-By Jeffrey Robinson

How Does Therapy Work? Unpacking the Common Factors in Psychotherapy

Therapy is often viewed as a mysterious process—a place where people go to discuss their feelings and, somehow, emerge feeling better. But what exactly happens in therapy that facilitates change and healing? While various therapeutic approaches differ in technique and philosophy, research suggests that it is not necessarily the specific techniques of a given therapy that are most crucial. Instead, what seems to matter most are the common factors that underpin all therapeutic modalities. Understanding these common factors provides a clearer answer to the question, “How does therapy work?”

The Foundation of Common Factors

The concept of common factors in psychotherapy has been a subject of interest and research for decades. Common factors refer to elements that are present in all effective therapies, regardless of the specific theoretical orientation. These factors are considered the core mechanisms that contribute to the success of therapy. The idea gained significant traction with the work of Bruce Wampold (2015), who argued that common factors, rather than specific therapeutic techniques, are the primary drivers of therapeutic success.

Wampold’s (2015) contextual model suggests that therapy works through a complex interplay of various elements, including the therapeutic relationship, the client’s beliefs and expectations, and the therapist’s characteristics. His research, along with numerous meta-analyses, has shown that these common factors account for a substantial portion of the variance in therapeutic outcomes (Elkins, 2022; Wampold, 2015)

The Therapeutic Relationship: A Key Common Factor

Among the most studied and supported common factors is the therapeutic relationship. The alliance between therapist and client is often cited as the most significant predictor of positive outcomes in therapy. This relationship is built on trust, empathy, and mutual respect, allowing clients to feel safe and understood. When clients believe that their therapist genuinely cares for their well-being and understands their experiences, they are more likely to engage fully in the therapeutic process.

Research has consistently shown that a strong therapeutic alliance contributes more to successful outcomes than any specific therapeutic technique. This finding underscores the importance of the human connection in therapy—clients heal not just because of what therapists do, but because of who therapists are and how they relate to their clients.

Client Factors: The Active Role of the Client in Therapy

While the therapist plays a crucial role, the client’s involvement and characteristics are equally important. Arthur Bohart (2013), a prominent figure in the common factors movement, emphasized the client’s active participation in therapy. He suggested that clients are not passive recipients of therapy but active agents in their own healing. This perspective aligns with the view that clients’ personal strengths, resources, and motivations significantly influence therapy outcomes.

Clients who are motivated, open to change, and actively engage in the therapeutic process tend to experience better outcomes. Moreover, the client’s belief in the efficacy of the therapy, often referred to as “expectancy effects,” plays a crucial role. When clients expect that therapy will help them, they are more likely to experience positive changes.

The Therapist’s Skills and Qualities

Another essential common factor is the therapist’s personal qualities and professional skills. Therapists who exhibit empathy, warmth, and genuineness create an environment conducive to healing. These qualities help to establish a strong therapeutic alliance, enabling clients to explore difficult emotions and experiences.

Therapists’ ability to adapt their approach to meet the individual needs of their clients—often referred to as “therapeutic responsiveness”—is also critical. This involves adjusting the therapeutic techniques and interventions based on the client’s feedback and progress, ensuring that the therapy remains relevant and effective for each client’s unique situation..

The Role of the Therapeutic Environment

The setting in which therapy takes place is another common factor that influences outcomes. A therapeutic environment that feels safe, private, and supportive allows clients to open up and engage fully in the process. This environment includes not only the physical space but also the emotional climate created by the therapist. A healing setting is one where clients feel respected, heard, and valued, which enhances their ability to work through their issues.

The Integration of Common and Specific Factors

While common factors are critical, it is essential to acknowledge that specific therapeutic techniques also play a role in therapy’s effectiveness. The debate between common factors and specific techniques is not about choosing one over the other, but rather understanding how they interact. Recent research suggests that specific techniques may enhance the therapeutic process by working within the framework provided by the common factors.

For instance, a therapist might use cognitive-behavioral techniques to help a client challenge negative thought patterns. However, the effectiveness of these techniques is often contingent upon a strong therapeutic alliance and the client’s belief in the process. Thus, therapy works best when specific techniques are applied within a context of strong common factors.

Conclusion: The Synergy of Common Factors

So, how does therapy work? The answer lies not in any single technique or approach but in the synergy of various common factors that transcend specific therapeutic models. The therapeutic relationship, client involvement, therapist qualities, and the therapeutic environment all come together to create a space where healing and change can occur.

Understanding the importance of common factors shifts the focus from the “brand” of therapy to the quality of the therapeutic process. Whether therapy is psychodynamic, cognitive-behavioral, humanistic, or any other approach, what ultimately drives success is the presence of these fundamental elements. By fostering strong therapeutic relationships, maintaining a responsive and supportive environment, and engaging clients as active participants, therapists can help facilitate meaningful change in their clients’ lives.

Therapy, at its core, is a human endeavor—a collaborative process where both therapist and client contribute to the journey of healing. And it is this shared human experience, supported by the common factors, that makes therapy work.

Jeff holds a PhD in Social Psychology, a Masters in Counselling Psychology, and a certificate as an ADHD Clinical Services Provider. His clinical skills combined with his passion for Philosophy enable him to help his clients delve the depths, and think differently. To book a free consult with Jeff, reach out to us via the contact form and he’ll be happy to discuss how he can help

References

Bohart. A. C., & Wade, A. G. (2013). The Client in Psychotherapy. In M. J. Lambert

(Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 219-257). Hoboken, New Jersey: John Wiley & Sons, Inc.

Cuijpers, P., Reijnders, M., & Huibers, M. (2019). The role of common factors in psychotherapy

outcomes. Annual Review of Clinical Psychology, 15, 207-231. https://doi.org/10.1146/annurev-clinpsy-050718-095424

Elkins, D. N. (2022). Common Factors: What Are They and What Do They Mean for Humanistic Psychology? Journal of Humanistic Psychology, 62(1), 21-30. https://doi.org/10.1177/0022167819858533

Meier, D., Tschacher, W., Frommer, A., Moggi, F., & Pfammatter, M. (2023). Growth curves of common factors in psychotherapy: Multilevel growth modelling and outcome analysis. Clinical Psychology & Psychotherapy. https://doi.org/10.1002/cpp.2864

Lauritzen, L. R., Jacobsen, C. F., Nielsen, J., Lunn, S., Mathiesen, B. B., Falkenström, F., & Poulsen, S. (2024). Common factors, responsiveness, and outcome in psychotherapy (CROP): Study protocol for a naturalistic prospective cohort study of psychotherapy in Denmark. BMJ Open, 13. https://doi.org/10.1136/bmjopen-2023-072277