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WHAT MAKES MIND THERAPY
WORK
Techniques and other
factors
*For an
explanation of the term 'functional mental
disorders', see the page
The Nature of 'Mental Illness'
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Because the medically-categorised functional mental disorders*
are conjectural clusters of symptoms,
none is more responsive
to particular theories of mind therapy than to others. Despite
the claims made by some 'schools', no
particular set of techniques – such as psycho-analytic
interpretations, systematic desensitisation,
dream analysis, guided imagery, hypnosis,
relaxation exercises, role playing and
biofeedback – is more efficacious than others.(1)
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'Non-Specific' Factors
*See: Saul Rosenzweig: 'Some implicit common factors in diverse methods of
psychotherapy' pp 412-415 American Journal of Orthopsychiatry 6 (1936)
and
G. Watson: 'Areas of agreement in psychotherapy' pp 698-709 American
Journal of Orthopsychiatry 10 (1940)
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Since 1936 at least, therapists have recognised that the most
important factors in beneficial
mind therapy are 'non-specific' and common to all the 'schools'.
These include clients' belief
that the therapy will help them, the quality of
the client-therapist relationship and concentration by client
and therapist on the client's objectives.*
Another major factor is the
readiness of clients to help themselves. Therapists are
there to provide the right kind of help and encouragement; but their
efforts will prove futile if clients merely talk and listen
without trying to put into practice what they learn in the
consulting room.
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'Client factors'
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The willingness of clients to help themselves may well depend on:
their particular circumstances; the support they receive from
family, friends, colleagues and so on; their
natural resilience to setbacks and being prepared to alter their circumstances or
themselves in some way.(2) In fact, according to
M. J. Lambert,
'A substantial number of
outpatients (on a waiting list
for their initial appointment) improved without formal psychological
intervention'.(3)
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The therapist factor
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A therapist's ability to foster a conducive working relationship,
or 'therapeutic alliance' is also very important. This largely
depends on their
interpersonal, or 'people', skills — such as the ability to:
get to know the real person
behind the 'mask' of status, appearance, manner and beliefs;
imagine
themselves in the client's situation;
understand and show they understand what
a client is struggling to communicate;
dedicate themselves to the task in hand;
provide emotional support as appropriate.
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'The attitude of the
psychotherapist is infinitely more important
than the theories and methods of
psychotherapy'. Carl Gustav Jung(4)
'Experience has taught me to keep away
from therapeutic 'methods' as much as from
diagnoses ... everything depends on the man
and little or nothing on the method.' Carl
Gustav Jung(5)
'.. however much therapists may focus on
the technical aspects of their procedures, an
increasing body of evidence suggests that it
is the personal relationship between
themselves and their patients which is
experienced by the latter as the most potent
therapeutic force.'
David
Smail(6)
'Some years ago I formulated the view
that it was not the special or professional
knowledge of the therapist, nor his
intellectual conception of therapy (his
'school of thought') , nor his techniques
which determine his effectiveness. I
hypothesised that what was important was the
extent to which he possessed certain personal
attitudes in the relationship.' Carl R. Rogers(7)
'... the crucial factor in psychotherapy
is not so much the method, but rather the
relationship between the patient and his
doctor or, to use a popular expression the
'encounter', between the therapist and his
patient. This relationship between two
persons seems to be the most significant
aspect of the therapeutic process, a more
important factor than any method or
technique.' Victor E. Frankl(8)
'Experience provides
clinicians with a special sense of what
should be done next in (psycho)therapy: on a
deep level, this special sense reflects a
very complex decision-making process that is
informed by dozens, perhaps hundreds, of bits
of data related to the client, the therapist
and the context.' John
D.W. Andrews, John C. Norcross & Richard
P. Halgin(9)
'If any single fact has been
established by psychotherapy research, it is
that a positive relationship between patient
and therapist is positively related to
therapy outcome.' Irvin D. Yalom(10)
'A psychoanalyst's personality is his
major therapeutic tool.'
Henri F. Ellenberger(11)
'If I can only be myself in the
relationship, not a professional expert, not
a "psychologist", not a
"psychotherapist", just me in that
relationship, that's helpful.' Carl R. Rogers(12)
'... we are only more helpful than the
average layperson because of our greater
experience of people in distress ... rather
than because of our extensive knowledge of
psychodynamic/humanistic theory and practice
... By simple virtue of being professionals,
we may be seen as knowing best — and we may
come to believe in this myth ourselves,
perhaps setting great store by psychodynamic
formulations rather than being a fellow
pilgrim with our clients ...' Gill Edwards(13)
'There is growing evidence that
effectiveness in therapy is primarily
dependent on the quality of the relationship
between therapist and patient and that that,
in turn, depends on the quality of the
therapist. The results of psychotherapy are,
however, difficult to assess, especially
since many or most of the conditions treated
naturally improve with time. There can be
little doubt that many people can benefit
greatly from wise and considered counselling
by an educated and experienced life-guide. Whether there is any school of
psychotherapeutic training which can produce
such qualities is another matter.' Robert M. Youngson(14)
'... it is becoming increasingly obvious
that the (psycho)therapist's personality is a
more decisive factor than the school to which
he belongs. Arthur Koestler(15)
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References:
(1) L.
Luborsky, B. Singer & L. Luborsky: 'Comparative studies of psychotherapies: is it true
that "everybody has won and all must have prizes"?' pp
995-1008 Archives of General Psychiatry 32 (1975)
D.A. Shapiro & D. Shapiro: 'Meta-analysis of
comparative therapy outcome studies: a republication and
refinement' pp 581-604 Psychological Bulletin 92 (1982)
(2)
Michael J. Lambert 'Psychotherapy outcome research' pp
94-129 in Handbook of Psychotherapy Integration [John C.
Norcross & Marvin R. Goldfried (eds)] Basic Books, New York
1992
(3)
'Spontaneous remission
in adult neurotic disorders: a revision and summary' pp 107-119 Psychological
Bulletin 83
(4)
p. 281 Modern Man in Search of a
Soul. Routledge & Kegan Paul, London 1933
(5)
'The Realities of Practical
Psychotherapy' p. 329 in The Practice of Psychotherapy Routledge
& Kegan Paul, London 1966
(6) p. 49 Illusion and Reality.
J.M. Dent & Sons, London 1984
(7)
p. 81 Person to Person (co-author
B. Stevens). Souvenir Press, London 1973
(8)
p. 137 Psychotherapy &
Existentialism. Penguin, Harmondsworth 1973
(9) 'Training in psychotherapy
integration' pp 576-577 in Handbook of Psychotherapy
Integration [John C. Norcross & Marvin R. Goldfried (eds)] Basic Books, New York 1992
(10) p. 401 Existential
Psychotherapy. Basic Books, New York 1980
(11)
The Discovery of the Unconscious. Basic
Books, New York 1970, p. 48
(12)
Interviewed by Tony Hobbs ['The Rogers
Interview' Changes vol. 4, no 4, 1986, p. 255]
(13)
p. 22 Changes vol.3, no 1 (1984)
(14) p. 670 Encyclopedia of Family
Health. The Royal Society of Medicine, London 1995
(15)
p. 248 The Act of Creation Hutchinson
& Co., London 1964
Suggested Reading:
D.M. Stein &
M.J. Lambert: 'On
the relationship between therapist experiences
and psychotherapeutic outcomes' pp 1-16 Clinical
Psychology Review 4 (1984)
Hans Strupp & Suzanne Hadley: 'Specific
versus non-specific factors in psychotherapy' pp
1125-1136 Archives of General Psychiatry
36 (1979)
The Heart and Soul of Change: What Works in
Therapy by Mark A. Hubble, Barry L. Duncan,
Scott D. Miller. American Psychology Association,
Washington DC 1999
The Great Psychotherapy Debate by Bruce
E. Wampold. Lawrence Erlbaum Associates, Mahwah,
New Jersey 2001
The
Heroic Client: A revolutionary way to improve effectiveness through
client-directed, outcome informed therapy by B. Duncan, S.
Miller, J. Sparks, G. Jackson, R. Greenberg, K.Kinchin. Jossey Bass,
San Francisco 2004
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