Chapter 2.Essential Ingredients for Successful Psychotherapy

A number of psychotherapy models have received empirical support for their usefulness in dealing with mental disorders such as depression and anxiety. As illustrated in this book, each model presents a coherent rationale and a variety of techniques for achieving clinical success. Yet, despite their differences, they all display one thing in common. Each approach is delivered in an interpersonal context requiring interactions between a therapist and a patient. Moreover, it is the use of the interpersonal factors within the therapy sessions, the “how is the treatment being delivered,” that has come to the fore as a prime determinant of whether or not the treatment will be successful. Terms such as common factors, psychosocial elements, and placebos have often been used interchangeably to refer to the nature of the treatment relationship. In short, the seemingly same brand of treatment delivered by different clinicians may achieve different outcomes as a result of differences in a therapist’s clinical sensitivity and interpersonal skills. The idea that some practitioners and some clinical settings may be more therapeutic than others is highlighted by multiple research reviews (e.g., Baldwin and Imel 2013; Greenberg 2016; Wampold 2015). Several years ago, I had a psychiatric resident in psychotherapy supervision who dutifully brought audiotapes to each of our supervisory meetings. Each psychotherapy session we reviewed began with minutes of painful silence and a patient made clearly uncomfortable by the soundless process. Finally, after observing the pattern for several weeks, I asked the resident, “Don’t you ever greet your patient, say hello, or ask patients how they are doing?” The resident replied, “You never told me to!”