❤️🩹 What Heals Most in Psychotherapy?
Research consistently shows that the specific techniques or modalities used in psychotherapy (such as CBT, psychodynamic, or humanistic approaches) account for only a small portion—about 1% to 11%—of the variance in therapy outcomes. The majority of healing is attributed to other factors, often called "common factors"[1][2].
Scientific Support: What Matters Most
1. Common Factors
These are elements present in almost all forms of psychotherapy and have the strongest scientific support for contributing to healing:
Therapeutic Alliance: The quality of the relationship between therapist and client, including trust, collaboration, and agreement on therapy goals[1][3].
Empathy: The therapist’s ability to understand and share the feelings of the client[1].
Positive Regard and Affirmation: Unconditional acceptance and support from the therapist[1].
Genuineness/Congruence: The therapist’s authenticity and transparency[1].
Client Expectations and Hope: The belief that therapy will be helpful and instilling hope for change[1][2].
Therapist Differences: Individual therapist qualities, such as interpersonal skills and responsiveness, can influence outcomes[1].
2. Client Factors
- Characteristics like motivation, resilience, social support, and external life circumstances often account for the largest share of improvement[2].
3. Placebo/Expectancy Effects
- The client’s belief in the treatment and the perceived credibility of the therapist and the process can significantly impact outcomes[1][2].
Empirical Findings
A 2014 summary of research provided the following breakdown of factors influencing psychotherapy outcomes[1]:
| Factor | % of Outcome Variance |
|---|---|
| Goal consensus/collaboration | 11.5% |
| Empathy | 9.0% |
| Therapeutic alliance | 7.5% |
| Positive regard/affirmation | 7.3% |
| Genuineness/congruence | 5.7% |
| Therapist differences | 5.0% |
| Treatment method | <1% |
Other meta-analyses and reviews confirm that the specific therapeutic modality or technique typically accounts for only a small fraction (5-11%) of the variance in outcomes, while common factors and client variables play a much larger role[3][1][2].
Reference to the Study
The claim that tools or modalities account for about 5-11% of healing is based on well-known research in psychotherapy, particularly the work of Michael J. Lambert and later meta-analyses by Bruce Wampold and others. These studies and reviews are widely cited in the field and support the idea that what matters most is not the specific technique, but the quality of the therapeutic relationship and other common factors[3][1][2].
In summary:
If you are training as a psychologist, focusing on building strong relationships, empathy, trust, and understanding client needs is scientifically shown to be more important for healing than mastering specific modalities or techniques. The evidence strongly supports the "common factors" model as the primary driver of successful psychotherapy outcomes.
[1] https://en.wikipedia.org/wiki/Common_factors_theory [2] https://www.uwspace.uwaterloo.ca/bitstreams/6df28353-e17f-4940-b474-3f7635844f9f/download [3] https://pmc.ncbi.nlm.nih.gov/articles/PMC4592639/ [4] https://psychodrama.org.nz/wp-content/uploads/resources/empirical-case-common.pdf [5] https://www.ncbi.nlm.nih.gov/books/NBK608012/ [6] https://research.vu.nl/files/105340005/annurev_clinpsy_050718_095424_The_Role_of_Common_Factors_in_Psychotherapy_Outcomes.pdf [7] https://bmjopen.bmj.com/content/13/6/e072277 [8] https://pmc.ncbi.nlm.nih.gov/articles/PMC6878277/ [9] https://www.annualreviews.org/doi/10.1146/annurev-clinpsy-050718-095424 [10] https://journals.copmadrid.org/pi/art/pi2021a4 [11] https://www.sciencedirect.com/science/article/pii/S0005796715000480 [12] https://oxfordre.com/psychology/display/10.1093/acrefore/9780190236557.001.0001/acrefore-9780190236557-e-79?p=emailAWo.6fmeK7xwY&d=%2F10.1093%2Facrefore%2F9780190236557.001.0001%2Facrefore-9780190236557-e-79 [13] https://pmc.ncbi.nlm.nih.gov/articles/PMC11024738/ [14] https://www.bacp.co.uk/media/14412/bacp-what-works-in-counselling-and-psychotherapy-relationships-gpac004-jan22.pdf [15] https://pubmed.ncbi.nlm.nih.gov/30550721/ [16] https://www.sciencedirect.com/science/article/pii/S2468125323001863 [17] https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.678397/full [18] https://www.whatworksintherapy.com [19] https://revistas.um.es/cpd/article/view/578171 [20] https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.2015.69.3.301