Welcome to the archived web site of
Will Joel Friedman, Ph.D. Psychologist (1950-2013)
California License No. PSY 10092
Specializing in Presence-Centered Therapy
balancing mind and heart, body and spirit
Now in memoriam - This website is no longer being updated
Articles by Dr. Friedman (except where noted otherwise)
on the Effectiveness of Therapy
by Will Joel Friedman, Ph.D.
In 1979, the Federal Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) published a summary of 28 studies that had investigated the issue of psychotherapy and somatization. This research, which we had initiated 20 years before with our work at Kaiser-Permanente, consistently showed that psychotherapy reduced the use of medical services for somatizers and that the decrease in medical care was usually enoughoften more than enoughto pay for the cost of the therapy...By now, more than 80 studies have looked at somatizing patients in various medical settings and geographical regions. The findings consistently show the benefits of psychotherapy in reducing these patients' stress, the physical symptoms it triggers, and the frequency of visits to physicians.
(Nicholas A. Cummings, Ph.D. Somatization: when physical Symptoms Have No Medical Cause, in MindBody Medicine, Daniel Goleman, Ph.D. and Joel Gurin, Eds., Consumer Reports Books, Consumer Union: Yonkers, New York, 1993, 221-230, citation: 226-227).
A well-known study examined a group of Blue Cross/Blue Shield patients with four common chronic diseases [airflow limitation disease (a group of illnesses including asthma and emphysema), diabetes, coronary heart disease, and high blood pressure] underwent some form of psychotherapy and were compared with a control group with similar diagnoses. Three years after receiving their medical diagnoses, patients who had undergone 7 to 20 mental health treatment visits had lower medical charges than those who did not have psychological treatment. The total charges for the first group (including expenses incurred for psychotherapy and counseling) were $309 lower than for the other group.
H.J.; Mumford, E; Glass, G.V.; et al. Mental Health Treatment and Medical
Care Utilization in a Fee-for-Service System: Outpatient Mental Health Treatment
Following the Onset of a Chronic Disease. American Journal of Public
Health, 73, 1983; 422-429).
A review of 13 studies that used post-surgery or post-heart attack hospital days as outcome indicators showed that intervention in the form of psychological preparation reduced hospitalization by 2.4 days on the average.
E.; Schlesinger, H.J.; and Glass, G.V., The Effect of Psychological Intervention
On Recovery From Surgery and Heart Attacks: A Review of the Literature,
American Journal of Public Health, 72, 1982, 141-151.)
Two studies support how combining medical therapy with brief psychotherapy is superior to medical treatment alone for Irritable Bowel Syndrome. In both psychotherapy was focused on identifying stressors that worsened the patient's symptoms and teaching the patient more effective ways of coping. The symptoms that improved most were pain and diarrhea with constipation being relatively unresponsive. In each study, 12 months after therapy, most patients who received the combined treatments still had fewer symptoms than before. This suggests that the initial improvement was not due to a desire to please the therapist or to the placebo effect.
by William E. Whitehead, Ph.D., Gut Feelings: Stress and the GI Tract,
in MindBody Medicine, Daniel Goleman, Ph.D. and Joel Gurin, Eds., Consumer
Reports Books, Consumer Union: Yonkers, New York, 1993, 161-175, citation: 171).
A published large-scale study by Consumer Reports (November 1995) concluded that clients benefited "very substantially" from psychotherapy. Further, long-term treatment did "considerably better" than short-term treatment. Psychotherapy alone did not differ significantly in effectiveness from medication along with psychotherapy. No specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness; and all these professionals did better than long-term family doctors and marriage counselors. clients whose length of therapy or choice of therapist was curtailed by insurance or managed care did worse. (Adapted from abstract)
E. P. Seligman, University of Pennsylvania, "The Effectiveness of Psychotherapy:
The Consumer Reports Study." American Psychologist, December 1995, Vol.
50, No. 12, pages 965-974.)
Research results released in November 2009 by the University of Warwick and the University of of Manchester found that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money. Reseachers compared large data sets where 1000s of people had reported on their well-being and at how well-being changed due to therapy in regard to getting sudden increases in income. They found that a 4 month course of psychological therapy had a large effect on well-being and showed that the costs of the therapy would take a pay increase of 32 times that amount to achieve an equivalent increase in well-being. So this research demonstrated that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money. Chris Boyce, the lead researcher on the article, states, "Often the importance of money for improving our well-being and bringing greater happiness is vastly over-valued in our societies. The benefits of having good mental health, on the other hand, are often not fully appreciated and people do not realise the powerful effect that psychological therapy, such as non-directive counselling, can have on improving our well-being."
et al. Money or mental health: the cost of alleviating psychological distress
with monetary compensation versus psychological therapy. Health Economics Policy
and Law, 2009.]
Psychotherapy reduces repeat ER trips---Emergency room "intensive, short-term dynamic psychotherapy" by a staff psychologist provided relief to three out of four patients whose physical symptoms have no medical explanation: Research published in November 2009 and released in January 2010 by the Canadian Broadcasting Corporation addressed patients arriving at the emergency department of a Health Sciences Centre in Halifax with chest pain that doctors could find no physical reason for it after a barrage of tests. In an average treatment course of 3.8 sessions, in which the person recognized the link between their physical symptoms and their stress or emotions, resulted in a 69 per cent drop in repeat visits to the emergency room and hospital visits dropped from an average of almost 4.6 visits a year to 1.4 visits a year. An 80 per cent drop in panic attacks resulted from a single interview in many cases. Dr. Allan Abbass, director for the Centre, said that for every 100 people seen by the staff psychologist, there will be 300 fewer emergency visits a year, which adds up to a huge savings and reduction in unnecessary tests. Also patients reporting a high degree of satisfaction.
Abbass, M.D., et al, Canadian Journal of Emergency Medicine, 2009; 11 (6):
529-534. "Intensive short-term dynamic psychotherapy to reduce rates of emergency
department return visits for patients with medically unexplained symptoms: preliminary
evidence from a pre-post intervention study"]
A meta-analysis of 23 previously published studies on the efficacy of psychodynamic therapy published in the October 2008 issue of the Journal of the American Medical Association (JAMA) showed that it can be a very effective therapeutic technique, especially in complex cases, such as those involving a personality disorder.
F. & Rabung, S. (2008). Effectiveness of Long-term Psychodynamic Psychotherapy:
A Meta-analysis. JAMA, 300 (13), 1551-1565.]
The February--March 2010 issue of American Psychologist contains the article "The Efficacy of Psychodynamic Psychotherapy by Jonathan Shedler. The abstract reads: Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist
65 (2), 98-109.]
Arehart-Treichel, "Evidence is in: Psychotherapy Changes the Brain." Psychiatric
News, 36 (13), July 6, 2001. Full article available at pn.psychiatryonline.org/cgi/content/full/36/13/33)
A New York Times article reviews current research findings that psychotherapy, like drugs, can change brain chemistry.
A. Friedman, M.D., "BEHAVIOR; Like Drugs, Talk Therapy Can Change Brain Chemistry."
The New York Times, August 27, 2002. Full article available at www.nytimes.com/2002/08/27/health/behavior-like-drugs-talk-therapy-can-change-brain-chemistry.html)
A research-based professional review article details how "words change the brain." Drawing upon neurobiology, evidence is presented for how psychotherapy alters brain function and structure.
Kranzberg, "Words Change the Brain." Originally published in the December 2000/January
2001 issue of The Group Circle. Full article with references available
A peer-reviewed article explored how brain studies reveal the mechanisms by which psychotherapy works and how it alters brain structures and chemistry in the context of psychotherapy effectiveness. For example, one researcher (Ari Zaretsky, M.D.) presents evidence that various forms of psychotherapy can alter brain processes with different types of psychiatric disorders in a similar way that antidepressants do. Positron emission tomography (PET) scans of people with obsessive-compulsive disorder (OCD) before and after a brief period of behavior therapy also revealed changes to brain metabolic activity. Another researcher (Jacques Barber, Ph.D.) noted that there is relatively strong evidence indicating that "more-intensive treatment often leads to better outcomes than does less-intensive treatment."
(Eve Bender, "Brain Data Reveal Why
Psychotherapy Works." Psychiatric News, 39 (9), May 7, 2004. Full article
available at pn.psychiatryonline.org/cgi/content/full/39/9/34)
A peer-reviewed article summarizing in part research on the effectiveness of psychological therapy cites studies that support three findings:
(Cited by Gabriel S. Dichter, Jennifer N. Felder and Moria Smoski in "Effects of Psychotherapy on Brain Function: Brain Imaging Studies Indicate Changes." Psychiatric Times, 25 (10), September 1, 2008. Full article with references available at http://www.psychiatrictimes.com/vol-27-no-7
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