Author: Adam Bates, TMH Psychologist
This blog post will review some of the factors which research suggests can contribute to successful outcomes in therapy. Whether you are considering beginning therapy or already engaged in the process, this post should help you become a more discerning consumer of therapeutic services and provide you with several important topics you could raise with your therapist if you feel things are not progressing as you would like.
So what are the factors that studies suggest have the biggest impact on outcome for clients? Below I will consider several.
1. Towards a new understanding
One helpful task often accomplished in the early stages of therapy is to equip you with a new way of understanding what you are struggling with. Such a new understanding can provide a means to overcome or cope with new or ongoing difficulties (Meichenbaum, 2017; Wampold, 2015). Ideally, this process should help you feel realistic hope about your situation, and engender expectation that engaging in the tasks of therapy will be helpful.
2. The importance of a good therapeutic alliance
The therapeutic alliance, or working relationship between the client and therapist, is generally regarded as one of the most important determinants of therapy outcome. This has been conceptualized as comprising the elements of a warm emotional bond, agreement on goals, and agreement on the tasks of therapy (Bordin, 1979). It is important that your therapist is empathic, caring, and affirming, that you feel fully seen and understood, and that you and your therapist are on the same page regarding treatment goals and how you will work together to achieve them. However, while the working relationship with your therapist is very important, don’t despair if it is not all you might hope for initially. This would be an excellent thing to give your therapist feedback about, and doing so will hopefully provide you with an opportunity to directly address whatever is missing or unsatisfactory, and in so doing improve things as a team. There is some evidence to suggest that those clients who can improve the therapeutic relationship in therapy through discussion with their therapist often do best in therapy. Also remember that the more engaged you are in treatment, the greater the likelihood of a positive outcome.
3. Is the type of therapy important?
It may surprise you to learn that the specific approach your therapist uses may not be one of the most important factors that determine how successful therapy is, though it probably is important that their approach makes sense to you and resonates with you. Indeed, there is a body of academic literature dating back as far as 1936 finding that different approaches to therapy often have broadly similar outcomes (Duncan, 2002; Luborsky, Singer, & Luborsky (1975; Nahum, Alfonso & Sönmez, 2018; Rosenzweig, 1936).
4. Specific techniques
Many types of therapy are distinguished by specific techniques the therapist will use. How important are these in the effectiveness of therapy? It may be unrealistic to arrive at a definitive, precise quantification due to the complexity of the therapeutic enterprise and the fact that the myriad studies and meta-analyses have not always taken account of or measured exactly the same factors or constructs. Nevertheless, Lambert (1992) estimated techniques of specific approaches to specific problems to contribute 15% of the variance in therapy outcomes, and Norcross & Lambert (2019) arrived at the same figure of 15% as a “crude empirical estimate.”
5. What about what is going on outside of the therapy office?
Perhaps unsurprisingly, we know from the research that factors outside of the therapy itself can also impact outcomes. If you are struggling with motivation, social support, or stressful life events, for example, these could be important things to share with your therapist and to work on together.
How to keep therapy working
In the course of therapy, while working towards your goals by engaging in the tasks you have collaboratively decided upon, your therapist will likely help you identify and intentionally utilize existing strengths, skills, resources, and social supports while also supporting you in developing new ones. Once you have made improvements, focus may shift to relapse prevention. This will give you an opportunity to review what you have learned and found helpful in therapy, normalize setbacks and help you to use them as learning opportunities, distinguish between lapses and relapses, and identify future high-risk situations to help you formulate a plan for dealing with them.
What sort of outcomes can you expect from therapy?
If you can develop a new understanding of your problems that is empowering, build a nurturing working relationship with your therapist, and set and achieve appropriate goals in your therapy, what sort of outcomes can you expect from the therapeutic process? Reviews of studies have found approximately 75% of clients to derive some benefit from psychotherapy (American Psychological Association, 2012), that average success rates for treated cases range from 65 to 72% (Carr, 2007), and that an average psychotherapy client was better off than 60 – 82% of individuals not receiving treatment (Wampold, 2001). If you are interested in the sorts of outcomes clients achieve with Tokyo Mental Health, then please have a look at this blog article
or at this audit poster presentation.
About the Author
Adam received his Doctorate in Clinical Psychology from the California School of Professional Psychology, Los Angeles campus. At TMH, Adam works with clients experiencing a wide range of challenges, using cognitive behavioral therapy, person centered counseling, and emotionally focused therapy based approaches.
References:
American Psychological Association. (2012, November 1). Understanding psychotherapy and how it works. American Psychological Association. Retrieved February 15, 2023, from https://www.apa.org/topics/psychotherapy/understanding
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885
Carr, A. (2007, June 13). The effectiveness of psychotherapy: A review of research. Retrieved February 15, 2023, from http://www.psychotherapycouncil.ie/wp-content/uploads/2019/01/The-Effectiveness-of-Psychotherapy.pdf
Duncan, B. L. (2002). The legacy of Saul Rosenzweig: The profundity of the dodo bird. Journal of Psychotherapy Integration, Vol. (12, No. 1), 32–57.
Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.). Handbook of psychotherapy integration (1st ed.). (pp. 94–129).
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32, 995-1008.
Meichenbaum, D. (2017). The evolution of cognitive behavior therapy: A personal and professional journey with Don Meichenbaum. Routledge.
Nahum, D., Alfonso, C. A., & Sönmez, E. (2018). Common Factors in Psychotherapy.
In A. Javed & K. N. Fountoulakis (Eds.) Advances in Psychiatry (pp.471-481).
Norcross, J. C. & Lambert, M. J. (2019). Psychotherapy relationships that work: Volume 1: evidence-based therapist contributions (3rd ed.). Oxford University Press.
Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy.
American Journal of Orthopsychiatry, 6, 412–415.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Erlbaum.
Wampold, B. E. (2015, October). How important are the common factors in psychotherapy? an update. World psychiatry : official journal of the World Psychiatric Association (WPA). Retrieved February 15, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/
