Frequently Asked Questions

1. What are the goals of therapy?
2. What makes therapy effective?
3. Why Narrative Therapy?
4. How will I know when I’m done?
5. How do I go about finding a therapist?
6. Where do I find resources about therapy's effectiveness?

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 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. Often 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 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.

• The Therapeutic Relationship: We therapists become enamored with 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 improvements in therapy.

• Expectancy, Hopes and “Placebos”: If you think things are going to improve, they probably will. This sense that things can change has real effects, accounting for 15 percent of improvements in therapy.

•  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. (For an excellent discussion of what makes psychotherapy effective, see "What Works in Therapy".)

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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 creates a lot 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 giving substance to the hopes clients bring to therapy.

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How will I know when I’m done?

Ideally you will be having regular conversations with your therapist about how therapy is going. There is some evidence that people feel more satisfied when they are in therapy for longer periods of time (See Seligman's "The Effectiveness of Therapy"), but there’s also evidence that the impact of therapy declines over time. In other words, you may get the maximum benefit early on in therapy with diminishing returns as time goes on.

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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 “Links Page” in this website also features a number of “therapist locator” services.

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Where do I find resources about therapy's effectiveness?

The Heart & Soul of Change: What Works in Therapy (1999). By Mark Hubble, Barry Duncan & Scott Miller. Washington D.C.: American Psychological Association.

Escape from Babel: Toward a Unifying Language for Psychotherapy Practice (1997). By Scott Miller, Barry Duncan & Mark Hubble. New York: Norton.

"Mental health: Does therapy help?" Consumer Reports, November 1995, pp. 734-739.

"The Effectiveness of Psychotherapy: The Consumer Reports Study" By Martin Seligman. American Psychologist, December 1995, Volume 50, Number 12, pp. 965-974.

"Comparative studies of psychotherapy: Is it true that ‘Everyone has one and all must have prizes?’" By Lester Luborsky, Barton Singer & Lise Luborsky. Archives of General Psychiatry, 1975, Volume 32, pp. 995-1008.

"Psychotherapy outcome research: Implications for integrative and eclectic therapists" (1992). By Michael Lambert, in John Norcross & Marvin Goldfried (Editors), Handbook of Psychotherapy Integration. New York: BasicBooks, pp. 94-129.

"Meta-analysis of psychotherapy outcome studies". By Mary Smith & Gene Glass. American Psychologist, 1977, Volume 32, pp. 752-760.

"Studying the effectiveness of psychotherapy: How well can clinical trials do the job?" By Neil Jacobson & Andrew Christensen, American Psychologist, October 1996, Volume 51, Number 10, pp. 1031-1039.

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By Jim Sparks
Copyright © 2002. All rights reserved.
Revised: 05/09/02.