This episode might surprise you, or at least provide some new information about the factors that are actually responsible for therapy or coaching success. Today I will be sharing a few important insights from the book "The heart and soul of change: What works in therapy" by Hubble, Duncan & Miller. We'll talk about what are the most effective modalities (the answer is not what you think) and why and when therapy and coaching work, and when and why it doesn't. Over the years I've created all the free resources you'll ever need to grow, fill, and run your private practice. They're all just one click away: the6figurepractice.com May these resources help you help more clients!
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About the 6-Figure Practice Program:
The Six Figure Practice with Sasha Raskin, is an online program and community for helpers such as counselors and coaches, who are building their private practice. If you’re looking for a clear, step-by-step road map for creating and marketing your private practice, you're at the right place!
My name is Sasha Raskin. I’m a Number 1 Best Selling Co-Author in 12 Countries, a Doctoral student in Counseling Education and Supervision, a coach, a psychotherapist and an adjunct faculty at a graduate counseling program at Naropa University.
One of the things I’m enjoying the most is helping other therapists and coaches build their successful private practice so that they could actually help the clients they were taught to help, and thrive themselves. I’m almost always fully booked, so my ability to work with individuals is limited. That is why I’ve created this program to deliver powerful results and create a community where you will feel supported by each other!
This program's primary goal is to help you build a thriving private practice, in a fun and authentic way. Counselors and coaches invest an incredible amount of time, money, and effort into building their helping skills. However, when their training ends, they usually find themselves lacking the business skills that are needed to start and run a successful private practice, feel isolated, discouraged and not knowing where to start.
I believe that to be truly helpful to others, therapists and coaches have to learn to thrive themselves and definitely know how to get clients whom they can help.
This is where this program comes in. If you're willing to learn and work hard, a 6-figure private practice is within your reach in a year - 2 years. This program will give you a clear outline, and detailed instructions on how to get there.
What Actually Works In Therapy And Coaching
Hello. I hope you're having a good day. I just finished a great therapy session with a client, which brings me to today's topic - what actually works and what doesn't work in therapy? So we'll talk about that in a moment, and I am sure that the findings will surprise you. I'll be talking about research-based findings, of course, not just my own theories.
I hope you don't mind this silly t-shirt. I was thinking, "Well, should I wear a button-up short and I want to look presentable," etcetera. It kind of reminds me ... and then I felt, "Well, it's okay. You will survive." And I will survive. It reminds me of that day in a session, in a couple's therapy session I was doing with a couple, and I felt kind of warm, my feet felt warm and I'm like, "Ugh," I really want to take off my shoes, but I was really ... I heard a lot of times about the need to look presentable and professional. Then I said, "Well, the hell with it. I'm just going to experiment and see what happens. See if my clients survive." And I took off my shoes, and guess what my clients did next? They did the same. So I felt comfortable, they felt comfortable, everyone was happy and nothing horrible happened.
So let's get back to our subject today. If you're just listening to it, this is the book that we'll be talking about, the heart and soul of change, what works in therapy? By and Hubble, Duncan and Miller. One of my favorite books about therapy and what actually works when you're trying to help people. It's a heavily researched book. And I was actually introduced to it in my PhD program in counseling education and supervision. And I love the PhD level education because it helps to take a look from more of a bird's-eye view and view to see ... to kind of step out of the specifics and the small details and to look at the bigger picture of this field.
Now even though this book was written about therapy I definitely think, this is my opinion, it applies to coaching as well because honestly coaching and therapy are not very different. And if you are a family therapist and you've been trained in solution focus therapy or brief therapy, strategic therapy and you've done some coaching training you probably know that it's pretty much the same.
So I'm going to read a little paragraph and then we're going to talk about that. The book first it starts with the fact that the number of therapy modalities out there are just constantly growing. It grows and grows and grows, it grows fast, the DSM, the diagnostic statistic manual which is the manual for mental health since it's a disease model, this is in a way, challenges. It constantly grows and the therapy modalities constantly grow. And the book talks about the problem with dogma eat dogma world of therapy modalities when one therapy modality competes with the other. And of course, there is a lot of factors that go into it and why it's happening. And I think it's important to not get stuck in that trap as therapists and coaches.
So the book starts with discussing the findings of comparative studies. They tried to take a look at what are the best therapists out there, right? Because that would be nice to know, if I know what's the best therapy I'm just going to study that modality and adhere to it and then I would be the best therapist ever.
And this is what they say ... by the way, I hope you can suffer from my collection of accents, the Russian, Hebrew and English right now. "So as it turned out," they say, "The underlying premise of the comparative studies that one or more therapy would prove superior to others received virtually no support." That's from Norcross and Newman study that's been done in 92. Again, there is no support to show that there is one superior therapy modality.
"Besides occasional significant finding for a particular therapy, the critical mass of data revealed no differences in effectiveness among the various treatments for psychological distress. The finding of no difference was cleverly tagged the Dodo bird verdict." That's from Luborsky, Lester Luborsky 75. "Borrowed from Alice in wonderland it says everyone has won and so all must have prizes," right? So we can kind of focus on the fact that there aren't any differences, major differences, between therapy modalities' success rate or the health, right? But, no, you can flip it and say, "Wait a minute, so many therapy modalities are actually effective," which is kind of awesome.
"Now more than 20 years later and after many attempts to dismiss or overturn it, the Dodo bird verdict still stands. Therapy works." I know it from doing my own therapy with so many various therapists and it seems to be working for my clients. "Now more than 20 years later," yes, therapy works, "But our understanding of what works," that's the important part, "In therapy is unlikely to be found in the insular explanations and was the posteriori reasoning adopted by the different theoretical orientations."
So if there aren't big differences between therapies but maybe we can look at the commonalities and figure out, "Well, what's actually working?" And that's where Michael Lambert comes in from Brigham Young University, in 92 he proposed four very important factors that are the common factors between the various therapy modalities, today there are definitely more than 200 by the way, major therapy modalities. And those common factors spawn a lot of research after that. So this is where we're getting into actually what works in therapy.
So the four factors are, the first one - client and extra therapeutic factors - that's a big one, that accounts for 40% success rate in therapy or coaching. And those 40% have nothing to do with you or the therapy or the coaching at all. So I don't know if it's good news or bad news but I think it's a little ... it's a pretty humbling information to have, right? It's not about you as a helper, right? You don't hold the keys to success for your clients. So some relief there and some humbling information in terms of there is a cap on how much you can do.
So those factors, the client and extra therapeutic factors, they consist of the client's strengths, supportive elements in the environment and even chance effect events. In short, they are what clients bring to the therapy room and what influences their life outside of it. So here you have it, 40% of everything that is going to happen in your clients lives would not be the result of therapy, the changes in their lives while they're doing therapy or coaching.
Again, I am taking it into the coaching world as well because it's very similar to talk therapy, just add some goals into it.
Now the big one, if you're familiar with Carl Rogers you probably already heard that the relationship part is the biggest one, and that's what the research shows. Relationship factors do account for 30% of the success in therapy. And those can be caring, empathy, warmth, acceptance, mutual affirmation, and listen to this - and encouragement of risk taking and mastery are about a few, right? So that kind of debunks the myth of therapists need to be passive, right? There are some things that can be done in terms of encouragement and leading the client as well. Except what the client brings to therapy, these variables are probably responsible for most of the gains resulting from psychotherapy interventions.
So it is about the relationship. That's why it doesn't matter that much what therapy modality you're using or which coaching modality you're using, right? It's what happens between you and the client, the depth of the relationship, etcetera.
Now this is a very interesting one - placebo hope and expectancy. So following those previous two factors, the next one would be that is responsible for 15% of the success in therapy is expecting that ... the client expecting that the therapist knows what they're doing or the coach and the therapist and the coach expecting that they're knowing what they're doing, there is a hope that something will change and there's some process around that. So just by expecting that we're going to do something in therapy or coaching and there's a big chance that it will bring some changes that's already affecting the change by itself.
And the least, not the least, same as placebo, 15% of the success in therapy or coaching are attributed to the model or the technique factors. And they say in a narrow sense model, technique factors may be regarded as beliefs and procedures unique to specific treatments. The miracle question in solution-focused breath therapy, the use of the genogram in brain-oriented family therapy, hypnosis, systemic dysenterization, biofeedback, transference interpretation and the respective theoretical promises, attending these practices are exemplary.
So here you have it - the theory and modalities you're using as a therapist or as a coach are accountable to only 15%. Still needs to be said that those 15% are important, right? So I think there are wonderful modalities out there and it's incredible to learn from all of this or at least the ones that you feel connected to. So I'm wondering what do you think about that. Was that surprising or you kind of knew it already or had a gut feeling about that? Leave a comment. And I'll see you on the next live.