An interesting review of the "common factors" phenomenon is included in the 1995 article by Miller, Hubble, & Duncan entitled, "No More Bells and Whistles" (Miller, S. , Hubble, M. , & Duncan, B. . The Family Therapy Networker, 19, 52-63). In this article the authors suggest that the outcome of all therapy is influenced by 4 factors common to all effective psychotherapy: 1) Therapeutic Technique, e.g., CBT, Person-centered, etc. (accounts for 15% of outcome), 2) Expectancy and Placebo, e.g., client beliefs re the effectiveness of counseling, etc. (15%), 3) Therapeutic relationship of which "bedside manner" is a euphemistic way of referring to the practitioner's influence on the relationship (30%), and 4) Client Factors, e.g., access to treatment/means to pay for treatment, supportive family, social contacts, etc. (40%).
Although one can argue that practitioners have control over which therapeutic technique will be
An unrelated but nonetheless tangential issue to the significance of the relationship in the outcome of therapy is the fact that the health care professional--of any type--least likely type of being sued is the practitioner who clients/patients report "liking," the corollary being, the most likely to be sued is the practitioner whom the client/patient does not like or sees as condescending, arrogant, patronizing, aloof, "cold, etc. See EXAMPLE 1, EXAMPLE 2.
When discussing these points with students I would point out that establishing a warm, caring and empathic relationship with a client does not preclude addressing issues a client may not want to hear. As a matter of fact, a strong, positive relationship can enable the delivery of such feedback/information more
As important as a positive relationship with clients may be, it is also important for students to not mistakenly think that this means they must "be friends" with clients. They need to understand that developing a positive relationship is of paramount importance but that it does not equate with only telling clients what they will appreciate hearing.
What do you think?
1Thomas, M. L. (2006). The Contributing Factors of Change in a Therapeutic Process. Contemporary Family Therapy: An International Journal, 28(2), 201–210