Optimising the therapy experience

Elements of good therapy

There is a large body of research about what a ‘good’ therapy should consist of, and it is remarkably consistent across all therapy modalities. Indeed, the precise orientation of your therapy (psychoanalytic, person-centred, CBT...) seems to have very little impact on its chances of success. Of more importance are factors that seem to be common to all therapies, which include:

  • The quality of the client-therapist relationship, which can itself be affected by variables such as:
    • Therapist warmth and genuineness – clients want to feel comfortable, respected and to have their priorities taken seriously
    • Therapist confidence in the treatment – clients want a therapist who believes in what they are doing and can give them ground for optimism.
    • Therapists who are willing to collaborate – clients come into an imbalanced power relationship with a therapist who usually has more knowledge and experience than them and the more you can treat your client as an equal the better.
  • A therapy or therapist that plausibly explains a client’s current problems according to some rational framework
  • Interventions involving the active participation of both therapist and client and which both believe are likely to improve things
  • Mutually agreed goals – these could be very clear ‘SMART’ goals with behavioural objectives or a more general agreement about the direction of the therapy. But therapies without an explicit agreement of some sort are less likely to do well.
  • Active monitoring of progress and intervention in ‘off-track’ therapies – contrary to folk belief, most people do not get worse before they get better. The best predictor of a good eventual outcome is an initial improvement in symptoms. Conversely, initial deterioration is a good predictor of failure and/or drop-out and requires immediate attention.
  • Client-sensitive treatments that are sensibly adjusted to individual need rather than imposed in strict obedience to a manual or protocol.

These may seem like obvious suggestions to which nobody could object but it might be worth occasionally stopping to check (in reflection, peer support, supervision or even with your client) how far your current practice meets this description, where it departs from it, and how you could get back towards this ideal.