Techniques and theories

Theories, or 'schools', of psychotherapy, abound; but none is more likely than another to help someone cope successfully with functional mental illness!(1)   Pace Sigmund Freud, psychotherapy, however systematic, is a craft, not a science.

Some schools – art, cognitive/behavioural, existential, family, Gestalt, group, hypno-, Jungian, music, neo-Freudian, psychodynamic, psychodrama, rational-emotive, Rogerian, transactional analysis and so on – make use of specialised techniques, such as biofeedback, desensitisation, dream analysis, guided imagery, paradoxical intention, relaxation.   Every day seems to spawn a new school or technique!

Although every practising psychotherapist's toolkit is likely to include such techniques, claims that competence and integrity depend on a thorough training in one or more of the schools (conducted by other 'therapists!) are misleading and irresponsible.   

'Non-specific' factors

Since 1936 at least, reputable psychotherapists have acknowledged that the most efficacious factors are ‘non-specific’ and common to all the 'schools'.⁽²⁾   These include clients' belief that the 'therapy will help them, their readiness to help themselves, the quality of the client-'therapist relationship and exclusive attention by 'therapists to the needs expressed by their clients. 

Client factors

The readiness of clients to help themselves depends on:

Another important factor is clients' 'world-view', their mental picture of their social environment and how they fit into it.   

Attempts by a 'therapist to help and encourage clients will achieve a satisfactory outcome only if clients are prepared to put into practice what they discover during the 'therapeutic process.

<sup>'The attitude of the psychotherapist is infinitely more important than the theories and methods of psychotherapy'. Carl Gustav Jung(4)

'Experience has taught me to keep away from therapeutic 'methods' as much as from diagnoses ... everything depends on the man and little or nothing on the method.' Carl Gustav Jung(5)

'.. however much therapists may focus on the technical aspects of their procedures, an increasing body of evidence suggests that it is the personal relationship between themselves and their patients which is experienced by the latter as the most potent therapeutic force.' David Smail(6)

'Some years ago I formulated the view that it was not the special or professional knowledge of the therapist, nor his intellectual conception of therapy (his 'school of thought') , nor his techniques which determine his effectiveness. I hypothesised that what was important was the extent to which he possessed certain personal attitudes in the relationship.' Carl R. Rogers(7)

'... the crucial factor in psychotherapy is not so much the method, but rather the relationship between the patient and his doctor or, to use a popular expression the 'encounter', between the therapist and his patient.   This relationship between two persons seems to be the most significant aspect of the therapeutic process, a more important factor than any method or technique.' Victor E. Frankl(8)

'Experience provides clinicians with a special sense of what should be done next in (psycho)therapy: on a deep level, this special sense reflects a very complex decision-making process that is informed by dozens, perhaps hundreds, of bits of data related to the client, the therapist and the context.' John D.W. Andrews, John C. Norcross & Richard P. Halgin(9)

'If any single fact has been established by psychotherapy research, it is that a positive relationship between patient and therapist is positively related to therapy outcome.' Irvin D. Yalom(10)

'A psychoanalyst's personality is his major therapeutic tool. Henri F. Ellenberger(11)

'If I can only be myself in the relationship, not a professional expert, not a "psychologist", not a "psychotherapist", just me in that relationship, that's helpful.' Carl R. Rogers(12)

'... we are only more helpful than the average layperson because of our greater experience of people in distress ... rather than because of our extensive knowledge of psychodynamic/humanistic theory and practice ...   By simple virtue of being professionals, we may be seen as knowing best — and we may come to believe in this myth ourselves, perhaps setting great store by psychodynamic formulations rather than being a fellow pilgrim with our clients ...' Gill Edwards(13)

'There is growing evidence that effectiveness in therapy is primarily dependent on the quality of the relationship between therapist and patient and that that, in turn, depends on the quality of the therapist.   The results of psychotherapy are, however, difficult to assess, especially since many or most of the conditions treated naturally improve with time.   There can be little doubt that many people can benefit greatly from wise and considered counselling by an educated and experienced life-guide.   Whether there is any school of psychotherapeutic training which can produce such qualities is another matter.' Robert M. Youngson (ed.)(14)

'... it is becoming increasingly obvious that the (psycho)therapist's personality is a more decisive factor than the school to which he belongs. Arthur Koestler(15)</sup>