Therapy Online: Critical Conditions of Successful Change

However it just isn’t possible to receive instruction in all the thousands of excellent intervention modalities available, especially when exciting new ones regularly emerge. Some approaches have been preferred more than others due to the sheer quantity of data backing their validity; in particular Cognitive Behaviour Therapy (CBT) and Interpersonal Process Therapy (IPT) are prime examples.

That therapy actually does work is a well-known conclusion reached after decades of research, however the relative superiority of one type of therapy over another has not been successfully demonstrated. In fact the famous "dodo-bird finding" whereby "Everyone has won and all must have prizes" after Lewis Carroll’s "Alice in Wonderland" was announced in a major review of psychological treatment outcome studies (Luborsky et al., 1985). A more credible explanation, based on a wide-ranging review of the research since 1970, is that within all positive change there exist four common factors, which if present, guarantee successful outcomes (Hubble et al.,1999). Here are the descriptions of these common factors:

Client Factors (40%)

Client factors are the most influential force for change in psychotherapy, which explain 40% of improvement. These factors are the strengths and resources that clients bring into psychotherapy. These resources encompass a range of life domains, both internal and external, for example a keen sense of humour and intelligence can be just as practical as a supportive network of friends and material possessions. The change process is greatly augmented when the therapist calls attention to and expands a client’s abundance of strengths. Reminders of how resourced clients actually often surprises them as their attention is redirected away from their negative judgements of themselves and on the way to their strengths.

Therapeutic Relationship (30%)

A good therapeutic relationship, where clients feel supported, understood and respected depicts at least 30% of the variance in the course of change. The medical equivalent is having a good "bedside manner". The characteristics of a good therapeutic relationship are:

=> How much competence for caring, compassion and empathy the therapist has

=> How much a therapist can like or love the client

=> Mutual confirmation between client and therapist

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

=> Engaging self-responsibility

=> A focus on collaboration as opposed to giving advice.

Placebo or Expectancy (15%)

The placebo effect is a compelling, with 15% of the change happening because a client expects it to. Clients change for the better when they know their capable as a competent, trustworthy and experienced professional.

Model or Technique (15%)

Only 15% of the change observed in therapy is due to the specific treatment modality, yet university training centres around teaching students only one or two specific modalities. Therefore many mental health professionals become "technicians" covering menu-style treatment manuals over client issues instead of treating the unique and complex, whole person. Even if these professionals are proficient in a particular treatment technique but don’t tap into the other common factors they will have little authority to be adequate agents of change.

Therefore therapy will be successful if the four common factors can be exploited to their complete potential. When you are looking for a therapist, make sure they demonstrate the following traits: attunement to you and the ability to tell you the truth, kindness, compassion, intelligence and experience.