Based on 80 patients randomly allocated to two styles of therapy, this had found that neither better overall but that some types of people did better in one than the other. Specifically, clients high in ‘learnt helplessness’ (feeling unable to control one’s everyday life) did much better in structured therapy where the counsellor took the lead and focused on behaviour rather than emotions. Clients who felt more in control did better in a less structured therapy where the therapist facilitated self exploration and focused on feelings. With now 120 patients randomised, the new report confirms this finding for during-treatment measures including patient and therapist ratings of benefit, attendance, and number of drug-free urines, and finds that the matching effect persisted to six months after treatment on measures of drug, family, social and psychiatric problems. Pre-treatment levels of depression (another relevant variable – more depressed clients did best in the more structured therapy) did not account for the findings: when depression was statistically ‘evened out’, learned helplessness was still just as or even more important.
This finding provides some guidance regarding when control might be therapeutic and when it’s not: