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

Surviving Grief During the Holidays

Losing someone you love sucks. Losing someone you love near the holidays sucks. Losing someone you love and then going through the holiday season for the first (or second, or sixth, or tenth…) time without them sucks.

Unfortunately, death is all too familiar to all of us and, as a counselor who specializes in grief, I often find myself talking to my clients who are grieving about how to survive the holidays. Here are a few tips:

  • Plan ahead.
    • Often times the anxiety that comes from the anticipation of the holidays as well as all of the what questions (“What will I do?”, “Where will I go?”) can be worse than the actual holidays themselves. Take some time to think about what you will need that day.
  • Give yourself permission to take care of you.
    • In all of your planning ahead, if you decide that what you need is stay home and be by yourself or just be with your immediate family; do it. If you decide that what you need is to be surrounded by many people that love and care for you; do that. If your typical holiday involves going to two or more different households to celebrate, but you really only have the energy to go to one; then just go to one. Be honest with your loved ones and explain to them that this year, “It’s going to take a lot of energy for me to just get through the day, so I’m going to need to head home early. I’m sorry to miss the festivities.” Grieving is very difficult, very emotional work and you are the only one who can take care of you.
  • Keep some traditions and think about starting new ones.
    • When someone close to us dies, there might be a part of us that wants everything to be different and yet everything to stay the same. It’s a good idea to think ahead about some of the meaningful traditions you had with your loved one and keep those. These can help you connect with your loved one. (More on this later.) Also, it may be helpful to include some new meaningful traditions too. For example, light a special candle or make their favorite holiday food to honor your loved ones memory. If you have kids, perhaps making a special craft, such as laminated placemats with drawings or pictures of your loved one and family, would help to include children who are grieving. These kinds of traditions can also help inspire others to share stories and reminisce about their loved one, which is a healthy and meaningful way to move through the grief process.
      • And while we’re on this topic, here’s something that some people might not know. FACT: (Most) people who are grieving WANT you to talk about their loved one because it helps them in their grief to know that their loved one hasn’t been forgotten. So, if you know someone who’s grieving and you’re not sure if you should bring up their loved one who died, share an old story, or tell them how something recently in your life reminded you of their loved one, I would encourage you to either ask the person who’s grieving if they’d like to hear it, or just say it anyway despite any uncertainty that may arise within you personally. I’ve heard countless stories about how these seemingly small stories can have a big impact on a person’s grief. But I digress. On to the next tip.
  • Find ways to connect with your loved one.
    • This one is so important. Losing a loved one often feels like a hole has been left in your heart. Although you grieve the existence of that hole, it’s also important to honor this space that is solely theirs by finding ways to connect and feel as close as you possibly can to your loved ones. So think about this, how/where/when do you feel closest to your loved one? Is it at the cemetery, in nature, at church, while listening to a particular song, while talking to them as if they were still here to listen, or maybe it’s when you sit in silence? Whatever it is, make time to connect with them.
  • Take time to grieve.
    • You’ve lost someone. You may feel sad, angry, hurt, confused, worried, and empty, so it’s important to acknowledge exactly those emotions. Take time to cry, scream, punch a pillow, talk through what you are thinking and how you are feeling at that moment with someone you trust. The only way to manage grief is to move through it and acknowledge the myriad of thoughts and emotions you have along the way.
  • Find some space for joy
    • Finally, it’s important to find even the smallest joy. Everyone needs a break from their grief sometimes, so think about what may help you crack a smile for a moment. Even if it’s a mindless TV sitcom or some silly YouTube video, give yourself permission to find some joy in the day in some way.

Wishing you all a holiday season full of joy, hope and peace.