Why does Therapy Work: Part I

It seems that the world in which we live is increasingly judgmental, factionalized, and distracted.  Clearly, social media and technology interfere with people’s capacity to listen to each other in a focused and attentive way. Most of us can recall times when we were talking with others only to realize that they have shifted their focus to their phone or device. It is also likely, if we are honest with ourselves, that there have been times when our attention waned or shifted, as well.  Johan Hari has discussed this phenomena in great detail (this will be the focus of an upcoming blog but in the interim we highly recommended his latest book on Attention) (1). The increase in social tensions and conflicts that are roiling our country have also exacerbated this problem.  People appear to be increasingly tribal and less willing to consider the perspectives of others. In addition, many people are feeling more stressed, on edge, and are struggling to cope with the demands and challenges of daily life.  These pressures likely further compromise one’s ability to respond to others  in a caring and open manner. Taken together, these factors all suggest that finding a place where one can feel listened to and accepted may be increasingly rare. 

Therapy offers a time and place where one can feel listened to, and hopefully not feel judged.   The opportunity to talk out and reflect on one’s concerns in a non-judgemental setting has been repeatedly identified as one of the critical or core factors that make therapy work/help, regardless of the specific treatment model utilized by the therapist.  A broad range of theorists (2)  have stressed the importance of empathy and non-judgmental acceptance. In many respects, Carl Rogers’ person centered model, epitomizes this approach. Rogers repeatedly stressed the importance of unconditional positive regard for one’s client, and highlighted the importance of listening to one’s client in an empathetic and non-judgmental way. The importance of empathy is highlighted in the research and discussion of what makes therapy effective.  In fact, proponents of the common core model of therapy,  which argues that therapies work because of common or shared components (3), have found that empathy is one of the most important components of therapy (3).  Moreover, research clearly supports the importance of empathy in treatment (4). 

It is important to note that empathetic listening is not easy. In detailing his approach to work with non-compliant and explosive children,  Ross Greene, PhD, details the importance of an empathetic response to helping these children calm themselves (5).  However, Greene goes on to detail that helping parents respond empathetically can be quite challenging. He provides multiple examples of this in his work, where parents struggle to respond empathetically to an angry and increasingly volatile child. These situations clearly illustrate the challenges of empathetic listening. It is easy to listen empathetically to an individual who is sharing their distress and struggles in an open and non-hostile manner. However, when we encounter people who are angry and upset, and whose beliefs, judgements, and values differ from ours, we may find that our  ability to respond empathetically becomes more difficult.  

Therapists who work with couples or families face the additional challenge of trying to respond empathetically to people who may be hostile, disdainful, critical and judgmental of their partners and/or family members, who are also present in the session.  In these instances, our capacity to respond empathetically may be put to the test,especially when we encounter highly conflictual couples and families. However, it has often been my experience that if we can respond empathetically (accept how the person is feeling without necessarily accepting the validity of their arguments) that we are able to help these individuals calm themselves and reflect more thoughtfully on their own behavior and the actions of others. It is also worth noting that empathetic responding does not preclude setting limits and clarifying boundaries. This is particularly important in couples and family therapy where participants may need to be told that hostile, critical, demeaning statements are not acceptable. However, at our best, we can hopefully set these limits without compromising our ability to listen empathetically to our clients’ concerns. 

While empathy is an essential ingredient for effective therapy we are not asserting that empathy is the only ingredient that makes therapy work. Far from it.  In fact, there are clearly times when people need more than empathy.  In our upcoming blog on What Makes Therapy Work: Part II, we will discuss other components that appear to be key to effective therapy. 

 

References and suggestions for further reading/exploration of topics discussed in this blog. 

  1. Hari, Johann, Stolen Focus:Why you can’t pay attention and how to think deeply again (2022).
  2. The importance of empathy and non-judgmental listening can be traced back to Carl Rogers.  More recent discussions of the importance of empathy can be found in the writings of John Norcross, Michael Lambert,  Scott Miller, and a wide range of other psychologists/mental health professionals. While these writers may focus more on the therapeutic alliance, it is important to note that empathy is a key ingredient of a strong therapeutic alliance.
    • For a study and discussion of the therapeutic alliance see: Ardito, R, and Rabellino, D., Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research, Front Psychol. 2011; 2: 270, and Published online 2011 Oct 18. doi: 10.3389/fpsyg.2011.00270
  3. Examples of the debate regarding the role of common factors versus specific treatment models has been present in the field for decades. Advocates of specific models cite the research supporting their models while advocates of the Common Factors model, which dates back to the work of Truax and Carkhuff (1976), and includes the work of  Douglas Sprenkel and his colleagues on the role of Common Factors in Couples therapy, as well as extensive writings by Bruce Wampold,  Barry Duncan,  and Scott Miller,  to name a few, press the case for a Common factors model to explain the benefits of therapy.
  4. Watson, J. C. (2016). The role of empathy in psychotherapy: Theory, research, and practice. In D. J. Cain, K. Keenan, & S. Rubin (Eds.), Humanistic psychotherapies: Handbook of research and practice (pp. 115–145). American Psychological Association. https://doi.org/10.1037/14775-005
  5. Greene, Ross.  The explosive and non-compliant child.
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