How You Attach to People May Explain a Lot About Your Inner Life

In 2006, a team of Norwegian researchers set out to study how experienced psychotherapists help people to change. Led by Michael Rønnestad, a professor of clinical psychology at the University of Oslo, the team followed 50 therapist-patient pairs, tracking, in minute detail, what the therapists did that made them so effective. Margrethe Halvorsen, a post-doc at the time, was given the job of interviewing the patients at the end of the treatment.

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Over the past three years, I’ve talked to dozens of therapists from various schools, trying to understand how therapy works – and by this I mean heals: the darker entrapments of compulsive confession or the complex entanglements of unresolved transference are not my subjects here. Lately, I’ve broadened my quest to understand the basis of therapeutic efficacy to include researchers as well as practitioners, but most of these conversations left me feeling that neither the experts studying therapeutic change nor those effecting it could, when pressed, convincingly explain how people heal.

Begrudgingly, I kept going back to what Alan Kazdin, a professor of psychology and child psychiatry at Yale University, said in 2009 in a widely cited paper: “It is remarkable that after decades of psychotherapy research we cannot provide an evidence-based explanation for how or why even our most well-studied interventions produce change.”

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