Common Factors in Psychotherapy



Many meta-analyses and research study reviews affirm the comparable effectiveness of psychotherapies in adult patients. This points to common (or core) factors in diverse schools of psychotherapy.

In this chapter, we review the core factors that we believe are fundamentally responsible for transformative change in psychotherapy processes.

These core factors include the therapeutic alliance, empathy, goal consensus and collaboration, positive regard and affirmation, mastery, congruence/genuineness, mentalization and emotional experience. Evidence-based research on common factors has shown that relationship factors in a therapeutic dyad or group setting predict the outcome of psychotherapy, which is related to some of these common factors, and is also found to correlate with improved levels of functioning (Fisher et al. Psychotherapy 53:105–116, 2016). The effectiveness of psychotherapies may rely more on commonalities rather than on differences of theory and technique.


Therapeutic alliance Empathy Emotional experience 


  1. 1.
    Addass AA. Bona fide psychotherapy models are equally effective for major depressive disorder future research directions. JAMA Psychiatry. 2016;73(9):893–4. Scholar
  2. 2.
    Connolly Gibbons MB, Gallop R, Thompson D, et al. Comparative effectiveness of cognitive therapy and dynamic psychotherapy for major depressive disorder in a community mental health setting: a randomized clinical non-inferiority trial. JAMA Psychiatry. 2016;73(9):904–11. Scholar
  3. 3.
    Driessen E, Hegelmaier LM, Abbass AA, et al. The efficacy of short-term psychodynamic psychotherapy for depression: ameba-analysis update. Clin Psychol Rev. 2015;42:1–15.CrossRefPubMedGoogle Scholar
  4. 4.
    Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry. 2016;4(2):109–19. Scholar
  5. 5.
    Stone MH. Management of borderline personality disorder. A review of psychotherapeutic approaches. World Psychiatry. 2006;5:15–20.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Laska KM, Gurman AS, Wampold BE. Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective. Psychotherapy. 2014;51(4):467–81.CrossRefPubMedGoogle Scholar
  7. 7.
    Tschacher W, Haken H, Kyseloz M. Alliance: a common factor of psychotherapy modeled by structural theory. Front Psychol. 2015;6:421.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fisher H, Atzil-Slonim D, Bar-Kalifa E, Rafaeli E, Peri T. Emotional experience and alliance contribute to therapeutic change in psychodynamic therapy. Psychotherapy. 2016;53(1):105–16.CrossRefPubMedGoogle Scholar
  9. 9.
    Horvath AO, Del Re AC, Flückiger C, Symonds D. Alliance in individual psychotherapy. Psychotherapy. 2011;48(1):9–16.CrossRefPubMedGoogle Scholar
  10. 10.
    Hilsenroth MJ. A programmatic study of short-term psychodynamic psychotherapy: assessment, process, outcome and training. Psychother Res. 2007;17(1):35–4.CrossRefGoogle Scholar
  11. 11.
    Blank G, Blank R. Ego psychology theory and practice. New York: Columbia University Press; 1974.Google Scholar
  12. 12.
    Høoglend P, Amlo S, Marble A, Bøogwald K, Søorbye Ø, Sjaastad MC. Analysis of patient-therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations. Am J Psychiatry. 2006;163(10):1739–46.CrossRefGoogle Scholar
  13. 13.
    Preston SD, Hofelich AJ. The many faces of empathy: parsing empathic phenomena through a proximate, dynamic-systems view of representing the other in the self. Emot Rev. 2012;4:24–33.CrossRefGoogle Scholar
  14. 14.
    Bridges MR. Activating the corrective emotional experience. J Clin Psychol. 2006;62(5):551–68.CrossRefPubMedGoogle Scholar
  15. 15.
    Diener MJ, Hilsenroth MJ, Weinberger J. Therapist affect focus and patient outcomes in psychodynamic psychotherapy: a meta-analysis. Am J Psychiatry. 2007;164(6):936–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Sullivan HS. The psychiatric interview. New York: WW Norton & Company; 1954.Google Scholar
  17. 17.
    McCullough L, Kuhn N, Andrews S, Valen J, Hatch D, Osimo F. The reliability of the achievement of therapeutic objectives scale: a research and teaching tool for brief psychotherapy. Journal of Brief Ther. 2004;2(2):72–90.Google Scholar
  18. 18.
    Wampold BE. How important are the common factors in psychotherapy? An update. World Psychiatry. 2015;14(3):270–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Eisenthal S, Lazare A. J Nerv Ment Dis. 1976;162(3):169–75.CrossRefPubMedGoogle Scholar
  20. 20.
    Lietaer G. Authenticity, congruence and transparency. In: Brazier D, editor. Beyond Carl Rogers. London: Constable; 1993.Google Scholar
  21. 21.
    Rogers CR. On becoming a person: a therapist’s view of psychotherapy. Boston: Houghton Mifflin; 1961.Google Scholar
  22. 22.
    Greenberg L, Rice L, Elliott R. The moment by moment process: facilitating emotional change. New York: Guilford Press; 1993.Google Scholar
  23. 23.
    Bateman A, Fonagy P. Mentalization-based treatment. Psychoanal Inq. 2013;33(6):595–613.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of KentuckyLexingtonUSA
  2. 2.European Federation of Psychiatric TraineesBruxellesBelgium
  3. 3.Psychotherapy SectionWorld Psychiatric AssociationGenevaSwitzerland
  4. 4.Psychoanalysis in Psychiatry SectionWorld Psychiatric AssociationGenevaSwitzerland
  5. 5.Department of PsychiatryColumbia University Medical CenterNew YorkUSA
  6. 6.Department of PsychiatryNational University of MalaysiaBangiMalaysia
  7. 7.HIV Psychiatry SectionWorld Psychiatric AssociationGenevaSwitzerland
  8. 8.Education in Psychiatry SectionWorld Psychiatric AssociationGenevaSwitzerland
  9. 9.USA Regional BranchWorld Association for Dynamic PsychiatryGenevaSwitzerland
  10. 10.Marmara UniversityIstanbulTurkey

Personalised recommendations