The Treatment Model of Psychotherapy
This month’s column is based on a very interesting presenting I heard a year or so ago from Dr.
Arthur C. Bohart about what actually makes therapy work.
The traditional assumption
is that a patient or client presents their problems and the therapist makes a diagnosis. From that diagnosis,
the therapist chooses what treatment to apply (medication, cognitive behavioral therapy, a Rogerian or Jungian approach, etc)
to the patient’s condition. The patient is then “fixed” by the treatment.
is a “treatment” model of therapy. The emphasis is on treatment techniques with specific treatments
for specific disorders. Relationship between the patient and the therapist is secondary but does serve
a support function.
However studies do not support this model. There seem to
be no statistically valid differences in outcome due to different treatments being used.
the Therapeutic Relationship Make the Difference?
Studies show that therapist empathy only
accounts for about 8% of the outcome of therapy. There is little evidence that professional training and
experience makes one a better therapist. My own past experience in training and supervising lay therapists
(volunteers with an interest in helping but with no professional education or licensing) is that they made excellent therapists,
often with better outcomes than professionals with the same patient populations.
In addition, self-help
studies show that the therapeutic relationship is not necessary at all.
So What Is Most
If different approaches work equally well, if techniques play only a small role,
if professional training is not that important, and if, in fact, therapists aren’t even needed, what conclusion does
this lead us to?
The answer is that the patient or client is the most important common factor.
Client involvement is the single best predictor of outcome of psychotherapy.
So the client
is an active self-healer. The client or patient invests in the therapeutic procedures offered, thinks about
the process, draws his/her own meaning from it, and creatively translates what happens in therapy into his/her own life to
As I reach my 40th anniversary since becoming a professional therapist,
I can attest to the fact that this is true. It’s like the old joke about how many psychologists it
takes to change a light bulb…one, but the bulb has to want to change!
it still worthwhile trying to find a therapist who offers what you want or need? Of course, but that is
because as the client or patient, that will be the only context in which you will be willing to do the work you need to do.