Research on What Works In Psychotherapy

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Extensive reviews of the literature exploring the commonalities in approaches suggest that the therapeutic relationship, technique, client variables and placebo or expectation of change are consistently found to be the important factors in determining positive outcomes (Lambert, 1992; Miller et al. 1995; Bergin and Garfield, 1994). Interesting to note also, is that much of this work has been considered within the field of psychotherapy and is under represented in the Social Work literature.

On the broader level of social work practice studies have suggested that tested forms of practice that relied heavily on problem solving and task centred methods, usually in conjunction with behavioural methods such as social skills training.... were found to be effective with such diverse groups as mildly and moderately retarded adults; chronic schizophrenics in aftercare; young non chronic psychiatric patients; women on public assistance and low income children experiencing school problems (Rubin, 1985:474). These client populations would be considered by most social workers as being common areas of practice. They are also presentations in which there are multiple levels of intervention possible with potentially multiple issues to be addressed over time. They require from a social work point of view a milti-dimensional approach to the intervention noting particularly that the intervention may not always be targeted at the individual in order to achieve a successful social work outcome. On the other hand studies into the therapeutic alliance have indicated that when rated by external judges, patient components have emerged as better predictors of positive outcome, whereas therapist factors have been only inconsistently related to improvement (Bachelor, 1991:535)

Therapeutic Relationship

Therapeutic relationship refers to the range of variables that are found in therapy that are evident irrespective of practice orientation. These factors are identified in most basic texts on casework etc. (Hepworth and Larsen, 1993; Nelson, 1986; Shulman, 1991). The factors that work include empathy, positive unconditional regard, encouragement and respect of clients’ gains. Lambert (1992) suggest that these factors count towards 30% of positive outcomes.

Client Variables

Client variables or extra therapeutic change, accounting for 40% of positive outcomes (Lambert, 1992), constitute the aspects that are brought to the client/ practitioner encounter and aid in recovery regardless of the intervention. Such factors may include the client’s ability to maintain a homeostatic state within their environment, ego strengths, social supports and unexpected events (Lambert, 1992).


Factors that are unique to the practice approach selected. Possibly much to the disgust of the clinically minded practitioner Lambert (1992) suggests that technique only count towards 15% of positive outcome.

Placebo or Expectancy

This refers to the change that may be attributed to the client’s knowledge that they are to be treated from the differential credibility of specific treatment techniques and rationale (Lambert, 1992:97).Given the empirical research and theoretical arguments outlined above, it would be reasonable to suggest that for a particular model of intervention to be relatively more rather than less effective across a range of presenting issues, it must draw upon and combine the aspects of what works in therapy as outlined above. The question is now; how adequately does BSFT fit with what works in direct practice? (See Article 2)


Bachelor, A. (1991) Comparison and Relationship to Outcome of Diverse Dimensions of the Helping Alliance as seen by Client Therapists, in Psychotherapy Vol. 28. No. 4 pp 534-549.
Bergin, A. and Garfield, S. (Eds) (1994) Handbook of Psychotherapy and BehaviourChange, John Wiley and Sons NY.
Lambert, M. J. (1992) Psychotherapy Outcome Research: Implications for Integrative and Eclectic Therapists in Norcoss, C. and Goldfried, M. (Eds) Handbook of Psychotherapy Integration, Basic Books, United States. Ch 3.
Miller, S. Bubble, M. and Duncan, B. (1995) No More Bells and Whistles in Family Therapy Networker March/ April. pp 53-63
Nelsen, J. (1986) Communication Theory and Social Work Treatment in Turner, F. and Kendall, K.(Eds) Social Work Treatment Interlocking Theoretical Approaches, (3rd Ed.) The Free Press, NY. pp 219 - 243.
Rubin, A. (1985) Practice Effectiveness: More Grounds for Optimism in Social Work National Association of Social Workers, Vol. 30, Number 6, November -December. pp 469 - 473.