What makes therapy work?

T

he following linked article, "Finding a way to talk about me", was shown to me by a neighbour, and explores how people can find the right therapist for them. Whilst I do not agree with the article's view on the difference between counselling and psychotherapy - i.e. that the former is short-term and more superficial, and the latter is longer-term and deeper - the article is informative and gives very good guidance for people who are trying to find a suitable therapist.

The advice in the final paragraph of the article is the key: '"Don't get too hung up on the modalities [i.e. different therapeutic approaches, such as cognitive behavioural therapy, person-centred, or psychoanalytic]. Find someone you feel a connection to - someone you like."'. A lot of research reinforces this idea that it is not just the therapeutic approach which helps people, but also the relationship between counsellor and client. In Mick Cooper's (2010) book Essential Research Findings in Counselling and Psychotherapy, he uses 'Lambert's Pie' (Assay and Lambert, 1999) to explain what factors lead to a client improving in therapy (see diagram below). 'Lambert's Pie' suggests that the therapeutic approach - called 'Technique & model factors' in the diagram - is only responsible for 15% of a client's improvement in therapy. While 30% of a client's improvement is due to the relationship between therapist and client. So 'Lambert's Pie' is saying that the therapeutic relationship is twice as important as the approach that the therapist is using. I should add that whilst 'Lambert's pie' is only an estimate of these figures, he is "...drawing on years of experience as one of the world's leading psychotherapy researchers..." (Cooper, 2010; p.56) so we will take his estimate as a good indicator!

Lambert's Pie: what affects a client's improvement during therapy? (from Cooper, 2010)

My therapeutic approach is Person-Centred. From my own experience, I think that being heard is a crucial need for us all. While family and friends can go some of the way to fulfilling this need that we have, person-centred therapy offers a very special way of being heard: without judgment; with honesty; with love (or Positive Unconditional Regard, as Carl Rogers would say); and with empathy (i.e. understanding another person's difficulties from their own perspective). If the therapist can offer these conditions, and the client is then willing to accept them, a good therapeutic relationship can grow.

So, to go back to the title of this blog: what makes therapy work? It turns out that the approach a therapist uses is actually less important than the relationship that the client and counsellor have. This is why it is so important to meet a few therapists before choosing which one to work with, rather than just going with the first one that you meet. If you don't feel comfortable with a therapist, don't work with them! There are lots to choose from. You wouldn't pick the first pair of shoes that you saw - you'd try on a few before buying the pair that fit. It is the same with therapists, but hopefully it will have a much bigger effect on your life than a new pair of shoes!

References

Asay, T. P and Lambert, M. J (1999): 'The empirical case for the common factors in therapy: quantative findings', in M. Hubble, B. L. Duncan, and S. D. Miller (eds): The heart and soul of change: what works in therapy. Washington, DC: American Psychological Asociation, pp. 351-357 

Cooper, M (2010): Essential Research Findings in Counselling and Psychotherapy: The facts are friendly. Sage publications LTD.

Journeys

I recently completed my Mountain Leader Summer training, which involved six days of walking and camping in the Cairngorms. It was brilliant, and I hope it will lead me to be able to guide others out into the outdoors, and show them the fundamental importance of a connection with nature in our lives. 

Loch Morlich with Cairngorm in the distance taken at 7pm

Before, during and after the training I have been thinking more and more about journeys that we animals make. In particular, the parallels that exist between the journey of our lives, and the smaller journeys that we make within that; the parallels between macro and micro. For example, the daily commute which we feel is dull, repetitive and slow (i.e. the micro journey), can mirror the dull and repetitive point that we have reached in our lives (i.e. the macro journey). 

Ryvoan bothy, Cairngorm National Park taken at 10pm

So, within my own life's journey the questions keep returning: what is my direction? Am I on the 'right' course? What is my destination? These questions could just as well be asked when out walking, as well as being applied to my life. So, on Cairngorm, I looked behind me to see where I had come from, and then in front of me to see where I could go. I could see the summit of Cairngorm, but there were many ways to get there, and actually my destination did not have to be the summit of the mountain. This looking around also gave me perspective on where I was at that moment: in-between Lochan na Beinne, and the peak of Carn Lochan na Beinne.  Hence, I knew where I was, where I had been, and where I could go. This mountain journey mirrored the way in which I go through life: evaluating the journey so far; looking to where I am going; and trying to stay on track by looking around to see what landmarks there are.

However, my aunt taught me that life is not a linear journey, but rather a meandering path which evolves as we walk. I left school thinking that I had to have a specific direction in life, but as I got older, I saw that there is a richness is sometimes only having short-term goals; sometimes changing where I see myself in five years time; and sometimes allowing myself to simply drift and see where things around me (not that I'm very good at that mind!).

So coming back to therapy, the journey that we travel through life, and the journey that we take through therapy is another example of the parallel journeys. This can be a journey of words, emotions, stories, and (in the outdoors) a physically walked journey. And this is what therapy is: a shared journey with a another person (the therapist) through your life, and through what you have experienced. The route is chosen by you, but the relationship with the therapist will slightly alter that, so that the journey becomes co-created. Carl Rogers was known to describe person-centred therapy as a walk along a beach with the client walking side-by-side with the therapist. I imagine the client to be walking slightly in front of the therapist, leading him/her through the landscape of themselves. And the therapist is there for support, encouragement and elucidation if needed

I wonder what journey has led you to where you are right now?

The temporary nature of life

I spoke with a friend at the weekend (after the Tour de France had passed through!) about the cyclical nature of life and death. She spoke of a t-shirt which she had seen which said "Always and Forever". Her reaction was one of irritation that modern society continues to think in this way, when actually everything is temporary. There is no such thing as 'forever' - from the butterfly in our field, to our solar system - all is temporary. This led me to thinking about the cycle of life and death cycle which is all around us. For example, the growth of leaves on an oak tree in springtime, followed by their death in Autumn, as they fall on the forest floor to nourish the plants below the oak's canopy. Or the growth of a bluebell from its bulb of stored energy, to its flowering, and then death as the seeds germinate and are spread by the wind. Our own births in our springtime, followed by our deaths in the winter of our short lifetimes', giving way to the next generation of humans. Birth, life and death surrounds us.

However, in the West there is a palpable fear of death and dying; a fear of loss; a fear of our own mortality. Many human civilisations have looked to immortality as a life-long goal in order to escape the cycle. The ancient Greeks told myths where the protagonists strived to gain 'the gift' of immortality from the gods. Now we look to medicine, instead of the Greek gods of old, to give us immortality. Or at the very least, to give us more time . We give the elderly a cocktail of drugs in order to give them a few more weeks, months or years of life. We keep people on life-support machines for years before finally switching them off. We keep life going whatever the cost. This longing for eternal life can also be seen in plastic surgery when done for solely cometic reasons, where there appears to be an echo of a deep fear of ageing and death; a longing to go back to have our time again. Yet all this feels useless against the insurmountable force that is the cycle of life and then death. 

I fear my own death. Yet it is also something which I know is part of the human condition, and something I will have to get over! Actually, not simply 'get over', but rather be able to accept and feel comfortable about my own eventual death. I have killed animals - mostly to put them out of their misery. Pigeons as they have been hit by cars, and yet are somehow alive. One of our chickens as our dog 'played with her' too much. Mice which the cats have caught but not killed yet. I kill these animals as I cannot bear the thought of a drawn-out and painful death for them. However, I have also shot rabbits and pigeons to eat. We have two pigs at the moment which we plan to slaughter of meat in the Autumn. I have 'killed' weeds by uprooting them and throwing them on the compost. And I actively kill mosquitos. All of these deaths make me more and more acutely aware of my own eventual death. It is so easy (in practical terms) to kill another life - whether it be an act of mercy or for my own sustenance - I have come to think that my own life cannot be so special. I fail to see how my life is more important that the life of that pig in the field, or the mouse that our cat just killed and ate. These are all simply parts of the natural cycle of life and death. We are not above this cycle. We are part of it.