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What Influences Successful Psychotherapy?

You might think the most important factor in therapy success is the skillful technique used by your therapist, or the therapist's knowledge, or their years of experience. Those are certainly important factors, but what's even more important for you is how strongly you feel aligned with your therapist. There are four main factors that influence successful psychotherapy. Let's take a look.

Finding the right therapist is important!

The Big Four

  1. The therapy technique

  2. The therapeutic alliance

  3. The client's expectation

  4. The client's extra-therapeutic factors


The Therapy Technique

The type of techniques used by your therapist will influence how well therapy goes. Think of them as tools, a hammer is good for nails but not for screws. Here are some examples of therapy techniques:

  1. Cognitive-Behavioral Therapy - Focuses on thoughts, emotions, and behaviors

  2. Interpersonal Psychotherapy - Focuses on interpersonal features

  3. Mindfulness-based Cognitive Therapy - Focuses on nonjudgmental awareness

  4. Acceptance and Commitment Therapy - Focuses on values

  5. Psychodynamic Psychotherapy - Focuses on unconscious processes

  6. EMDR - Focuses on reprocessing traumatic experiences

  7. The list goes on and on.... there are hundreds!

...I collaborate with clients to determine which technique to use.

Most techniques can effectively treat many different disorders (e.g., anxiety, depression, and trauma). Some people benefit from one technique more than another (e.g., client 1 prefers CBT over EMDR, client 2 prefers EMDR over CBT) Also, some therapists prefer to use certain techniques more than others. I am an integral therapist who has a wide range of experience using different techniques, and I collaborate with clients to determine which technique to use. This integral approach is becoming more common.

So the technique the therapist uses, how skilled they are at using it, and how well it fits with your situation will have an influence on the success of therapy.


The Therapeutic Alliance

Your relationships with your therapist has more impact on outcomes than the techniques used! This is likely because no technique will work, no matter how advanced it is, if you don't feel safe or trust your therapist. So having a safe, honest, and open communication with your therapist helps all techniques work more effectively.

Your relationships with your therapist has more impact on outcomes than the techniques used!

If you tried therapy and it didn't work, you might think psychotherapy doesn't work, or it doesn't work for you. That would be an understandable feeling, but more likely the problem was that the therapist you were working with was not a good match for you! Research very clearly indicates that therapy is effective across the board for everyone, especially when there is a good therapeutic alliance.

When therapy doesn't work, it's likely due to various factors. Remember, there are four main factors that influence therapy. One factor is how safe, connected and open you feel with you therapist; aka the therapeutic alliance. That's important, it influences approximately 30% of the outcome. So the client should seek out a good match. The therapy technique on the other hand influences approximately 15% of the outcomes. This factor is outside of the client's control. However, approximately 55% of influence emerges from client factors!

The grey slices are the factors that the client brings to therapy. The percentages are estimates established by Miller et al., 1997.


The Client's Expectation

When you take a pain reliever, you expect some reduction in pain. What you expect to happen influences the outcome! If you unknowingly eat a sugar pill, it could cause a reduction in pain if you expected that outcome. This is not magic, it is your nervous system changing due to thoughts, beliefs, emotions, and behaviors.

...if a client expects therapy to work it is more likely to work...

If you expect to never feel better, you will act, think and feel in ways that prevent healing. If you believe you've picked the worlds best therapist, your beliefs will influence you to act, think and feel in ways that improve your chances of success. This is the placebo effect.

Please understand placebo is not some random chance or mind-over-matter magic, it is real biological changes related to how we think, feel and act.

Client expectation can be more complex than that too. For example, if a client expects to be healed as a passive observer like he is going into surgery, this would influence therapy. Most of the benefits from therapy arise from actions and changes on behalf of the client, which is what therapy focuses on. So expecting to sit back, do nothing and be healed will likely slow down therapy or prevent progress at all.

In short, a client's expectations influence therapy outcomes.


The Client's Extra-therapeutic Factors

Okay, what the heck are extra-therapeutic factors?

Extra means outside of, and therapeutic means therapy. Simply stated, it is everything outside of therapy which the client brings into therapy. The following are some examples:

  1. Personality (strengths, hobbies, interests, beliefs, ideas, thoughts, emotions, persistence, etc.)

  2. Support system (family, friends, community, religion, co-workers, etc.)

  3. Environment (safety, community, job, home life, weather, pollution, etc.)

  4. Genetics (biological factors, hormone factors, disease, predispositions, etc.)

  5. Chance events (random factors)



There are many factors that influence the success of therapy, from a clients culture, beliefs, and values, to the therapist's training, techniques and skill.

Most importantly, remember that successful therapy almost always requires a good therapeutic alliance. Finding the right therapist is important!




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