Why Therapy Works (Or Doesn’t Work)

You may wonder why going to therapy works for some people but not everyone. Or maybe you yourself went to therapy in the past with no success, but then you tried it again later and found it more meaningful and helpful. Here is some information on what may have been working or not working in your therapy.

During my grad school days, we were introduced to research done by Hubble, Duncan, & Miller (1999) in their book The heart and soul of change: What works in therapy? This book outlines four factors that influence change and success in therapy. I often share these with my clients during our first session together because I think it’s worthwhile information. So here it is…

  1. Client Factors: This is basically what you bring to the table: the characteristics of your personality, your inner strengths, support system, your environment or other components of life that may affect change such as any unforeseen event either positive or negative. This factor is estimated to contribute 40% to meaningful change in therapy.
  2. Client/Counselor Relationship: This factor accounts for 30% of change and has everything to do with the trusting relationship between the therapist and the client. I stress to my clients that it is imperative to have a strong therapeutic relationship based on empathy, acceptance, compassion and encouragement. (For more info on how to choose the right therapist for you, stay tuned for a future blog post on this topic!)
  3. Therapeutic Technique: These are the interventions/techniques that the therapist uses in session with you. (i.e. Cognitive Behavioral Therapy, Mindfulness, Dialectical Behavioral Therapy, etc.) It also includes your particular counselor’s theoretical orientation. I consider myself to be an integrative therapist which means that I pull tools from various theories in order to cater my treatment to the needs of my clients. My theoretical orientation is also largely inspired by mindfulness as well as the philosophy of trauma outlined by my training in Eye Movement Desensitization and Reprocessing (EMDR) therapy. This factor makes up 15% of the change process.
  4. Hope and Expectancy: Lastly, another 15% of the change process comes from being hopeful at the beginning of therapy or becoming more hopeful as the therapeutic process continues. Believing in the reliability of the treatment and the likelihood that positive and lasting change will happen as a result of doing the hard work is helpful in predicting success.

If your last experience in therapy was just “meh”, I hope this information will help you understand which factor may have been lacking. If you’re thinking about going back to therapy, I’d encourage you to take a look at these four factors. Do a little soul searching related to your personal client factors, hope and expectancy, and then choose a therapist whose personality and therapeutic approach feel right for you.

For more information about this research and the four factors, check out the links below.

Journal Article about Hubble, Duncan & Miller

Hubble, Duncan & Miller’s Book