First it marked out a race-course, in a sort of circle, (`the exact shape doesn’t matter,’ it said,) and then all the party were placed along the course, here and there. There was no `One, two, three, and away,’ but they began running when they liked, and left off when they liked, so that it was not easy to know when the race was over. However, when they had been running half an hour or so, and were quite dry again, the Dodo suddenly called out `The race is over!’ and they all crowded round it, panting, and asking, `But who has won?’
This question the Dodo could not answer without a great deal of thought, and it sat for a long time with one finger pressed upon its forehead (the position in which you usually see Shakespeare, in the pictures of him), while the rest waited in silence. At last the Dodo said, `EVERYBODY has won, and all must have prizes.’
`But who is to give the prizes?’ quite a chorus of voices asked.
`Why, SHE, of course,’ said the Dodo, pointing to Alice with one finger; and the whole party at once crowded round her, calling out in a confused way, `Prizes! Prizes!’
(Alice in Wonderland, Lewis Caroll)
The Dodo Bird Verdict postulates that different orientations of therapy (cognitive-behavioral, rational-emotive, etc.) don’t have significantly different outcomes. They’re all winners! They all get prizes! That is to say, it’s less a matter of which kind of therapist you go to…and more a matter of what kind of relationship you develop with them. Are you comfortable disclosing? Do you feel that they’re invested in your success? Do you feel like you’re being patronized or led in circles? Strong therapist-client bonds matter.
[Sidenote: the studies and analyses I’m going to run through didn’t examine therapeutic outcomes in children or in those with psychotic features as part of their disorder.]
[Second sidenote: psychotic and psychosis are specific scientific terminology, and not adjectives for people who do weird and/or disagreeable things. Also, having psychotic features does not necessarily equal having schizophrenia. /rant]
Luborsky, Rosenthal, et al. do a really fascinating meta-analysis of seventeen meta-analyses (a Meta-Meta-Analysis?). In essence, when research corrects for the allegiance of the therapist (who may prefer on type of treatment to another), there are small, non-significant differences between treatments across patient types. Really, I’d suggest reading that study in its entirety (it’s freely available!).
The point is one I’ve tried to make before, albeit with fewer citations: If you are able to go to therapy, how you feel about your therapist matters. Ask questions! Conversely, if you feel like your counselor just isn’t getting it, it’s not necessarily because therapy doesn’t work. It’s not even necessarily because your therapist’s orientation is wrong. You may not find them to be empathetic, or to fit your personality. In fact, one of the tangets of the Luborsky article presents evidence that while across patients, outcomes in different therapeutic orientations are different in non-significant ways, there is research to suggest that pairing subgroups, such as temperament and personality types with specific types of therapy may account for slightly better outcomes.
That is to say, if you want to be given concrete direction in your life, you might develop a better client-therapist bond in a type of therapy where the counselor is viewed as the expert or teacher for the client. As someone who studies psych services and likes to draw their own conclusions, I prefer therapy with a ‘team’ structure; the therapist and I are both working together to fix things. Current research suggests that if you and I switched therapists, we’d both do better than if we didn’t attend therapy at all, but we might be more frustrated and less fully involved in the process.
So. Go read that article!