Does Therapy Really Work? Consider the DoDo Bird Effect


Recently, the New York Times ran a series of insightful stories in its Sunday Magazine section, in honor of Mental Health Awareness Month.  Among the varied features on stigma reduction, emerging techniques, psychedelics, somatic therapies, and more, was a centerpiece article looking at the history of clinical research over the past 50+ years, and asking the question distilled in its title: Does Therapy Really Work?

The author—not a therapist herself but a longtime therapy client—reviewed scores of past and current studies, meta-analyses, and landmark publications; interviewed researchers, professors, therapists and clients, and kept encountering the same refrain: The benefits of talk therapy are hard to quantify, but nearly everyone agrees these benefits are significant, and very real.  The problem of course is that, even using sound research design, standard psychometric testing measures, and statistics, outcomes are subjective, and human variables too fluid to define.  Going to therapy is not the same as taking a pill.  Therapy “works if you work it,” but what that means is different for every client.  Freud himself—a neurologist by training—was famously skeptical of the ability of science to validate his “talking cure.”

Since the late 1980s—starting with the landmark SMILE studies at Duke University, which compared Sertraline to daily aerobic exercise as treatments for depression—research has been trending in support of the idea that talk therapy, medication and physical exercise are all equally important to improving mental health.  Driven largely by insurance payers, there has also been a shift toward “evidence-based treatment,” i.e. methodologies such as Cognitive Behavioral Therapy (CBT), now viewed as more “objective” and measurable than traditional psychoanalysis.  Somatic, or body-based, therapies have also enjoyed increased recognition, as a result of these research trends.

While there is some evidence that certain methods may be more effective than others for specific disorders, there is another idea that runs among all these studies like a common thread.  This idea is referred to as “The DoDo Bird Effect.”   Coined by psychologist Saul Rozensweig back in 1936, the term refers to the DoDo Bird character from Lewis Carroll’s Alice in Wonderland—who, when asked to judge a race, decreed that “everybody has won, and all must have prizes!”  Essentially, the DoDo Bird effect suggests that all forms of talk therapy are equally beneficial, because what matters is not the method, but the therapeutic relationship.  Although there has been consistent opposition to this idea, it continues to find support within the profession, and more recent research (such as the 1997 comparative study by Bruce Wampold et al) continues to show that, regardless of the theory or method used in therapy, it is the unconditionally accepting, nurturing bond between therapist and client that determines success.

So what does all this mean, for someone in acute distress, who is looking for a therapist, and needs support right away?  The endless information online is both useful and confusing.   To be sure, it can help to see a therapist who has experience in working with the specific types of issues or problems you are facing.  But it can be daunting to try and evaluate different methods and approaches, without background knowledge or training…and anyway, most effective therapists are able to combine methods, pulling from here and there as the situation demands, using all the tools in their therapeutic tool box in fluid and responsive ways.

As you comb through the websites and online networks, looking for the perfect provider, give a thought to the DoDo Bird effect: Focus less on methods and pedigree, and more on how therapists talk about their work, the “vibe” they exude, the feeling.  What type of person are you most likely to connect with?  When you speak to them on the phone, or go in for initial consultation: Does the provider greet you with warmth and attention, do you feel comfortable in their presence, is the office appealing, cozy, and inviting?  Does their relational style work for you?  Most important, do you feel this person is listening—paying attention to you, respecting your needs and goals…is this someone who gets it?

The bottom line is, no one particular method, style or provider is likely to be the “right fit” for every client.  We are all different and—as the DoDo Bird Effect reminds us—that difference is a good thing.  When it comes to choosing a provider, “vive la difference!”  Don’t be afraid to interview more than one provider before you decide where to invest your time and energy.  Nothing is more important than your safety, well-being and comfort.  Your mental health matters, and you are worth it!