How Change Works in Therapy

There is a common fallacy in mental healthwith their clients. The medical equal is having a good
professions that it is the specific treatment that"bedside manner". A first-rate therapeutic relationship
provides the cure. The training received by mentalhas the following characteristics:
health professionals, including psychologists,=> The aptitude of the therapist for empathy,
emphasizes on the use of exact, empirically validatedcompassion and caring
therapies. However it just isn't possible to receive=> To what degree a therapist can like or love the
education in all the thousands of excellent treatmentclient
modalities available, especially when exciting new ones=> Mutual positive regard between therapist and client
regularly come out. Some approaches have been=> How much the therapist can support the client to
favoured due to the sheer quantity of data supportingtake risks and develop mastery
their validity; in particular Cognitive Behaviour Therapy=> Inviting the client to take on more self-responsibility
(CBT) and Interpersonal Process Therapy (IPT) are=> A focus on partnership as opposed to giving
prime examples.advice.
The decades' of therapy outcome research concludesPlacebo or Expectancy (15%)
that all therapy does actually work, but the evidence ofA minimum of 15% of the change observed occurs
one modality's dominance over another is equivocal. Inbecause a client waits for the change to occur; this is
fact the famous "dodo-bird outcome" wherebyknown as the placebo effect. Clients change for the
"Everyone has won and all must have prizes" afterbetter when they know their proficient as a
Lewis Carroll's "Alice in Wonderland" was announcedcompetent, trustworthy and experienced professional.
in a extensive review of psychotherapy outcomeModel or Technique (15%)
studies (Luborsky et al., 1985). If all psychotherapies areEven though the particular type of treatment modality
equivalent, a more plausible alternative was necessaryonly depicts 15% of observed change, university
to explain how successful change comes about and atraining focuses on modality-specific education. As a
review of all the research conducted since 1970result, there are many professionals who become
determined the existence of four common changetechnicians, using manuals to treat clients-by-numbers
factors (Hubble et al.,1999). These common factorsrather than engage with the complex and unique
are:whole person. Therapists who are unable to tap into
Client Factors (40%)the four common factors are likely to be ineffective
By far the most important causes of change are clientagents of change, even if they are highly proficient in
factors and these make up 40% of the varianceusing specific intervention modalities.
observed in successful therapeutic effects. ClientTherefore therapy will succeed if the four common
factors refer to the strengths and resources that allfactors can be exploited to their total potential. There
clients inherently possess. These resources can beare a number of important characteristics to look for in
visceral, spiritual, instrumental, social or psychological,a therapist, including the ability to sensitively be in sync
such as good health, friends and a sense of humour.with you and speak the truth, patience, compassion,
Successful outcomes in therapy are guaranteed whenintelligence and experience. Of utmost importance is
a therapist is able to engage, develop and extend theirthat you like each other and get on well!
clients' copious positive features. Therapists succeedReferences
when they are able to redirect their clients' attentionHubble, M. A., Duncan, B. L., & Miller, S. D. (1999). The
towards their abilities rather than their setbacks andHeart And Soul Of Change: What Works In Therapy.
surprise them with reminders of how resourced theyWashington, DC: APA
actually are.Luborsky, Singer & Luborsky. (1985). Therapist success
Therapeutic Relationship (30%)and its determinants. Archives of General Psychiatry,
At least 30% of all change is accounted for by42, 602 - 611.
therapists' capability to develop a strong, positive bond