Psychologists have made systematic efforts to identify the relation of events that occur during therapy to the beneficial outcomes clients report. This critical topic is addressed by every theory of psychotherapy, and well over a thousand studies of the efficacy of therapeutic interventions have been published during the last seven decades. Recently, psychologists have undertaken systematic analyses of that evidence to identify the common factors that—regardless of therapeutic approach—account for much of the success of psychotherapy.
Robert Elliott analyzed data from 24 single-session interviews in 1985 and identified 86 helpful therapist responses that he clustered into eight types of helpful events. He further grouped these helpful events into two “superclusters.” Four helpful events formed the task supercluster because they involved direct work or progress on the client’s presenting problem. They are as follows:
- New perspective: asking information-gathering questions to get clients to think about the effects of their behaviors
- Problem solution: providing a detailed summary at the end of the session and suggesting strategies for clients to try before the next session
- Problem clarification: asking questions at the beginning of the session to help clients clarify the nature of their problem
- Focusing awareness: directing clients’ attention to some aspect of the problem to obtain information that is more detailed
The other helpful events formed the interpersonal supercluster because they referred to some form of helpful interpersonal contact. They are as follows:
- Understanding: making a comment that illustrates an understanding of clients’ thoughts and feelings
- Client involvement: proposing one possible course of action and encouraging clients to evaluate its feasibility for their personal situation
- Reassurance: making a positive comment that encourages clients to believe they can deal with their problems effectively
- Personal contact: revealing relevant personal information to seem more human to clients
Psychologists concerned primarily with group interventions have focused their efforts on the identification of in-therapy events that clients perceive as having a helpful therapeutic effect. Raymond J. Corsini and Bina Rosenberg identified mechanisms that account for beneficial change during group psychotherapy in an influential article that provided the initial foundation for research on this topic. Betty Berzon and her associates proposed a list of nine helpful therapeutic factors that Irvin D. Yalom expanded upon in his influential The Theory and Practice of Group Psychotherapy. Yalom suggested that 12 factors were responsible for most of the therapeutic benefits of group psychotherapy: altruism, group cohesiveness, universality, interpersonal learning: input, interpersonal learning: output, guidance, catharsis, identification, family reenactment, self-understanding, instillation of hope, and existential factors.
Dennis M. Kivlighan, Karen D. Multon, and Brossart performed principal components analysis of critical incidents data to further refine and reduce the list of helpful impacts. Based on this research they developed the Group Counseling Helpful Impacts Scale for use in research on the relation between group leader behaviors and clients’ perceptions of their helpful impact. This instrument measures four helpful impacts: Emotional Awareness—Insight, Relationship, Other Versus Self Focus, and Problem Definition— Change.
None of these taxonomies has stimulated much research, but the idea that some therapist interventions are more likely than others to stimulate beneficial changes in clients continues to be important to psychologists.
References:
- Berzon, B., Pious, C., & Parsons, R. (1963). The therapeutic event in group psychotherapy: A study of subjective reports of group members. Journal of Individual Psychology, 19, 204-212.
- Corsini, R., & Rosenberg, B. (1955). Mechanisms of group psychotherapy: Process and dynamics. Journal of Abnormal Social Psychology, 51, 406-411.
- Elliott, R. (1985). Helpful and nonhelpful events in brief counseling interviews: An empirical taxonomy. Journal of Counseling Psychology, 32, 307-322.
- Kivlighan, D. M., Jr., Multon, K. D., & Brossart, D. F. (1996). Helpful impacts in group counseling: Development of a multidimensional rating system. Journal of Counseling Psychology, 43, 347-355.
- Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Hillsdale, NJ: Lawrence Erlbaum.
- Yalom, I. D. (2005). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.