WHAT MAKES THERAPY EFFECTIVE?

A guide on core components of successful therapy

Successful & Effective Therapy

Have you ever wondered what makes therapy effective and successful?

Have you been to therapy before and didn’t feel like you made progress? Conversely, have you been to therapy before and found it super helpful?

We’ll explore the concept of The Common Factors, or researched back evidence that contribute to successful mental health treatment.

#1 Therapeutic alliance

#1 - Therapeutic Alliance

  • The therapeutic alliance is the relationship you have with your therapist.

  • Trust, collaboration, empathy, and non judgment are all important aspects of a strong therapeutic alliance.

  • Research shows that a strong and supportive relationship between you and your therapist influences positive outcomes in therapy.

  • When clients like, trust, feel comfortable, feel supported, and vibe with their therapists, treatment is more likely to be successful because clients will invariably be more open, honest, and engaged in treatment.

  • Trust takes time. The therapeutic alliance is constantly being developed over time. It is not a one time thing.

  • This also means that ruptures/conflicts/disagreements are to be expected and it is the therapist’s job to facilitate difficult conversations first and to attempt to repair these ruptures.

  • Examples of a strong therapeutic alliance:

    • Mutual trust and respect

    • Agreement on the therapy goals

    • Agreement on how to achieve/work toward therapy goals

    • Collaboration and making decisions together

    • Strong bond between therapist and client

Research shows the relationship between client and therapist accounts for client improvement (or lack of improvement) as much as, and probably more than, the particular treatment method/approach (Norcross and Lambert, 2018).

#2 Collaboration

#2 - Collaboration & Goal Consensus

  • Therapy is a relationship requiring active engagement from both parties.

  • Collaboration is key.

  • Collaboration can include:

    • Active participation

    • Setting goals

    • Goal consensus/agreement

    • Completing homework/tasks outside of session

    • Integrating learning outside of session

  • Goal consensus/agreement is particularly important.

  • Goal consensus refers to mutual agreement between therapist and client on what is being worked on in therapy.

  • If there is not a goal consensus/agreement, treatment can become messy because therapist and client are working on two separate goals and are misaligned.

#3 Hope & expectations

#3 - Hope & Expectations

  • Clients often come to therapy during moments of distress.

  • Thus, they often feel pressured and overwhelmed, after attempting other methods of coping with their concerns.

  • The therapist should instill hope there is possibility for something new and that the current life situation can be resolved or decreased.

  • Clients’ expectations must be managed. Often clients come to treatment with a medical based framework (deficit based to get rid of symptoms entirely).

  • Therapists cannot promise to get rid of symptoms entirely due to ethical reasons. Often times, this is not possible due to the complexity of mental health, but can be decreased and managed.

  • Expectations can be managed through:

    • Providing thorough education on symptoms

    • Providing education on the therapeutic process and what is possible and not possible

    • Providing a written and verbal treatment plan

    • Validation

    • Reassurance

    • Answering client questions

  • If expectations are not managed, this can lead to conflicts, disagreements, and ruptures.

#4 empathy

#4 - Empathy

  • No one likes to be judged, especially by their therapist.

  • Empathy refers to the ability to place yourself in someone’s else experience.

  • There are 2 types of empathy:

    • Cognitive

    • Emotional

  • Examples of empathy

    • Feeling understood by your therapist

    • Feeling like your therapist “gets” you

    • Compassion

    • Shared emotions

    • Nonverbal communication of understanding

      • Leaning in

      • Nodding

      • Arms uncrossed

    • Verbal communication of understanding including

      • Validation

      • Clarifying

      • Summarizing

      • Checking for accuracy

      • Active listening

#5 The client

#5 - The Client

Factors outside of therapy such as:

  • Client’s level of motivation and engagement

  • Perceptions of the therapy

  • Commitment to the therapy framework

  • Integration of concepts into everyday life

  • Hope that therapy will work

It is estimated that clients and factors outside of the therapy account for about 40% of the change that takes place (Assay & Lambert, 1999).

#6 the therapist

#6 - The Therapist

  • Some therapists are better at therapy than others

  • This can include:

    • Building rapport with clients quickly

    • Clear and concise communication skills

    • Empathy

    • Self awareness and self reflective

    • Critical thinking

    • Creativity

    • Responding to disagreements, ruptures, and conflicts skillfully and in service of the therapy and client

    • Engaging in lifelong learning, training, and consultation

    • Able to pick up on patterns, dynamics, and themes

#7 feedback & measurement

#7 - Feedback & Measurement

Regular measurement toward client goals and soliciting feedback

Examples include:

  • Verbal check ins

    • “Did we talk about everything you wanted to talk about today? If not, what else did you want to talk about?”

    • “How was my approach for you today?”

    • “Did you feel heard, respected, and understood? If not, do you feel comfortable sharing why not?”

    • “How are you feeling about our sessions so far?”

    • “Are our sessions useful for you?”

  • Written assessments

  • Evaluations like the PHQ9, GAD 7, and PCL5

  • Reviewing your treatment plan (goals, progress, barriers, length of treatment, anticipated time to end therapy)

Research shows using outcome measurement tools and asking for feedback throughout psychotherapy results in therapeutic effectiveness including more treatment gains and fewer client dropouts (Lambert, Whipple & Kleinstäuber, 2018).

resources & research

Resources & Research

    • Asay, T.P., & Lambert, M.J. (1999). The empirical case for the common factors in therapy: Quantitative findings.

    • Lambert MJ, Whipple JL, Kleinstäuber M. Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy (Chic). 2018 Dec;55(4):520-537.

    • Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III.Psychotherapy, 55(4), 303–315.