David Baxter PhD
Late Founder
Improving Therapy: What Can be Done?
by Elisha Goldstein, Ph.D., MentalHelp.net
Feb 9th 2010
If you have ever gone to therapy, are in therapy or are thinking about going to therapy, you might find this interesting. It was contemplated early on that when people go into therapy the outcome of them getting better is not dependent on the actual approach of therapy. In other words, the theoretical orientation of our therapists didn't matter. In research, Michael Lambert found this in 1992 a similar finding.
Overall, the largest variance in outcome (about 40%) is determined by factors that have nothing to do with the approach (e.g., as age, gender, prior history of depression, social support and other extratherapeutic factors). Another 15% is determined by the patients belief that s/he will get better or the placebo effect and then 15%, is accounted for by specific techniques unique to the treatment modality. So, at the end of the day, 30% of the variance in outcome is attributed to relationship factors that are present in most therapeutic encounters.
There have been arguments on the other side that say there are certain therapies that are better than others for specific issues such as Cognitive Behavioral Therapy for panic attacks or OCD.
However, what has long been speculated and is also true is that that percentage is attributed to the common factor of the relationship between therapist and client.
In her book, The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions, Shauna Shapiro makes an argument for The Mindful Therapist. She makes the point that one of the most important qualities of a therapist is the ability to pay attention. But not just any kind of attention, attention imbued with qualities of non-judgment, kindness, non-attachment, curiosity, patience, acceptance and trust.
Mindfulness training has been shown to cultivate better attention and also helps people integrate the aforementioned attitudes. It has also been shown to engage the same social neuro-circuitry of the brain that lights up when we're having interactions with others. This leads to the assumption that the more attuned we are with ourselves, the better able we are to attune to others.
In my own practice as a mindfulness-based psychotherapist I have found these skills essential in allowing me to connect with the people I'm working with and also able to recognize what I am experiencing and being able to bring that into the encounter. Mindfulness is the practice of cultivating pure awareness.
This is not to say that if a therapist did not have a mindfulness practice they are no good. Many skilled therapists embody the ability to be present with the attitudes I mentioned above. However, I would like to piggy back on Shauna Shapiro's point that cultivating a mindfulness practice could support many therapists in deepening their connection with qualities of attention that, I believe, facilitate that a positive outcome in the extra 30% that we have to work with.
One way the therapist and/or client can begin is with a brief practice, maybe focusing on the breath, grounding to the present moment and mindfully checking-in with what thoughts, sensations, or emotions are there. Shapiro mentions that it is even helpful to periodically ask the question, "Am I awake," during the session.
by Elisha Goldstein, Ph.D., MentalHelp.net
Feb 9th 2010
If you have ever gone to therapy, are in therapy or are thinking about going to therapy, you might find this interesting. It was contemplated early on that when people go into therapy the outcome of them getting better is not dependent on the actual approach of therapy. In other words, the theoretical orientation of our therapists didn't matter. In research, Michael Lambert found this in 1992 a similar finding.
Overall, the largest variance in outcome (about 40%) is determined by factors that have nothing to do with the approach (e.g., as age, gender, prior history of depression, social support and other extratherapeutic factors). Another 15% is determined by the patients belief that s/he will get better or the placebo effect and then 15%, is accounted for by specific techniques unique to the treatment modality. So, at the end of the day, 30% of the variance in outcome is attributed to relationship factors that are present in most therapeutic encounters.
There have been arguments on the other side that say there are certain therapies that are better than others for specific issues such as Cognitive Behavioral Therapy for panic attacks or OCD.
However, what has long been speculated and is also true is that that percentage is attributed to the common factor of the relationship between therapist and client.
In her book, The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions, Shauna Shapiro makes an argument for The Mindful Therapist. She makes the point that one of the most important qualities of a therapist is the ability to pay attention. But not just any kind of attention, attention imbued with qualities of non-judgment, kindness, non-attachment, curiosity, patience, acceptance and trust.
Mindfulness training has been shown to cultivate better attention and also helps people integrate the aforementioned attitudes. It has also been shown to engage the same social neuro-circuitry of the brain that lights up when we're having interactions with others. This leads to the assumption that the more attuned we are with ourselves, the better able we are to attune to others.
In my own practice as a mindfulness-based psychotherapist I have found these skills essential in allowing me to connect with the people I'm working with and also able to recognize what I am experiencing and being able to bring that into the encounter. Mindfulness is the practice of cultivating pure awareness.
This is not to say that if a therapist did not have a mindfulness practice they are no good. Many skilled therapists embody the ability to be present with the attitudes I mentioned above. However, I would like to piggy back on Shauna Shapiro's point that cultivating a mindfulness practice could support many therapists in deepening their connection with qualities of attention that, I believe, facilitate that a positive outcome in the extra 30% that we have to work with.
One way the therapist and/or client can begin is with a brief practice, maybe focusing on the breath, grounding to the present moment and mindfully checking-in with what thoughts, sensations, or emotions are there. Shapiro mentions that it is even helpful to periodically ask the question, "Am I awake," during the session.
