What makes therapy effective? When I pose this question to my students—offering a list of possible answers that they are to rank order from most to least associated with therapy outcome—many of them are surprised to learn that the number of years of experience for therapists has almost nothing to do with whether or not the therapy will be effective. Almost zero, based on available research evidence.
It turns out that there are many more important things than therapist years of experience, including: what happens for a person outside of therapy (e.g., major life events, like the beginning or ending of a significant relationship), the quality of the relationship between therapist and client (as rated by the client, rather than as rated by the therapist). Specific techniques, like using a very effective treatment like exposure therapy with phobias or OCD, also make a difference in making therapy effective. Other elements that make therapy effective are common across therapists and their different therapeutic orientations, shared by therapists in spite of their different language for describing these elements.
These common elements of effectiveness in therapy are used by therapists whether or not they are actively thinking about them. These elements are usually part of the therapy itself. When a person experiences depression, anxiety, or mental health distress due to any number of factors (see our other posts regarding eating disorders, religious transitions and deconstruction, etc.) the therapist makes decisions about how best to treat the person and help them through their challenges. The therapist uses these common elements throughout the course of treatment.
Based on these elements, I and a co-author have created a new guidebook for therapists called Common Factors Therapy: A Principle-Based Treatment Framework. Therapists using this guidebook can become more aware of the common principles of effectiveness and use them as a framework to inform and enhance their therapy with clients. The elements in the book include:
- therapeutic relationship,
- motivation,
- corrective experiencing,
- insight, and
- self-efficacy.
These common factors are meant to be guideposts for your therapist, but it may be that learning about them can be relevant to you as you work to address your concerns in therapy.
Therapeutic Relationship
Having a trusting relationship with a therapist is key to finding improvement over the course of therapy. When this trust is lacking, it becomes much more difficult to feel that one is making progress. Therapists are trained to discuss miscues and misunderstandings with their clients, but often an open discussion on the topic of the relationship is the best way to resolve concerns about cooperating as therapist and client.
For example, a client may feel unsure about a sense of direction they have experienced during therapy sessions or they feel that the way the therapist is addressing their concerns does not seem to be helping. The therapist would do well to address this perspective and the client, if possible, could make the therapist aware of their concerns. An open discussion to resolve concerns and get back on the same page as therapist and client often leads to significant, positive improvement.
Motivation
It is very typical for humans who want to change something in their lives (how they act, how they think, how they feel) to experience mixed feelings about making those changes. I may tell my therapist that I intend to follow through on a homework assignment, to complete a practice they recommended, to have a crucial conversation with my boss I know I need to have, to change a habit I was going to reduce, etc. Then when I find that I haven’t done it, I feel unsure about addressing it with my therapist. If my therapist can help me talk through my mixed feelings about change, both the reasons to make the change and the obstacles I experience in following through, I am more likely to figure out how to make effective change. I can often find myself more motivated to move in the direction of change that I may have previously avoided.
Corrective Experiencing
Feelings and emotions are a big part of therapy and they are often a big part of the healing we experience through therapy. Corrective experiencing means I may need to have a different emotional experience than I have had up to this point in my life in order to find healing.
For example, if I have tended to feel anxiety and panic, then a new emotional experience may be learning to soothe myself through a panic attack. On the other hand, if I have held difficult emotions inside, like grief for a loved one or anger at someone who wronged me, it may be healing for me to express these emotions. Working with my therapist to find where I feel emotionally stuck can help my therapist identify ways to have new, corrective, emotional experiences that are healing for me.
Insight
In therapy we are often looking for new perspectives—new ways to think about our concerns. Insights may include a moment of realization, a lightbulb moment, but it is often a more subtle shift in how we think about our experiences. Sometimes it takes a new experience to think differently, but other times it can help when my therapist points out that how I am thinking about a situation is not really helping. A therapist can help to reframe how I think about these experiences or help to design new experiences that will lead to new insights.
Self-Efficacy
Therapy is not about the therapist. It’s about the client and the healing that a client experiences over the course of therapy. As the healing occurs, the therapist reminds and encourages the client to take stock of what is being learned, what is helpful from the therapy, and how these experiences and insights can be applied to the client’s life. The goal here is for the client to feel empowered, not that they will not ever experience challenges again, but that they feel ready to manage their challenges. Therapy can then be a freeing, empowering experience.
In summary, these factors represent key elements that are present in therapy generally. While the Common Factors Therapy guidebook may be directed to therapists, these common elements in therapy may be useful and relevant as you proceed with therapy. Feel free to let any of these factors spark conversation with your therapist as you move toward healing.
