Whether or not therapy works is a question that has hounded psychotherapists for more than thirty years, when evaluative studies began to cast doubts on its effectiveness. Since then, several hundred studies of the effectiveness of psychotherapy have been made. Some of them appear to show that psychotherapy is highly successful, and many have pointed to evidence that psychotherapy is no more effective than no treatment at all. The ambiguity about this issue has been very troublesome to therapists and tends not to be openly discussed with clients, for obvious reasons. Why reports about psychotherapy's effectiveness have been so contradictory and ambiguous has never been made clear. But understanding the reasons behind these opposing claims will give us a basis for optimism. CLAIMS AGAINST THE EFFECTIVENESS OF PSYCHOTHERAPY If people who are emotionally troubled "get well" through psychotherapy in about the same length of time as those who are not given any treatment at all, we would be inclined to say that {268} psychotherapy didn't help. Several studies have shown that the majority of people with "neurotic disorders" improve spontaneously, on the average, in one to two years.[1] When people with similar problems _are_ treated with psychotherapy, the outcome is virtually the same: the spontaneous remission rate for all practical purposes is the same as the rate of success due to therapy. Psychotherapy doesn't seem to make a difference. We'll call this the _spontaneous remission criticism_ and will come back to it in a moment. [1] S. Rachman, _The Effects of Psychotherapy_ (New York: Pergamon Press, 1971) p. 18. Most studies of the effectiveness of psychotherapy make use of "placebo treatments": a group of emotionally troubled individuals is treated with one of the major approaches to psychotherapy by well-trained therapists, and another group of similarly troubled people is treated by untrained "therapists" who offer their clients a "therapy" that is simply _made up_ but is carefully presented so as to be believable. And, again, it turns out that clients treated with the legitimate therapy improve, but not significantly more than those in the placebo group. We'll call this the _placebo criticism_ and will come back to it, too, in a moment. A few studies have shown that psychotherapy can actually be _injurious_ to clients. A disorder _brought about_ by medical treatment is called an _iatrogenic disturbance_. _Iatrogenesis_ is the Greek word for "brought about by doctors." If the iatrogenesis criticism is valid, then therapy may be not only ineffective but sometimes actually _harmful_.[2] [2] See, for example, Thomas J. Nardi, "Psychotherapy: Cui Bono?," in Jusuf Hariman, ed., _Does Psychotherapy Really Help People?_ (Springfield, IL: Charles C. Thomas, 1984), pp. 154-164.