Psychotherapy is a dynamic interplay of biological, psychological, and social dimensions, all converging to foster meaningful change. Being a vast field, psychotherapy encompasses many approaches, techniques, and philosophies. Despite this diversity – and sometimes because of it, someone who is considering talk therapy could face difficulties in deciding which type of practitioner and what type of therapy would be best suited for them. Research has consistently identified several key factors that contribute significantly to successful therapeutic outcomes for clients of psychotherapy. One of the most influential models in understanding these outcomes comes from Michael Lambert (1992), who identified four "common factors" responsible for client change in psychotherapy. In this blog post we look at these factors — client factors, the therapeutic alliance, expectancy effects, and therapeutic techniques — which can be useful to consider among others, if you are in the process of deciding to work with a therapist.
Client Factors: It's about you
Client factors, which includes personal attributes such as motivation, resilience, and life circumstances, play a major role in therapy. Lambert’s research indicated that up to 40% of the variance in therapeutic success can be attributed to these. A client’s readiness for change, events outside the therapy room, and external support systems are examples of client-related factors. This suggests that your own unique factors play a major role on the effectiveness of therapy.
The Therapeutic Alliance: Building a Healing Connection
The next biggest factor that Lambert found brought about client change was the therapeutic relationship. This includes the bond between therapist and client, mutual trust, and the collaborative nature of their work. One of the most extensively researched factors in psychotherapy, numerous studies have found that a strong therapeutic relationship is consistently correlated with positive outcomes, regardless even of the specific therapeutic approach.
Expectancy Effects: The Power of Belief
To a lesser extent, Lambert as well as other researchers found that individuals’ belief in the effectiveness of therapy and the hope or optimism that therapy generates itself as an important factor. this means that clients who believe in the therapy process and expect to benefit from it often experience more significant improvements! So, if you develop positive expectations and have hope in the therapeutic process, it is more likely to work for you.
Therapeutic Techniques: Tailoring Interventions to the Client
Unsurprisingly, specific techniques or interventions used by the therapist contributes towards client change too. However, their effectiveness can depend on the therapist’s ability to apply and adapt them to the client's unique needs. If you are starting on therapy, can you identify a therapist skilled in various methods and approaches who work in a way that resonates with you?
Additional Factors Influencing Therapy
Related to the last point above, other research has emphasised the importance of therapist characteristics, such as competence, empathy, and emotional stability. Studies like those by Wampold (2015) demonstrate that different therapists applying the same therapeutic framework can cause variability in client outcomes. Thus, a therapist's experience, training, and personal qualities cannot be overlooked. The context of therapy is another crucial factor. Research on culturally competent therapy shows that when therapy is sensitive to the client's cultural background, it tends to be more effective.
Although sometimes overlooked, the therapeutic environment — whether it is safe, comfortable, and private — can significantly impact the client’s ability to engage openly in the process. If you are accessing therapy online, this can include that you are sure nobody will overhear your conversation and that there are unlikely to be any interruptions during the time you spend in therapy.