Therapeutic change is due more to factors outwith therapy than any one aspect of therapy. Factors outwith the session are at least as important as our rapport with our clientsâ€¦and much more important than our years of experience or the technique weâ€™re using.
The myth of therapy is that it is done by therapists to patients and that the outcome is a measure of the therapist or of the technique employed, not of the client (unless, of course, the client is â€œresistantâ€ or â€œnon-compliantâ€, in which case the outcome is very definitely attributed to them!).
The myth of therapy is perpetuated by research focusing upon the outcome of a given intervention on a given condition, where the therapist is merely a vessel for delivery of the treatment and the client is an interchangeable recipent of said treatment.
Research exploring common patterns across therapies and conditions has identified four factors which together determine the outcome.
- The technique employed by the therapist: 15%
- The expectations of the client, based in part upon the apparent expertise of the therapist: 15%
- The rapport between therapist and client: 30%
- Events outwith therapy, over which the therapist has no control: 40%
The reality of therapy is that the therapist has direct control over less than a fifth of the variation in outcome and is involved in less than two thirds of said variation. While technique is important, much more important is the therapistâ€™s manner and engagement with the client.
Hubble MA, Duncan BL & Miller SD (1999) The Heart & Soul of Change. American Psychological Association: Washington.