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Essential Conditions of Successful Change in Therapy
Home Self-Improvement Psychology
By: Sophie Henshaw Email Article
Word Count: 679 Digg it | it | Google it | StumbleUpon it


Successful results in therapy have far less to do with the exact intervention used than many health professionals actually suppose. During their university treatments, mental health professionals learn how to dispense specific, empirically validated therapies. However, with thousands of good intervention options available and new approaches regularly vying for attention, it is just not possible for professionals to receive education in each one. Some models reach pre-eminence as a result of the numerous empirical studies supporting their efficacy; for example, Cognitive Behaviour Therapy (CBT) and Interpersonal Process Therapy (IPT) have wide-ranging validation.

Immeasurable scientific studies conducted over decades demonstrate irrefutably that therapy does indeed work; however studies testing the ascendancy of one approach over another are substantially less convincing. In fact the famous "dodo-bird verdict" whereby "Everyone has won and all must have prizes" after Lewis Carroll’s "Alice in Wonderland" was announced in a extensive review of psychological treatment outcome studies (Luborsky et al., 1985). In a ground-breaking review of the research conducted since the early 1970s, Hubble et al. (1999) concluded that there were four common factors of change present in all successful
therapy outcomes. These common factors are:

Client Factors (40%)

Client factors are the most powerful force for change in psychotherapy, which account for 40% of improvement. Client factors refer to the strengths and resources that all clients intrinsically possess. These resources encompass a diversity of life domains, both internal and external, for example a keen sense of humour and intelligence can be just as helpful as a supportive network of friends and material possessions. The change process is greatly augmented when the therapist calls attention to and builds on a client’s abundance of strengths.
Reminders of how resourced clients actually often shocks them as their attention is redirected away from their negative views of themselves and towards their strengths.

Therapeutic Relationship (30%)

At least 30% of all change is accounted for by therapists’ capacity to develop a strong, positive bond with their clients. Doctors know this as a skilled "bedside manner". The characteristics of a first-rate therapeutic relationship are:

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

=> The amount a therapist can like or love the client

=> Mutual affirmation between client and therapist

=> How much the therapist can encourage the client to take risks and acquire mastery

=> Encouraging the client’s capability for self-responsibility

=> Collaboration with a client instead of advice giving.

Placebo or Expectancy (15%)

Change also to takea place because clients expect it to and this can explain 15% of the observed change. Clients who believe their psychologist to be trustworthy, competent and experienced are more likely to know positive change.

Model or Technique (15%)

Only 15% of the change observed in therapy is due to the specific treatment modality, yet university education centres around teaching students only one
or two precise modalities. Therefore many mental health professionals become "technicians"
covering menu-style treatment manuals over client problems instead of treating the unique and complex, whole human being. Proficiency in particular therapy modalities does not guarantee that therapists are able to tap into the four common factors, thus their ability to facilitate deep change will be inadequate.

Therefore therapy will thrive if the four common factors can be exploited to their total potential. When you are looking for a therapist, make sure they demonstrate the following qualities: attunement to you and the ability to tell you the truth, kindness, compassion, intelligence and experience. It is also vitally important that you like each other!

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.

Dr. S Henshaw is a clinical psychologist in Perth, working with individuals to alleviate depression and anxiety. To learn more about improving your emotional well being, visit:

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