Recovery Plus: reclaiming lives
12 April/May 2017 Effective therapy:
know what works
'Psychosocial’ therapies range from brief
advice and counselling to extended outpatient
therapies and all-embracing residential
communities where clients can stay for months.
In their content and techniques therapies
also differ, varying for example from the deep
probing of psychoanalysis to the more skillsbased
cognitive-behavioural approaches. But as
long as it is a well structured, bona fide treatment
which ‘makes sense’ to patient and therapist, the
‘common factors’ shared by supposedly distinct
therapies seem more critical to their success.
For patients and researchers, how the therapist
relates to the client is the main embodiment of
the common factors shared by therapies and the
most salient way they affect engagement and
outcomes. We have seen this generally across
treatment and in respect of medical treatments.
Unsurprisingly, the evidence is strongest for
psychosocial therapies, when the structured
enactment of the therapist-client relationship
is the treatment, forcing attention to it even in
studies designed to minimise such influences.
This article focuses on client-worker relationships,
and on whether some therapists are more
successful because they more strongly forge
the right kind of relationships – ‘therapeutic’
relationships. We identify evidence-based key
points, and give links to access the full research.
Fundamentals of effective therapy: genuineness,
positive regard and empathy (1957). No paper on
psychosocial counselling and therapy has had
more influence than Carl Rogers’ formulation of
the “necessary and sufficient conditions” for
clients to get better, the foundation of much
substance use counselling. This link is to a free
50th anniversary reprint: www.sunriseservicesuk.com/
pdf. In the Recovery Plus sister e-mag, you can also
click on commentaries by George Silberschatz
and Elizabeth Eager.
Counsellors’ relationship style affects patients’
relapse rate (1981). US study found a strong link
between higher levels of empathy, genuineness,
respect, and concreteness exhibited by alcohol
clinic counsellors and a reduced risk of their
patients relapsing after treatment ~ http://findings.
Empathy makes the difference (1980). Big
differences in therapy content and duration did
not affect the progress of US heavy drinkers.
What did seem to, for at least two years (1983)
after treatment, was the degree to which their
therapists displayed “accurate empathy” ~
See also this assessment of the impact of
empathy in psychotherapy generally (2011) ~
Therapist effects emerge even in one of the
most highly controlled studies ever (1999).
Despite exhaustive selection, training and
supervision, some therapists in the US Project
Match trial – http://findings.org.uk/docs/Ashton_M_13.
pdf?s=db&r=&sf=mx – had on average worse
outcomes (1998) than their peers and there was
enough variation in the therapeutic relationship
About the author
Mike Ashton is editor of Drug
and Alcohol Findings, a freeto
access website featuring
the Effectiveness Bank with
an extensive range of research