For Better or for Worse? Psychotherapy and Variance Change: A Critical Review of the Literature

It has been suggested that psychotherapy makes some persons better and some worse, and that this might explain why investigators have failed to demonstrate overall improvement by comparison with a control group.Other studies have inferred that this variance in psychotherapy outcome is related to therapist levels of empathy, warmth and genuineness.In a critical survey of the evidence, the experimental studies cited in support are reviewed separately. The review indicates that, with the exception of one study of which the findings were equivocal, the conclusion that psychotherapy may induce a mixture of improvement and deterioration rests upon a flimsy and poorly controlled or weakly documented base. Although it is important to realize that psychotherapy, like any other treatment, may have adverse effects, there is no convincing evidence that, in situations where psychotherapy is on the average ineffective, there is greater outcomevariation than in a control group.