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How does therapy help and/or work? The common factors approach.

Understanding how therapy works is remarkably complex! There are so many variables - including, the fit between client and therapist, the characteristics of the client (e.g., demographics; reason for treatment) and the therapist (e.g., experience; training), and the methods of a specific therapy (e.g., use of mindfulness exercises). This article introduces the "common factors" approach to conceptualizing how therapy helps and/or works.

The common factors approach to how therapy works

The"common factors" approach emphasizes the shared (i.e., "common") elements of all psychotherapies, especially emphasizing how the quality of the relationship (or "working alliance") between client and therapist affects treatment success. Researchers typically conceptualize the relationship between client and therapist on three, interrelated dimensions that unfold over time during treatment (Wampold & Flückiger, 2023):

  1. The extent to which client and therapist clarify/agree upon the general aims/goals of therapy

  2. The extent to which client and therapist agree on the tasks of treatment

  3. The relational bond between client and therapist, which includes the extent to which the therapist provides a collaborative, genuine, caring, empathetic, unconditional, and understanding presence for the client (see Rogers, 1957 for a landmark paper on this), and the extent to which the client trusts the therapist.

Research shows that the better the therapeutic relationship - as rated by the therapist, client, or a 3rd party observer - the better the client does in therapy (for review see: Wampold & Flückiger, 2023).

How understanding common factors might help you in therapy

The common factors model suggests questions we can use to reflect on our experiences in therapy. Examples of these questions, include (See Professor Hovarth's website for more questions):

  • What I am doing in therapy gives me new ways of looking at my problem?

  • I believe [my therapist] likes me.

  • [My therapist] and I collaborate on setting goals.

  • I feel [my therapist] cares about me even when I do things that they do not approve of.

  • I feel that the things I do in therapy will help me to accomplish the changes that I want.

What you may notice from these questions is that they assume that you're already in therapy and have spent some time with your therapist. Indeed, the common factors model assumes that it takes several sessions to have a sense of how you and your therapist are relating (Wampold & Flückiger, 2023). So, if you're looking for a therapist then it may be helpful to contact one that appeals to and try them out for a few sessions. After some time together - or if you already have a therapist - then these questions can help you reflect on how well the relationship is functioning. Of course, your own sense of the "fit" with the therapist is important, too.

And as always, I'd be happy to speak with you if you'd like to to learn more about my approach to therapy, which I aim to be kind, collaborative, and evidence-based.

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