Frequently Asked Questions

What are the goals of therapy?

This will depend a lot on you and the therapist you pick. For some therapists, “the problem is the problem.” In other words, if you come in saying you want less anxiety in your life, or you would like to feel less depressed, that becomes the goal. Other therapists may see these presenting problems as symptomatic of “deeper” problems. They might see changing your personality as the true goal of therapy. Sometimes people seeking therapy aren’t entirely clear about what the problem is, but just want their life to be going differently.  In these cases, a therapist can be helpful in clarifying what you want to work on and creating a plan with you about how therapy could help.

Tip: Be clear as you can with your prospective therapist about what you want from therapy, and find out how your therapist sees you getting there.

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What makes therapy effective?

• Clients: After reviewing hundreds of studies about the effectiveness of psychotherapy, researcher Michael Lambert found that 40% of improvement in psychotherapy could be explained by what the clients bring to the table. Notable elements include clients’ abilities and strengths, their support systems, and “fortuitous” events occurring outside the therapy room. Other elements include motivation (being dragged to therapy vs. actively pursuing it) and how severe the problem is.  This work on outcomes in therapy is perhaps best chronicled in The Heart and Soul of Change: What Works in Therapy, edited by  Mark A. Hubble, Barry L. Duncan, and Scott D. Miller.

• The Therapeutic Relationship: We therapists become enamored of our models and techniques, but connecting with clients is far more important. Lambert found that the quality of the therapeutic relationship explained 30 percent of improvement in therapy.

• Expectancy, Hopes and “Placebos”: If you think things are going to improve, it is quite possible they will.  This sense that things can change has real effects, accounting for 15 percent of improvements in therapy.  It's also quite important that your therapist is someone who remains hopeful about your prospects.

•  The Therapeutic Model: The particular model of therapy (e.g. cognitive, psychodynamic, gestalt) explains a meager 15 percent of improvement, even though it probably gets 95 percent of the attention. In study after study, different types of therapy come out about equal in terms of effectiveness. Much as we therapists like to think our particular approach is the best, research doesn’t really support this. Some exceptions include a fair body of evidence that cognitive therapy is particularly effective for panic disorder and bulimia, and behavior therapy combined with medication is an effective approach for certain phobias.

• Implications for you:

   

  • Tip #1: Find a therapist who brings forth your own abilities, helps you develop systems of support, and capitalizes on significant events that take place outside the therapy room.
     

  • Tip #2: Find a therapist who connects with you, respects you and makes you feel understood.

   

  • Tip #3: Find a therapist who works with the hope you bring, or who helps you recover the hope you’ve lost.

   

  • Tip #4: Find a therapist who is flexible and whose way of working “clicks” with you.

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Why Narrative Therapy?

I just said different models of therapy don’t lead to dramatically different results, so why all the attention to Narrative Therapy on this website? Two reasons: First, it simply suits me best. I feel like I’m working "with" clients against a problem, rather than “intervening” on them or “treating” them. If most therapy approaches come out about equal, I want to be practicing one that seems respectful of the people I see. Second, I think Narrative Therapy promotes many of the conditions that seem to make a difference in therapy. I see it as capitalizing on clients’ abilities, fostering a close therapeutic connection, and sustaining the hopes clients bring to therapy.  Finally, I love the notion of stories, and the sense that all of us are multi-storied.  Holding this in mind, provides me with multiple possibilities of who people might be and keeps my enthusiasm for this work fresh. 

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How do I go about finding a therapist?

One of the best approaches is to talk to people who have seen that particular therapist and hear about their first-hand experience. If you get a referral from a doctor or other health professional, ask why they recommend that particular therapist. Even if your insurance plan limits the people you can see, try to gather information about your choices. Many therapists are willing to have a short phone conversation for free where you can briefly discuss the problem and find out how they might work with it. The “Useful Links Page” in this website also features several “therapist locator” services.

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By Jim Sparks
Copyright © 2002. All rights reserved.
Revised: 10/02/09.