When going to the psychologist does not work: are all therapies effective?

Is there a therapy for each patient? And a professional for each patient? Are there more valid therapies or therapists? Is it convenient to change treatment or psychologist when the patient feels that he is not progressing? What is the right treatment?

“When a therapy is not going well, it may be due to a training problem or lack of updating of the psychologist, due to a poorly chosen therapy, due to the lack of connection between the patient and the psychologist… The latter is what we call therapeutic alliance”, says Pablo Vallejo, professor of Psychology and Educational Sciences at the UOC.

Resorting to psychological therapy is a particularly common occurrence. As reflected in the scientific report on mental health published by the World Health Organization (WHO), a significant increase in mental health problems was observed throughout the world during the first year of the pandemic: cases of depression increased by 27.6% and anxiety, by 25.6%.

A survey of the American Psychological Association (APA), carried out among professionals in the United States and published in 2021, shows that this increase is directly reflected in the number of people who go to therapy. Many of these professionals (up to 96%) resorted to online assistance, a system that has proliferated during 2020 and 2021 and is perceived positively.

However, the exhaustion derived from having more patients is also reflected: almost half of the professionals indicated that they felt exhausted, and three out of ten acknowledged that they had seen more patients since the start of the pandemic. Beyond the influence that the increase in patients or the exhaustion of professionals may have on the success of a treatment, Vallejo points out six factors that must be taken into account:

For as long as psychology has existed as a discipline, there have been different generations of therapies, or, as Vallejo defines it, different “major moments in psychological therapy.” The oldest are psychodynamic or psychoanalytic. A little later the evolutions of psychoanalysis appear, in addition to the so-called second generation therapies, among which cognitive-behavioral therapy, systemic or Gestalt stand out. Already reaching the present, the third generation is dominated by behavioral-contextual therapies, among which acceptance and commitment therapy (ACT) or mindfulness predominate. Finally, there are the fourth-generation therapies, focused on the central processes, that is, on “trying to find the origin of the discomfort and acting with all the artillery available to psychologists,” says the professor.

In parallel, previous therapies, such as the second generation, “have also evolved, so that they are presented as more modern alternatives and with more empirical evidence.

The therapist must choose all the tools. “There are therapies that are more or less suitable for different processes”, comments Pablo Vallejo. “We began to personalize treatment based on the biopsychosocial characteristics of our patients,” he adds. In this context, the expert points out that “many of these advances will come to us thanks to artificial intelligence”, as a new tool that will be incorporated into therapies. A recent example is the pioneering trial that the UOC and the UB are carrying out, with the application of virtual reality in the therapies of a group of young people with depression.

“There is a popular saying that says, when a doctor does something wrong, it is the fault of that doctor, who knows nothing; However, when it is a psychologist who is wrong, it is psychology in general that is useless”, Vallejo comments. In addition, the visibility of mental problems has helped put aside this myth. “The idea that the psychologist is only for the crazy is already undone, and almost all of us know someone close to them who has gone to the psychologist,” says the expert.

If psychological therapy is becoming more common, how do we have to act if the treatment does not seem adequate? “There are multiple reasons for which therapy can go wrong,” explains the professor. “No professional is 100 percent successful. The best thing that the patient can do is to identify which are the factors of the therapy that they have not liked and look for a new professional who places more emphasis on those aspects”, concludes Vallejo.

This article was originally published on RAC1.