Assessment of psychotherapy: reflections of a practitioner.

Granting both the importance and the difficulty of assessing psychotherapy, I express my dissatisfaction with the relevance of large-scale controlled trials to the realities of outpatient clinical practice. I suggest that surveys of their psychotherapeutic experience by practitioners may have, at least, complementary value. It has been my impression that psychotherapy often is an effective modality for the symptoms and turmoil associated with emotional crises. It can also be effective in improving the life quality of patients with physical defects and disablement, with problems of aging, and with schizophrenia. For personality disorders and problems of living, psychotherapy has a good deal to offer if treatment goals are reasonable. I have been less favorably impressed with the efficacy of psychotherapy for symptomatic psychoneuroses and the sexual dysfunctions. I conclude with a discussion of the puzzling unpredictability of psychotherapy.