Sophie Henshaw

Essential Conditions of Successful Change in Therapy

If you are looking for therapy as a way to make personal changes in your life, don’t believe the hard sell that says only the most recent and greatest model of therapy will work for you. Extensive research conducted over the years reveals the value of thousands of different kinds of modalities. Successful change occurs because of the influence of 4 common factors, not the exact therapy per se. Find out what they are in this article and how you can use them to your benefit to be certain of successful change in therapy.

There is a common misconception in mental health professions that it is the exact treatment that provides the cure. Mental health

training stresses learning how to administer exact, empirically validated

therapies. However, with thousands of good intervention options available and new approaches regularly struggling for attention, it is just not feasible for professionals to receive instruction in each one. Some models reach pre-eminence as a result of the numerous empirical studies supporting their worth; for example, Cognitive Behaviour Therapy (CBT) and Interpersonal Process Therapy (IPT) have widespread validation.

That therapy actually does work is an established conclusion reached after decades of research, however the relative dominance of one type of therapy over another has not been successfully

proven. The most important finding of a major review of psychotherapy outcome studies concluded that: “Everyone has won and all must have prizes”, otherwise

known as the “dodo-bird verdict”, a derivation from Lewis Carroll’s “Alice in Wonderland” (Luborsky et al., 1985). In a ground-breaking review of the research conducted since the early 1970s, Hubble et al. (1999) showed that there were four common factors of change present in all successful

psychotherapy outcomes. The common factors are listed as follows:

Client Factors (40%)

Client factors are the most influential force for change in psychotherapy, which explain 40% of improvement. The strengths and resources that clients bring into treatment are what make the largest difference. These resources encompass a range of life domains, both internal and external, for example a keen sense of humour and intelligence can be just as practical as a supportive network of friends and material possessions. Successful outcomes in therapy are guaranteed when a therapist is able to engage, expand and extend their clients’ plentiful positive features.

Clients are often surprised when they realise how resourced they

actually are and benefit from having their focus redirected towards their abilities and away from their failures.

Therapeutic Relationship (30%)

At least 30% of all change is accounted for by therapists’ capacity to develop a strong, positive connection with their clients. The medical counterpart is having a good “bedside manner”. The

following characteristics control the success of the therapeutic relationship:

=> The competence of the therapist for empathy, compassion and caring

=> Loving and liking the client

=> How much Mutual affirmation there is between therapist and client

=> How much the therapist can promote the client to take risks and increase mastery

=> Facilitating self-responsibility

=> Actively collaborating with a client rather than a “therapist knows best” approach.

Placebo or Expectancy (15%)

The placebo effect is a compelling, with 15% of the change happening because a client expects it to. Clients who believe their therapist to be trustworthy, competent and experienced are more likely to know positive change.

Model or Technique (15%)

The exact type of intervention only explains 15% of the

observed change, yet despite this finding, they are typically highlighted above all else in university instruction. As a result, there are many professionals who become technicians, using manuals to treat clients-by-numbers rather than tackle the complex and unique whole

person. Even if these professionals are competent in a particular treatment method but don’t tap into the other common factors they will have little influence to be efficacious agents of change.

Therapy is determined to succeed if all four common factors are integrated to their fullest potential during sessions. Qualities to look for in a therapist are: the ability to attune to you and tell you the truth, kindness, compassion, wisdom, intelligence and experience. It is also vitally important that you like each other!

References

Hubble, M. A., Duncan, B. L., & Miller, S. D. (1999). The Heart And Soul Of Change: What Works In Therapy. Washington, DC: APA

Luborsky, Singer & Luborsky. (1985). Therapist success and its determinants. Archives of General Psychiatry, 42, 602 – 611.

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