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What makes therapy work?

Research has consistently shown that psychological therapy does help many people most of the time (see Duncan, Miller, Wampold, and Hubble 2010). But, interestingly, the research has solidly shown that this help is not because of the psychological technique or type of therapy chosen.  In fact all psychological approaches tested seem to work equally well. So, if it is not the psychology technique (including Gestalt therapy techniques), what makes therapy work? And does anything go?

Prominent researchers
Scott Miller, Barry Duncan, Bruce Wampold, and Mark Hubble  have examined many of the studies into therapy outcomes and concluded that factors common to all therapeutic approaches support change. That is:

  • The largest source of change lies in what the client brings – their strengths, struggles, culture, preferences and events in their lives.
  • The relationship and alliance between therapist and client directly contributes to change
  • The hope and expectations of both the client and the therapist contribute to change happening
  • Specific psychological techniques contribute a very small amout to outcomes - estimates range from about 1% to 8% of the change is due to specific psychological techniques

Research has also shown that clients not therapists make the most accurate predictions of whether therapy will be successful, and that this is based on the client’s experience of their relationship with the therapist.

This means that what has the best chance of working is a therapy that supports each of these sources of change. The chance of a successful outcome is supported if:

  • Clients are asked about their opinions about the therapy, the relationship
  • The therapist is committed to collaboratively evaluating the work with their clients, and to improving their own work
  • The clients explanation of how change happens for them is activated
  • The therapist must have a explanation of how change happens, and must believe in this explanation. 
  • The therapist's model of how change happens must be a good fit with the client
  • The therapist must have multiple techniques – if something is not working, they must be able change what they are doing

In light of this, if you are considering therapy with me, I encourage you to read what I have written on psychotherapy and gestalt therapy, so you may get a sense of whether my primary way of doing psychological work fits with how change happens for you.


More information about Miller and Duncan’s work can be found here.