What really helps counselees get better? A colleague handed me a newspaper editorial from the Bangor, Maine Daily News, written by Thomas Gaffney and published July 12, 2006. The editorial reviewed the situation in psychotherapy: Some 400 treatment approaches, 100 that are considered “evidenced based”, and yet many research studies show that most treatment approaches work equally well, about 80% of the time compared to non-treatment.
The editorial goes on to state that there are 4 factors for successful treatment:
1. Client strengths and resources (accounts for 40% of success)
2. Quality of client-therapist relationship (per the client) (accounts for 30% of success)
3. Client’s hope and expectation of success (accounts for 15% of success)
4. Techniques of the counselor (accounts for 15% of success)
While these numbers undoubtedly have some truth in them and while they do challenge the managed care notion of medicate first, the truth is a bit more complex. Psychotherapy is evaluated by both effectiveness and efficacy studies. Effectiveness has to do with real life change while efficacy has to do more with laboratory studies and observed change. Neither do us wonders. Who determines effectiveness? If the client, is it based on actual help or feeling better? Who determines efficacy? If there is change, does it last and is it enough?
Bottom line, counselors would do well to pay attention to using client resources and building a good relational bond in order to jointly choose good goals and techniques.
Musings on Faith and Psychology 
We recently studied this in my theories class at school (the percentages were in the book). Needless to say it has taught me alot with regards to how far congruence, respect and warmth for a client can take the relationship.
Basically, how we interact with people is important. If they already feel judged by everyone else in their life, why would they want to pay me to do that too? Having been in counseling myself, it was important to me to have someone treat me with unconditional acceptance. I hadn’t felt validated by anyone. And once the trust was built, THEN i could hear them speak truth to me through confrontation.
As for client’s strengths and resources, much of what I learned in counseling I then took and put into practice outside of sessions. Others had hurt me, but I was responsible for choosing what to do with that pain. In the same way, the counselor was responsible for showing me the skills/new ways of thinking/behaving, etc., but it was still up to me to incorporate what I learned into everyday life.
Thanks for sharing Phil!
Great line: “…why would they want to pay me to do that [judge them] too?” Funny thing, lots of folks come to counseling expect that very thing to happen and so judge themselves, outloud, before the counselor can do it to them. If I judge myself first then you can’t hurt me. Unfortunately, this kind of self-condemnation actually makes the counselee less open to change.