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The Client Is the Most Important Common Factor: Clients' Self-Healing Capacities and Psychotherapy

Abstract

I first briefly review the “dodo bird verdict” and suggest that we should be responding to it by looking for a new way to conceptualize how therapy works. Then I describe the dominant “medical” or “treatment” model of psychotherapy and how it puts the client in the position of a “dependent variable” who is operated on by supposedly potent therapeutic techniques. Next I argue that the data do not fit with this model. An alternative model is that the client is the most important common factor and that it is clients' self-healing capacities which make therapy work. I then argue that therapy has two phases—the involvement phase and the learning phase—and that the involvement phase is the most important. I next review the five learning opportunities provided by therapy. Finally, I argue that a relational model of therapy focused on consultation, collaboration, and dialogue is better than a treatment model.

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References

  1. Arkowitz, H. (1997, December). Will the “eal” therapist please stand up: Understanding the client's active role in the change process. Discussion paper presented at the Meeting of the North American Society for Psychotherapy Research, Tucson, Arizona.

  2. Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33–56). Washington, DC: American Psychological Association.

  3. Bachelor, A., & Horvath, A. (1999). The therapeutic relationship. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 133–178). Washington, DC: American Psychological Association.

  4. Bandura, A. (1997). Self-efficacy. New York: Freeman.

  5. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

  6. Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-focused approach. New York: Norton.

  7. Bergin, A. E., & Garfield, S. L. (l994). Overview, trends, and future issues. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 821–830). New York: Wiley.

  8. Beutler, L. E. (1986). Systematic eclectic psychotherapy. In J. C. Norcross (Ed.), Handbook of eclectic psychotherapy (pp. 94–131). New York: Brunner/Mazel.

  9. Beutler, L. E., Engle, D., Mohr, D., Daldup, R. J., Berjan, J., Meredith, K., & Merry, W. (1991). Predictors of differential and self-directed psychotherapeutic procedures. Journal of Consulting and Clinical Psychology, 59, 333–340.

  10. Bohart, A., & Tallman, K. (1996). The active client: Therapy as self-help. Journal of Humanistic Psychology, 36, 7–30.

  11. Bohart, A., & Tallman, K. (1999). How clients make therapy work: The process of active selfhealing. Washington DC: American Psychological Association.

  12. Brown, J., Dreis, S., & Nace, D. K. (1999). What really makes a difference in psychotherapy outcome? Why does managed care want to know? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 389–406). Washington, DC: American Psychological Association.

  13. Christensen, A. (1992, April). The challenge of nonprofessional therapies. Paper presented at a symposium on Extending the Integrative Boundaries: What Self-Change Processes Can Teach Us, Convention of the Society for the Exploration of Psychotherapy Integration, San Diego, California.

  14. Christensen, A., & Jacobson, N. S. (1994). Who (or what) can do psychotherapy: The status and challengeof nonprofessional therapies. Psychological Science, 5, 8–14.

  15. Dazoid, A., Gerin, P., Seulin, C., Duclos, A., & Amar, A. (1997). Day-treatment evaluation: Therapeutic outcome after a treatment in a psychiatric day-treatment center: Another look at the “utcome equivalence paradox.” Psychotherapy Research, 7, 57–70.

  16. De Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

  17. Duncan, B. L., Hubble, M. A., & Miller, S. D. (1997). Psychotherapy with impossible cases: The efficient treatment of therapy veterans. New York: Norton.

  18. Duncan, B. L., & Miller, S. D. (2000). The client's theory of change: Consulting the client in the integrative process. Journal of Psychotherapy Integration, this issue.

  19. Dweck, C. S., & Leggett, E. L. (1988). A social-cognitive approach to motivation and personality. Psychological Review, 95, 256–273.

  20. Efran, J. S., & Blumberg, M. J. (1994). Emotion and family living: The perspective of structure determinism. In S. M. Johnson & L. S. Greenberg (Eds.), The heart of the matter (pp. 172–206). New York: Brunner/Mazel.

  21. Elkin, I. (1994). The NIMH treatment of depression collaborative research program: Where we began and where we are. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 114–142). New York: Wiley.

  22. Elliott, R. (1984). Adiscovery-oriented approach to significant change events in psychotherapy: Interpersonal process recall and comprehensive process analysis. In L. S. Greenberg & L. N. Rice (Eds.), Patterns of change (pp. 249–286). New York: Guilford Press.

  23. Elliott, R. (in press). Research on the effectiveness of humanistic therapies: A meta-analysis. In D. J. Cain & J. Seeman (Eds.), Handbook of research and practice in humanistic psychotherapies. Washington DC: American Psychological Association.

  24. Feldman, P. E. (1956). The personal element in psychiatric research. American Journal of Psychology, 113, 52–59.

  25. Fensterheim, H. (1999, April). Untitled presentation. Clinical exchange: The case of Mrs. C. (John Norcross, Chair), Convention of the Society for the Exploration of Psychotherapy Integration, Miami.

  26. Finke, R. A. (1995). Creative insight and preinventive forms. In R. J. Sternberg & J. E. Davidson (Eds.), The nature of insight (pp. 255–280). Cambridge, MA: MIT Press.

  27. Fishman, D. B. (1999). The case for pragmatic psychology. New York: New York University Press.

  28. Frank, J. D. (1974). Psychotherapy: The restoration of morale. American Journal of Psychiatry, 131, 271–274.

  29. Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 190–228). New York: Wiley.

  30. Gerin, P., Dazoid, A., Guisti, P., Sali, A., & Marie-Cardine, M. (1992). L'Evaluation des facteurs psychothérapeutiques de changement en hôpital psychiatrique. Psychotherapies, 2, 123–132.

  31. Gold, J. R. (1994). When the patient does the integrating: Lessons for theory and practice. Journal of Psychotherapy Integration, 4, 133–158.

  32. Gold, J. (2000). The psychodynamics of the patients' active episodes, Journal of Psychotherapy Integration, this issue.

  33. Goldfried, M. R. (1995). From cognitive-behavior therapy to psychotherapy integration. New York: Plenum Press.

  34. Goldfried, M. R. (1997, April). Cognitive-behavioral theory and technique for psychodynamic/ non-behavioral therapists. Workshop presented at the Convention of the Society for the Exploration of Psychotherapy Integration, Toronto, Canada.

  35. Gould, R. L. (1989). Therapeutic learning program [Computer software]. Santa Monica, CA: Interactive Health Systems.

  36. Gould, R. A., & Clum, G. A. (1993). A meta-analysis of self-help treatment approaches. Clinical Psychology Review, 13, 169–186.

  37. Greenberg, L. S. (1984). A task analysis of intrapersonal conflict resolution. In L. N. Rice & L. S. Greenberg (Eds.), Patterns of change (pp. 67–123). New York: Guilford Press.

  38. Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The momentby-moment process. New York: Guilford Press.

  39. Greenberg, R. P. (1999). Common psychosocial factors in psychiatric drug therapy. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 297–328). Washington, DC: American Psychological Association.

  40. Grencavage, L. M., & Norcross, J. C. (1990). Where are the commonalities among the therapeutic common factors? Professional Psychology: Research and Practice, 21, 372–378.

  41. Gurin, J. (1990, March). Remaking our lives. American Health, 1990, 50–52.

  42. Hubble, M. A., Duncan, B. L., & Miller, S. D. (1999). Directing attention to what works. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 407–448). Washington, DC: American Psychological Association.

  43. Jacobs, M. (Chair). (1995). Computer psychotherapy: The direction of the future? Symposium presented at the Western Psychological Association Convention, Los Angeles.

  44. Kirsch, I., & Lynn, S. J. (1999). Automaticity in clinical psychology. American Psychologist, 54, 504–515.

  45. Kohlenberg, R. J., & Tsai, M. (1987). Functional analytic psychotherapy. In N. Jacobson (Ed.), Psychotherapists in clinical practice: Cognitive and behavioral perspectives (pp. 388–443). New York: Guilford Press.

  46. Lakoff, G. (1987). Women, fire, and dangerous things: What categories reveal about the mind. Chicago: University of Chicago Press.

  47. Lambert, M. (1992). Psychotherapy outcome research. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic.

  48. Leary, D. E. (1990). Psyche's muse: The role of metaphor in the history of psychology. In D. E. Leary (Ed.), Metaphors in the history of psychology (pp. 1–78). New York: Cambridge University Press.

  49. Luborsky, L., McClellan, A. T., Woody, G. E., O'Brien, C. P., & Auerbach, A. (1985). Therapist success and its determinants. Archives of General Psychiatry, 42, 602–611.

  50. Mahrer, A. R. (1996). The complete guide to experiential psychotherapy. New York: Wiley.

  51. Masten, A. S., Best, K. M., & Garmazy, N. (1990). Resilience and development: Contribution from the study of children who overcome adversity. Development and Psychopathology, 2, 425–444.

  52. Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel. New York: Norton.

  53. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.

  54. Murphy, J. J. (1999). Common factors of school-based change. In M. A. Hubble, B. L. Duncan, & S. M. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 361–388). Washington DC: American Psychological Association.

  55. Norcross, J. C. (1986). Eclectic psychotherapy: An introduction and overview. In J. C. Norcross (Ed.), Handbook of eclectic psychotherapy (pp. 3–24). New York: Brunner/Mazel.

  56. Norcross, J. C., Glass, C. R., Arnkoff, D. B., Lambert, M. J., Shoham, V., Stiles, W. B., Shapiro, D. A., Barkham, M., & Strupp, H. H. (1993). Research directions for psychotherapy integration: A roundtable. Journal of Psychotherapy Integration, 3, 91–132.

  57. Ogles, B. M., Anderson, T., & Lunnen, K. M. (1999). The contribution of models and techniques to therapeutic efficacy: Contradictions between professional trends and clinical research. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 201–226). Washington, DC: American Psychological Association.

  58. Orlinsky, D. (1989). Researchers' images of psychotherapy: Their origins and influence on research. Clinical Psychology Review, 9, 413–442.

  59. Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy-noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (th ed., pp. 270–376). New York: Wiley.

  60. Pennebaker, J. W. (1990). Opening up: The healing power of confiding in others. New York: Morrow.

  61. Phillips, J. R. (1984). Influences on personal growth as viewed by former psychotherapy patients. Dissertation Abstracts International, 44, 441A.

  62. Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for good. New York: Morrow.

  63. Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58, 7–29.

  64. Pulkkinen, L. (in press). Paths to the development of constructive and destructive behavior. In D. Stipek & A. Bohart (Eds.), Constructive and destructive behavior. Washington DC: American Psychological Association.

  65. Rennie, D. L. (2000). Aspects of the client's conscious control of the psychotherapeutic process. Journal of Psychotherapy Integration, this issue.

  66. Ratner, H. (Series director) (1990). Psychology: The study of human behavior. Motivation [video]. Produced by Coastline Community College, Fountain Valley, California.

  67. Roberts, A. H., Kewman, D. G., Mercier, L., & Hovell, M. (1993). The power of nonspecific effects in healing: Implications for psychosocial and biological treatments. Clinical Psychology Review, 13, 375–391.

  68. Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30–49.

  69. Schwitzgebel, R. (1961). Streetcorner research: An experimental approach to the juvenile delinquent. Cambridge, MA: Harvard University Press.

  70. Scogin, F., Bynum, J., Stephens, G., & Calhoon, S. (1990). Efficacy of self-administered treatment programs: meta-analytic review. Professional Psychology: Research and Practice, 21, 42–47.

  71. Scovern, A. W. (1999). From placebo to alliance: The role of common factors in medicine. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 259–296). Washington, DC: American Psychological Association.

  72. Segal, D. L., & Murray, E. J. (1994). Emotional processing in cognitive therapy and vocal expression of feeling. Journal of Social and Clinical Psychology, 13, 189–206.

  73. Seligman, M. E. P. (1990). Learned optimism. New York: Knopf.

  74. Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports Survey. American Psychologist, 50, 965–974.

  75. Selmi, P. M., Klein, M. H., Greist, J. H., Sorrell, S. P., & Erdman, H. P. (1990). Computeradministered cognitive-behavioral therapy for depression. American Journal of Psychiatry, 147, 51–56.

  76. Sheldon, K. M., & Elliot, A. J. (1999). Goal striving, need satisfaction, and longitudinal well-being: The self-concordance model. Journal of Personality and Social Psychology, 76, 482–497.

  77. Sloane, R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J., & Whipple, K. (1975). Psychotherapy versus behavior therapy. Cambridge, MA: Harvard University Press.

  78. Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore, MD: Johns Hopkins University Press.

  79. Snyder, C. R., Michael, S. T., & Cheavens, J. S. (1999). Hope as a psychotherapeutic foundation of common factors, placebos, and expectancies. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therap (pp. 179–200). Washington, DC: American Psychological Association.

  80. Stein, D. M., & Lambert, M. J. (1995). Graduate training in psychotherapy: Are therapy outcomes enhanced? Journal of Consulting and Clinical Psychology, 63, 182–196.

  81. Stiles, W. B., & Shapiro, D. A. (1989). Abuse of the drug metaphor in psychotherapy processoutcome research. Clinical Psychology Review, 9, 521–544.

  82. Suinn, R. M. (1999, September). President's column. American Psychological Association Monitor, 30(8), 2.

  83. Tallman, K. (1996). The state of mind theory: Goal orientation concepts applied to clinical psychology. Unpublished Master's Thesis, California State University Dominguez Hills, Carson, California.

  84. Tallman, K., & Bohart, A. (1999). The client as a common factor: Clients as self-healers. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 91–132). Washington DC: American Psychological Association.

  85. Task Force on Promotion and Dissemination of Psychological Procedures, Division of Clinical Psychology of the American Psychological Association (1995). Training and dissemination of empirically-validated psychological treatments: Report and recommendations. Clinical Psychologist, 48, 3–23.

  86. Tedeschi, R. G., Park, C. L., & Calhoun, L. G., (Eds.). (1998). Posttraumatic growth. Mahwah, NJ: Erlbaum.

  87. Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, All must have prizes. Psychological Bulletin, 122, 203–216.

  88. Wile, D. B. (1981). Couples therapy. New York: Wiley.

  89. Wylie, M. S. (1994). Endangered species. Family Therapy Networker, 1994 March/April, 20–33.

  90. Zabukovec, J., Lazove, S., & Shapiro, F. (2000). Self-healing aspects ofEMDR:The therapeutic change process and perspectives of integrated psychotherapies. Journal of Psychotherapy Integration, this issue.

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Bohart, A.C. The Client Is the Most Important Common Factor: Clients' Self-Healing Capacities and Psychotherapy. Journal of Psychotherapy Integration 10, 127–149 (2000). https://doi.org/10.1023/A:1009444132104

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  • self-healing
  • medical model
  • common factors
  • therapy as learning