherapy literally changes the way the neurons in the brain are interconnected, as evidenced by brain scans of clients before and after therapy. These changed connections basically represent learning, so simply stated therapy works because the client learns during the process. Depending on the problem, they may learn to think differently about some things, to feel differently, to relate to others differently, and/or to behave differently.
What is the process? How does this learning and improvement occur? In therapy, people improve through dedicating time to an active learning process that occurs through the relationship with their therapist. In their busy life, they set aside just one hour a week to focus on self, alleviating their problems, and self-improvement. Their therapist acts as a guide, investigator, tutor, coach, and supporter to help them achieve your goals.
Personality change: There is much controversy about how our personality is formed. Some psychologists believe it is formed in early childhood and remains stable through adulthood. Others would argue it is prone to change over time. Recently, personality psychologists have taken a more middle-of-the-road view… if personality traits change, it is slowly and somewhat limited. However, an article published in the Psychological Bulletin disputes those old ideas. A team of six researchers analyzed 207 studies on personality-trait changes and discovered that, with a therapist’s help, personality can and does change, a lot and usually within the first month of therapy. The trait identified through this research to be the most effected by therapy is neuroticism. Individuals with this trait are more likely to be moody and to experience such feelings as anxiety, anger, envy, guild, depressed mood and loneliness. Interestingly, a person’s gender or age or type of therapy did not seem to affect the outcome.
Does ‘forced’ therapy work? Research has shown ‘forced’ therapy, such as when ordered by a judge or required by a boss or parent, also tends to lead to at least some behavior change; so while this change may be slower than people who choose therapy, it appears once in therapy some positive changes often take place. Individuals involved in the legal system may find themselves being court ordered to go to therapy. Some reasons may include drug abuse, anger management, or parenting issues. A common question when it comes to court ordered therapy is: Is therapy effective if someone is being ordered or “forced” to go? Typically, if someone chooses to go to therapy (“choice therapy”) he or she is already starting with some internal motivation or reasons to get help and change. But what about someone who never would have chosen to go to therapy? The research shows that court ordered therapy is actually just as effective as choice therapy. Individuals court ordered to therapy tend to have higher attendance rates and remain in treatment longer. Of course, we can attribute some of that to the fact they are required to attend a certain number of sessions and they may have legal pressure to attend, but they still have a choice to either go through the motions, or actually learn and change.
So, what makes court ordered therapy the most effective so the person does learn and change? Receiving the proper type of therapy for what the individual needs. If the appropriate treatment is received for the necessary length of time, mandatory treatment can be just as successful as treatment when it is voluntarily sought. For example, there are many different types of substance abuse treatments and depending on severity of the abuse/addiction, additional mental health diagnoses, and other factors, certain treatment programs may not be the best fit, even for someone choosing to receive treatment. Finding the appropriate treatment for an individual is key for successful court ordered therapy. It turns out it is not whether therapy was by choice or not that determines effectiveness, but is whether the correct type of therapy is provided for the person’s presenting issues. To best determine what type of therapy could likely help your clients, consulting with a psychologist can be helpful. A brief description of the case should allow the clinician to provide some suggestions for proper therapeutic intervention.
In summary: Researchers continue to question as to whether real changes actually occur in the personality trait, i.e. neuroticism, or if therapists are able to help clients return to their “normal” before conditions such as depression or anxiety became an issue. But regardless of the underlying mechanism or process, the good news is there is research to support the idea that, with the help of a therapist, personality and behavior change is possible, for both people who choose to attend therapy, and those who are required to go.
