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(Which is, FWIW, a complaint and not a boast, since I never ask for help or advice unless I’ve already exhausted everything I personally can think of and it hasn’t helped.)

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All of that being said, I spend a heck of a lot of time writing about eating disorders and reading eating disorder treatment research. The things I’ve found to be best for working through what treatment works are the Science of Eating Disorders blog (http://www.scienceofeds.org/), and the phone app called Recovery Record (which is demonstrably evidence based, and the only known evidence-based phone app) which is free.

For therapy types beyond that, one particular modality, Cognitive Behavioral Therapy seems to do best (see: http://www.scienceofeds.org/2013/09/22/cognitive-behavioural-therapy-for-bulimia-nervosa-in-the-real-world-whats-the-evidence/), and I tend to prefer therapists who have interacted with eating disorders before (just because it’s easy to misstep).

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Ditto for substance abuse counselors, (in most states), marriage and family therapists, school counselors (except most have additional requirements), etc.

In fact, in my state the only thing I know of that doesn’t require licensure is social workers (many non degree holding people can use the name)! It’s weird and confusing and the national social worker org is trying to fix this.

I agree with all of Scott’s comment otherwise.

If you’re interested mainly in the practice of doing therapy, I would recommend the social work track if it’s similar to the US version of social work. I would flag that it pays less and has less status, but I feel as though I do far more hands-on work and get more training. That being said, I have to push pretty hard to work with research, which continues to make me sad.

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…this doesn’t promise that it’s perfectly fine for memory, but it’s a little info.

Additionally, depression and anxiety *do* cause problems with overgeneralization of autobiographical memory [DeBeers 2014 is a good study, iirc] so I’d be vaguely suspicious of research on burpropion and memory that wasn’t explicitly controlling for this.

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You can try to google scholar ‘therapeutic alliance’ and see where that gets you. It’s not completely the same thing, but I’d expect some of that research to have looked at some of the variables which might be of interest. It seems that a lot of research has been done on this stuff (though it also seems to me that a lot of it is quite poor). Here’s a quote from Handbook of Cognitive-Behavioral Therapies:

“The “therapeutic alliance” refers to the collaborative relationship between the therapist and patient. Research in the early 1980s showed that the therapeutic alliance is positively related to change in various types of psychotherapy (cf. Morgan, Luborsky, Crits-Christoph, Curtis, & Solomon, 1982). A vast body of research has examined the relationship between therapeutic alliance and outcome across a variety of treatment modalities and mental health problems. In general, reviews of the literature indicate that a stronger therapeutic alliance is associated with better treatment outcomes (Horvath & Bedi, 2002; Martin, Garske, & Davis, 2000).

As DeRubeis and his colleagues (DeRubeis & Feeley, 1990; Feeley et al., 1999) noted, however, many of the studies reporting a significant alliance–outcome association do not control statistically for symptom change preceding the assessment of the alliance (e.g., Castonguay, Goldfried, Wiser, Raue, & Hayes, 1996; Gaston, Thompson, Gallagher, Cournoyer, & Gagnon, 1998). Thus, in such studies, a significant alliance–outcome correlation may in part reflect the influence of prior symptom improvement on the therapeutic alliance. Indeed, DeRubeis and Feeley (1990) and Feeley et al. (1999) found that the alliance was not a significant predictor of subsequent therapeutic change. In addition, they found that in the latter half of therapy, the level of therapeutic alliance was predicted by the amount of prior symptom improvement. In other words, these two studies found that good therapeutic alliance early on did not predict good outcome, but that good outcome early on predicted good therapeutic alliance later. […] It is possible that the correlations reported in some studies reflect the impact of good outcome on the alliance rather than any causal effect of the alliance on symptom improvement.”

Some related observations on patient behaviour and therapist responses to patient behaviour:

“Patient resistance typically bodes poorly for treatment effectiveness, unless it is managed skillfully. It is generally assumed that some patients are more likely than others to resist therapeutic procedures. “Resistance” may be characterized as a dispositional trait and a transitory in-therapy state of oppositional (e.g., angry, irritable, and suspicious) behaviors. It involves both intrapsychic (image of self, safety, and psychological integrity) and interpersonal (loss of interpersonal freedom or power imposed by another) factors (Beutler et al., 1996). “Reactance,” an extreme example of resistance, is manifested by oppositional and uncooperative behaviors. […]

Resistance is easily identifiable, and differential treatment plans for patients with high and low resistance are easily crafted. The successful implementation of these plans, however, is often quite a different matter. Overcoming patient resistance to the clinician’s efforts is difficult. It requires that the therapist set aside his or her own resistance to recognize that the patient’s oppositional behavior may actually be iatrogenic. In a study of experienced and highly trained therapists in the Vanderbilt Study of Psychodynamic Psychotherapy, none were able to work effectively with patient resistance (Binder & Strupp, 1997). Rather, therapists often reacted to patient resistance by becoming angry, critical, and rejecting, which are reactions that tend to reduce the willingness of patients to explore problems. […] Research suggests that low-resistance patients may […] do better with authoritative and directive roles compared with nondirective ones (Beutler et al., 2003; Beutler, Engle, et al., 1991).”

More specific guidelines on how to deal differently with patients high and low in resistance levels are also presented in the text. There’s on top of that some research (which I’m not sure if I trust) presented in the text which indicated that some treatment methodologies within the CBT-framework do better than others in specific patient contexts; it may thus be that part of the ‘chemistry’-variable is explained by treatment methodology, rather than things like personality, and to the extent that this is the case one might use the available research to aim for a better fit (don’t use a guy using methodology X if you have problem Z, because it’s expected to work less well than method Y – most therapists presumably combine treatment methodologies, which makes it harder to use methodology as a selection variable, but on the other hand this might also improve average outcomes and make selection less important).

It’s not that there’s no knowledge about this kind of stuff, but I don’t have a big overview over which variables are most important – I’m not sure anyone does. It’s obvious that some factors which are under the control of the therapist affect the likelihood of success of treatment, and some informal guidelines and suggestions for how to optimize outcomes given stuff like this do seem to exist. But that doesn’t help you if your therapist doesn’t follow the advice in the textbook and for example get angry at you if you think his ideas are stupid and unhelpful.

The above comment wasn’t really an answer, but I hope you got something out of the details I added.

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One important related observation emphasized in a text I recently read (Newman & Kohn’s Evidence-Based Diagnosis – that book is awesome, incidentally, and highly recommended; I wrote a blog post about it here. It’s the sort of book I imagine many readers of a blog like this might like.) is also that proper blinding is in general more important in research using metrics which are to some extent subjective (‘how do you feel?’) than it is in research where metrics are relatively objective (‘blood pressure is 120/80′). As results of psychotherapy are usually quite subjective (compared to a T-cell count) this aggravates the problem.

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