What makes therapy work?

Recently, I have found myself thinking about this question. I know that my thinking is spurred by the several trends or developments in the mental health field: the push by the American Psychological Association (APA) and other professional groups for Evidenced Based Therapy (therapy that is clearly demonstrated to be effective); ongoing pressure from managed care organizations to demonstrate the effectiveness of therapy in order to obtain authorization for additional covered therapy sessions for clients; and increased requests from clients (and others)  for CBT (cognitive behavioral therapy) or other types of therapy that they have heard are reportedly most effective.

How important is the client-therapist relationship?

At the same time that there has been an increased call for Evidence Based Therapies there has been a growing body of research which has strongly suggested that the “working relationship,”  or “alliance,”  between therapist and client,  is one, if not the most important factors in predicting whether therapy will have a successful outcome. John Norcorss, Michael Lambert, Bruce Wampold and others working in this area has gone on to delineate what factors are key in considering the client-therapist relationship and have stressed that seeking feedback from clients about therapy, is it working for them, is a key factor in improving the working alliance, improving therapy outcomes, and decreasing premature terminations (clients dropping out of therapy).

How does this help us?

These findings suggest that an increased focus on the working relationship can help improve therapists’ effectiveness. Related research has clearly shown that soliciting feedback from clients is particularly important. There is much evidence that consistently asking clients for their perceptions about how therapy is working for them can improve the working relationship, and thus increase therapeutic effectiveness.

For further additional information the reader is directed to the works of John Norcross, Michael Lambert, Bruce Wampold, Scott Miller, to name just a few.

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