Thread by @JDaviesPhD

A short 🧵on how therapy works. Firstly, the kind of therapy (CBT, humanistic, psychodynamic, etc) does not solely determine outcomes. Research shows that *common factors* shared across therapies account for the majority of any improvement. Here’s what that research tells us👇

2/ e.g Research by Michael Lambert’s et al (based on dozens of metaanalyses) breaks down the influence of different factors on good therapy outcomes:
40%: Client factors & life circumstances
30%: Therapeutic relationship
15%: Expectancy/placebo effects
15%: Technique or method

3/ But what about the characteristics of the therapist?- are they not important too? Well, of course. Common factors Research shows they're integral to all aspects of the work, influencing everything from the depth of the therapeutic relationship; to how strong the alliance is...

4/...to how efficacious the technique is, to how much hope/engagement the client can muster. Practitioner traits enabling good outcomes also include the capacity to be empathetic, deeply listen, to be flexible, culturally sensitive & able to carefully challenge & repair ruptures

5/ Further, even within the same therapeutic model, different therapists wont get the same results.
Some therapists within the same model consistently outperform others irrespective of the clients seen. That suggests that *who* the therapist is matters more than *what* they do...

6/ This is to say, the personal qualities of the therapist, amplify the power & potential positive impact of any technique. A cold or rigid therapist using the 'right' method won’t get far, while a skilled, warm therapist can make even a modest intervention more effective.

7/ In the end: Outcome research indicates that therapy works best when the qualities of the client, approach & therapist all align positively to effect change. If you are interested in reading more, then here's a good primer to start with: academic.oup.com/book/30015