Talk Therapy Doesn’t Work?

by Dr. Eric G. Schneider, M.Ed., Ph.D., LMHC

B.S. propaganda isn’t just for politics. These days, we’re bombarded with claims that “talk therapy” doesn’t work, swiftly followed by promises of a revolutionary method that will fix everything. Gurus market their frameworks as the answer, often selling them to therapists and coaches desperate for solutions. But therapy doesn’t need a magic bullet. It requires deliberate, thoughtful, and research-backed practice that respects the complexity of human beings.

Therapy succeeds not because of a single method but because of principles that transcend any one framework: the importance of connection, the capacity for emotional honesty, the ability to face and process internal conflict, and the courage to embrace vulnerability. These are the ingredients of transformation. They also guide my practice, which integrates feedback, supervision, and ongoing training to ensure I am constantly improving.

The Therapeutic Relationship: The Foundation of Change

Research consistently shows that the therapeutic relationship is one of the strongest predictors of success (Horvath et al., 2011). But this relationship isn’t just about creating comfort. It’s about building a dynamic where patients feel safe enough to explore their deepest struggles while being gently challenged to face what’s holding them back.

In my work, the therapeutic relationship is a living, evolving process. To ensure I’m staying aligned with my patients’ experiences, I gather structured post-session feedback. Patients rate their experience on 17 relational questions, like whether they felt understood or if the session helped them move closer to their goals.

Below is a snapshot of anonymized scores from recent sessions. This feedback allows me to track patterns over time, identify areas for growth, and address potential relational ruptures. The hard work pays off!

For example, a dip in scores might reflect a moment where a patient felt misunderstood or where a sensitive topic was broached but not fully explored. By discussing this with the patient in the next session, we can repair the moment and use it as a springboard for deeper work.

Facing Emotional Truths with Courage

At its core, therapy is about helping people face emotional truths they’ve long avoided. Avoidance often takes the form of defenses—ways we protect ourselves from pain, fear, or shame. But defenses come at a cost, keeping us stuck in patterns that no longer serve us.

The principle of identifying and working through defenses is central to my practice. Whether it’s by exploring unconscious emotional blocks or using parts work to identify and dialogue with internal conflicts, the goal is the same: to help patients move beyond avoidance and connect with their deeper emotional experience.

This requires a high level of sensitivity and skill. That’s why I rely on video review and supervision to refine my ability to notice and respond to these moments. With patient consent, I record sessions and review them weekly, looking closely at how I responded to shifts in the patient’s emotions, anxiety, or defenses. This deliberate reflection sharpens my ability to help patients face what they need to, with both courage and support.

Balancing Pressure and Safety

Good therapy happens when people are both challenged and supported. Too much pressure and the patient shuts down; too little, and they stay stuck. This delicate balance is a principle that underpins effective therapy across modalities.

In practice, I strive to meet patients where they are while helping them move forward toward our mutually agreed upon goals. Feedback like the chart above helps me track how patients are experiencing the balance of challenge and support. Supervision provides an additional lens for refining this balance. My ongoing training—in multiple core programs and regular supervision—ensures that I continue to grow in my ability to assess and adjust this dynamic in real-time.

Integration: A Holistic Approach

Therapy isn’t about following a rigid methodology; it’s about adapting principles to each patient’s unique needs. My work is informed by ISTDP (Intensive Short-Term Dynamic Therapy and other experiential modalities) in which the principles of focus, emotional processing, and relational attunement.

What ties it all together is a commitment to evidence-based practice. Research shows that tools like feedback-informed treatment (Lambert & Shimokawa, 2011), deliberate supervision, and patient-centered approaches consistently lead to better outcomes. By integrating these tools, I ensure that my work is principled, flexible, and deeply attuned to the individual in front of me. However, even the best intentions fail, and that is why repair is also an essential feature of good therapeutic work.

Repair and Resilience

No therapeutic relationship is perfect. Ruptures happen—moments when trust is strained or the patient feels misunderstood. But these moments aren’t failures; they’re opportunities. Repairing ruptures deepens trust and models resilience, showing patients that relationships can survive conflict (Safran & Muran, 2000).

In my practice, repair is an ongoing process. Post-session feedback and video review allow me to spot ruptures I might not have fully addressed, allowing me to revisit and repair them with the patient. This commitment to repair reflects a core principle of therapy: that growth comes not from avoiding discomfort but from facing it together.

What Makes Therapy Work?

It’s not about gimmicks or secret methods. It’s about building relationships where patients feel safe, seen, and challenged. It’s about helping people face emotional truths, break free from old patterns, and rediscover their capacity for connection and change.

For me, this means a commitment to deliberate practice: collecting feedback, reviewing my work, engaging in ongoing training, and seeking supervision to refine my skills. It means integrating principles from multiple approaches. Therapy is not only a science (staying connected to research) It’s also an art or, better put by a trainer of mine, a craft. One that is cultivated thoughtfully, effectively, and deliberately is transformative. Let’s leave the noise behind and focus on what truly matters: connection, courage, and the patient’s journey toward healing.

References Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate.