What makes therapy work?


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)

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!


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.