The worst blow to fall on the shoulders of psychotherapists was dealt by placebo studies. Experiments were designed that would _convince_ a group of emotionally troubled clients that taking a pink pill (in reality, a sugar-filled placebo) would reduce their symptoms. In fact, their symptoms were, in general, reduced, and often by as much as treatment in formal psychotherapy. This fact has been interpreted by most therapists to mean that psychotherapy must therefore have been ineffective. If a pink and useless pill could equal the effects of therapy, then therapy was equally useless. But this involved a huge oversight and a mistake in logic. The therapy _did_ work, _as did_ the placebo. But why? The placebo effect has become increasingly interesting to psychological as well as medical researchers. Apparently, a client's or patient's strong _belief_ in the therapeutic value of a process sometimes has a measurable influence on his future health. The way belief can act in this way is not necessarily mysterious or mystical. If we are prepared to see emotional difficulties in terms of demoralization, then belief in therapeutic effectiveness is the most clear-cut counterbalancing force. Strong belief of this kind may be enough--_if_ the client really wishes to change and _if_ the therapist and the approach to therapy together can inspire the client's confidence in his own ability to regain control of his life--to help the client begin to lift himself by the bootstraps. Just what the necessary ingredients are to make this possible is not yet definitely known. Some approaches to therapy, however, seem to be more successful than others in inspiring confidence in clients with certain personality traits and with certain goals or problems. The best evidence for this comes from clients themselves, whose evaluations {273} of their own experiences in therapy we will look at in a moment. The second blow that fell on psychotherapy came from the spontaneous remission critics. Again, studies demonstrated certain facts: * How long it takes for spontaneous remission to occur depends greatly on what sorts of emotional difficulties clients have. People with depressive or anxiety reactions tend, for example, to have spontaneous remissions faster than persons with obsessive-compulsive or hypochondriacal symptoms. * The percentages of clients who do experience spontaneous remissions are related to the period of time a study uses as a basis. (The follow-up periods of different studies vary a great deal, from months to many years. As one researcher commented, "It is doubtful whether life can guarantee five years of stability to any person."[12]) [12] Eisenbud, quoted in H. H. Mosak, "Problems in the Definition and Measurement of Success in Psychotherapy," in Werner Wolff and Joseph A. Precker, eds., _Success in Psychotherapy_ (New York: Grime & Stratton, 1952), p. 13.