What makes therapy successful
There’s a whole heap of the unexplained in successful therapy.
The variety of variables, and methodological challenges, make it very difficult to study.
It’s partly why approaches, like CBT, which have measurable protocols and steps to follow have better evidence behind them. They are easier to measure - but don’t give you the whole picture as to what specifically leads to positive change.
When we look at the full breadth of available research, it consistently shows there are three areas key to successful therapy:
The client’s ability to engage with the therapy, their hope and expectation
The quality of the therapeutic relationship
How the therapist tailors the therapy to the client’s preferences
In reality, these are not distinct areas, they are all intricately woven together, symbiotically influencing one another and co-creating the positive outcomes.
A big part of successful therapy is down to the client
Ouch. This isn’t easy to acknowledge. It sounds a bit like “If therapy doesn’t work out, it’s your responsibility not mine”.
Yet the research tells us a big part of successful therapy is down to the client.
So what qualities and behaviours will help a client increase their chances of finding therapy helpful?
Bring motivation, hope and desire for change
Be open-minded, introspective and curious about yourself
Have a willingness for discomfort, be up for the challenge of feeling vulnerable
See the therapy as a collaborative process, the establishing of a relationship, and take responsibility for integrating therapy insights into everyday life
Some of these qualities and traits may be inherent for some clients. But, if not, they are skills that can be practiced too. Ask your therapist to help!
A relative level of stability in life and feeling supported is important too.
It’s clearly much harder to be hopeful, motivated, open-minded, and implementing learnings when you might just be focused on surviving the day. For those who are homeless, addicted to drugs, alcohol, or suffering from more severe mental health conditions, a more holistic approach will likely be needed (medication, peer/community support, more somatic (body) based therapies that don’t involve talking).
What isn’t so important for successful therapy
Your therapist’s gender, age, ethnicity and culture, training, theoretical approach and experience (the jury is out on this one a bit, there are pros and cons to experience), are not so important in determining successful therapy.
So, hang on, what were all those years of training for? Not to mention the continuous professional development.
And why choose me when anyone will do?
The caveat here is that client’s preferences matter. A lot.
So, if a client wishes to work with someone of a particular identity, or theoretical approach, that will impact the outcomes of the therapy. Honouring those preferences builds the therapeutic relationship, hope, expectancy and belief in the therapist’s ability to help them.
Never underestimate the importance of the healing power of belief!
All of this begs the question…what am I actually paying a therapist for?
There is a skill, dare I say, even an art to being a good therapist.
The quality of the therapeutic relationship, and tailoring the approach to the client’s needs, are both in the hands of the therapist. These play a considerable part in effective therapy.
Firstly, the therapist must help the client identify what they want from therapy; do we both agree on the goals and what we need to do in order to achieve them.
While the treatment approach (the therapy model) matters, it isn’t that one is better than another. But rather, each unique client will find a specific treatment approach resonates with them most. One that makes sense and provides a framework for insight and change.
It is then down to the therapist to be able to communicate and apply this approach in an understandable and inspiring way.
And alongside this, the therapist must form a strong collaborative relationship which is warm and affirming, creating an emotional bond with the client.
The client’s perspective of this is more important that the therapist’s!
In my next blog, I’m going to break down in more detail what makes a good therapist. What is meant by the therapeutic relationship; and what therapist skills and behaviours help lead to successful therapy.
References and further reading
