Stress, Illness and Points of View (2)

The last post briefly described a few psychotherapy concepts employed by students of Carl Jung.  I wrote this to suggest the diversity of the scores of theoretical models currently used to treat clients.  Why are there so many?  The answer seems to be that they are all about equally effective when compared in trials so none has become dominant.  Why are they so similar in their outcomes?  The best explanation is that the theory behind a particular psychotherapeutic approach is one of the least important of several factors that determine how much a client benefits from treatment.  What are these other components?  In order of importance they are factors connected to:

  1. The clients themselves (such as the nature and severity of their problems, their resilience and capacity for regeneration) and issues outside therapy (such as exacerbation or resolution of a stressful situation)
  2. The client-therapist relationship
  3. The placebo effect including the client’s hope and expectations.

If our choice of which theoretical model of psychotherapy to employ is not the key to improving outcomes for clients, then what is?  It turns out to be a focus on the client, in particular an emphasis on the client’s:

  1. Resources
  2. Theories of change (the client’s goals and how they plan to achieve them)
  3. Preference for particular outcomes of treatment
  4. Feedback about the effectiveness of treatment
  5. Feedback about the quality of the relationship with the therapist

It is numbers 4 & 5 on this list that make this approach more than just another theoretical model.  Instead of focusing on delivery of care based on a particular theory, this approach is based on determining whether a session met the client’s needs and then using that data to adjust the process toward a better fit for that client.  Duncan, Miller & Sparks (1) have written about how to use brief but specific rating scales to elicit feedback from clients that is then used for changes in process.  They point to a study showing that clients whose therapists had access to feedback about both effectiveness and relationship quality were twice as likely to achieve a clinically significant change. (Whipple JL et al.  Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice.  Journal of Counseling Psychology, 50(1), 59-68. 2003.)

If you are a therapist I highly recommend looking into these ideas.  If you are currently the client of a therapist you might ask if they are aware of this research.

1. Duncan B, Miller S and Sparks J.  The Heroic Client.  Jossey-Bass.  2004.

2. Duncan B, Miller S, Wampold B, Hubble M.  The Heart and Soul of Change: Delivering What Works in Therapy.  APA. 2009.