Charles Thomas: Does counseling work?

According to the CDC, more than half of Americans will be diagnosed with a mental health condition at some point in their lives, and more than 25% of us are suffering from a diagnosable mental health condition in any given year. Mental health problems are as prevalent as the common cold, but sadly they are often much more debilitating.

While there’s never been much of a question about whether mental health care is needed in our country, the pandemic has opened up the eyes of many of us to just how important this kind of healthcare really is.

But in spite of this, many barriers to care still exist: lack of insurance coverage, waiting lists, lack of providers, and perhaps the most sinister limitation of all, skepticism about treatment, especially skepticism about the effectiveness of counseling. I’ve met more than a few people in my life who believe counseling and psychotherapy are nothing more than a big pile of steaming horse shit.

And honestly, I understand why some people feel that way.

For one, there’s the problem of bad therapists. Unfortunately, bad counseling practitioners do exist, and if you see one, it will likely sour you on therapy in general. It’s the same with bad dentists or bad doctors. Those few bad apples scare people away from getting the care they need, and the bad therapists often lead people to believe that counseling is all bunk. 

But if you can find a good counselor who is well trained, patient, and compassionate, is there any hard evidence that counseling actually helps people?

The answer to that question is a resounding yes. The effectiveness of counseling has been extensively studied for decades and the results are clear: counseling improves psychological wellbeing in a majority of people who participate in it, regardless of the letters behind the therapist’s name or the duration of the treatment. In fact, in my experience practicing counseling, I’ve found that most people experience notable improvement within four or five sessions. 

Does that mean people are “cured” after four or five sessions? Unfortunately, it does not. But it does mean that most people have experienced some improvement within that timeframe, which is a really big deal if you are suffering from severe depression.

Of course, that begs the question, what it is about counseling that makes it effective? That’s an issue that has been heavily researched as well. Many studies have looked at this question over the years, and the general consensus is that the “purposeful collaborative relationship” in counseling seems to be the biggest factor in helping people feel better. 

And if you think about it, it makes a lot of sense. When you’re working with a therapist, you have a confidential place to talk about difficult issues. The person you’re working with is a trained listener who knows how to help you understand the problems that led you to seek treatment in a different way. I also think the practice of setting aside regular time to address whatever problem is causing you emotional pain can be extremely helpful in reducing that pain. People in therapy are actively engaging problems instead of just hoping things will improve on their own. 

When I started my private practice in 2018, I decided I was going to make measuring change a priority. There were a couple reasons I decided to do that. First, I thought it would be helpful for my clients to have real data that showed they were improving. While most psychotherapy clients report they feel better during treatment, I thought it would be powerful if I could present my clients with actual numbers that proved it. Second, I thought that measuring how my clients were doing would give me important information that would help make me a better therapist.

Recently, I completed an outcomes study of my own that looked at the question of whether the counseling I provide actually works. While my study is not rigorous enough for an academic journal, it did show the same thing all those better designed studies have shown over the years. 

Counseling does work. 

My study included pre and post tests from my clients for every year between 2018 through 2022. It showed my clients reported a 26.5% increase in their psychological health during their time in counseling, and a 22.9% increase in their peace of mind. It also revealed to me I might need to spend more time helping my clients manage their most important relationships because improvement in that area was only 6%. 

I understand why people ask if counseling works. It’s a fair question to pose if you’re considering committing time and money to working with a therapist.

But all the data, from the big research studies to my little homegrown study, all seem to say the same thing: counseling does work, and we have the numbers to prove it. 

Charles D. Thomas is a writer, psychotherapist, and Main Street Media Group board member who made Three Rivers his home for over a decade. Feedback is welcome at [email protected]

Any views or opinions expressed in “Big World, Small Town” are those of the author and do not necessarily reflect the views or opinions of the Watershed Voice staff or its board of directors.