Many factors determine if therapy works
There are all sorts of reasons whether a person will succeed in counseling
By John Wanserski
QUESTION: What makes therapy work?
ANSWER: It is probably a safe assumption that over the years, counselors and therapists the world over have pondered such questions as: What makes therapy (or counseling) effective? What are the determinants of successful therapy outcome? Just what makes therapy work; or, is any one kind of therapy more effective than another?
It is equally safe to speculate that many have arrived at what they believe is the answer to the above or similar questions. Obviously no one has precisely answered those questions as judged by the large numbers of therapists using a multitude of therapeutic approaches (one source estimates
that there are and have been 400 more or less distinct therapy models!).
Recently I came across what I personally consider a definitive piece of work that attempts to answer such questions as those posed above. In their most interesting and challenging book, The Heart and Soul of Change: What Works in Therapy, authors Mark Hubble, Barry Duncan and Scott Miller have identified the "common factors" that determine whether and why therapy does
or does not work. These common factors are four in number:
1) Extra therapeutic events and client variables. Put another way, chance events that occur and
help in recovery regardless of participation in therapy: for example, picture a client depressed and
anxious because of financial problems. Winning the lottery certainly would bolster recovery!
Client variables include the severity of the problem, level of motivation, the capacity to relate to
others. For example, a person diagnosed with schizophrenia, who has no desire to change and
displays no capacity to become involved in a relationship with a therapist, is unlikely to find relief
The authors estimate these factors account for 40% of the outcome of therapy.
2) Relationship factors: It is estimated that these factors account for approximately 30% of client
improvement. These are factors that affect the client-therapist relationship. Some examples are
therapist empathy, being engaged in the therapy process, understanding what is happening, being
understood. Other examples include such therapist characteristics as acceptance, empathy, caring
Admittedly, the whole subject of the therapeutic relationship is complicated and by no means can
be fully explained here. Those interested are encouraged to review The Heart and Soul of Change
or other sources.
3) Hope and expectancy: These factors refer to that part of therapy outcome that happens as a
result of the "clients knowledge of being treated and assessment of the credibility of the therapy's
rationale and related techniques." (Hubble, et al)
Expectancy relates to the idea that successful outcome in therapy is due to belief by client and therapist in the curative powers of treatment. These effects are not due to a given method or procedure. They result from positive and hopeful expectations of the method or procedure. It is
estimated that about 15% of successful treatment outcome is attributable to these factors.
4) Model and technique: These factors probably account for 15% of improvement in therapy. These factors may be seen as beliefs and procedures which are unique to specific treatments. Some interpret models/techniques as therapeutic rituals. Most methods prepare clients to take action to help themselves. Therapists expect their clients to do something different.
(Wanserski is a counselor in the Antigo Outreach Office of Catholic Social Services.)
Send questions to Counselor's Corner, c/o Catholic Social Services, P.O. Box 23825, Green Bay 54305-3825. All questions will be answered in print or through the mail. Identities will remain confidential.