7 - Psychotherapy: placebo effect or meaning response?

Summary

In the next two chapters, I will look closely at two areas where meaning is particularly effective: psychotherapy and physical pain.

Everyone has won and all must have prizes

Psychotherapy is a complex and contested business. Few doubt its effects, but many (at least many outside the field) are unsure of how to think about its effectiveness. Indeed, some have argued that psychotherapy is “only” the placebo effect. I will argue that this is good reason both to stop using the concept of the placebo effect in such a way, and to start thinking about the meaning response.

How does psychotherapy work? The simple answer is, “No one knows” (Dawes 1994:61-2). This is quite surprising and seems at variance with experience. Anyone who has ever peeked behind the surface of any sort of psychotherapy knows that practitioners have very strong views of how and why their practice works. Don't psychoanalysts know how their therapy works? Surely the behaviorists know what they are about and how things work. Of course they do, in some sense. But the problem is that both of these systems work, they seem to work more or less equally well, and they work equally well for the same sorts of problems.

There are huge differences in the attitudes, approaches, and theories underlying the different therapeutic schools - Freudian psychoanalysis and Skinnerian behavior therapy are about as different as one might imagine two approaches could possibly be when addressing, say, compulsive hand washing.