Why does therapy work?


Some of our participants have now had several sessions and are approaching the end of their therapy journey with us, so it feels like a good time to reflect on how therapy can help people to make changes in their lives. It’s very easy to sit in our little comfort zones and never push ourselves outside of it, but every single one of the people I am seeing at the moment is being brave, pushing themselves to try new things and seeing the benefits that can result.

When I asked one participant what was helping him so far, he said, “You helping me to know I’m in control. I’m not scared any more.”  Most of our participants have said that understanding the mechanics of speech and being able to relate this to what happens when they are stammering has been really helpful . Others have said they’ve found it helpful having a technique to use, which can increase fluency, but which also provides a safety-net effect, helping to reduce the anxiety around stammering.  Talking to other people about stammering and about coming for therapy is also proving very useful for many of our participants, and helping to challenge some of their assumptions about what other people might be thinking.

thoughts feelings behaviour

I’ve had a few discussions this week about how to overcome fears and anxieties and about different psychological approaches.  The great thing about being a speech and language therapist is that I’m not tied into any one particular approach, and can cherry-pick the bits I feel would be useful for each individual. So I use elements of Cognitive Behavioural Therapy, Solution Focused Brief Therapy, Acceptance & Commitment Therapy and Mindfulness, to name a few!

There is no consensus about which therapeutic approaches work best, but various meta-analyses of scientific studies (e.g. Wampold et al, 1997, 2002) have concluded that no one approach is more effective than any other. There seem to be other factors which influence whether therapy is effective, e.g. the therapeutic alliance between therapist and client, the client and their situation, their readiness for change, other support systems, etc.  And then there are those things that the therapist brings. Wampold’s Qualities and Actions of Effective Therapists lists fourteen qualities of effective therapists. I’m not convinced I fulfil all of these, but I do constantly strive to improve, and what I learn from the amazing clients I work with helps me to do this. I particularly like number 10 – for me, hope and optimism are a huge part of therapeutic change. As far the rest, I’ll leave it to our participants to judge!

  1. Effective therapists have a sophisticated set of interpersonal skills.
  2. Clients of effective therapists feel understood, trust the therapist, and believe the therapist can help him or her.
  3. Effective therapists are able to form a working alliance with a broad range of clients.
  4. Effective therapists provide an acceptable and adaptive explanation for the client’s distress.
  5. The effective therapist provides a treatment plan that is consistent with the explanation provided to the client.
  6. The effective therapist is influential, persuasive, and convincing.
  7. The effective therapist continually monitors client progress in an authentic way.
  8. The effective therapist is flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate progress.
  9. The effective therapist does not avoid difficult material in therapy and uses such difficulties therapeutically
  10. The effective therapist communicates hope and optimism.
  11. Effective therapists are aware of the client’s characteristics and context.
  12. The effective therapist is aware of his or her own psychological process and does not inject his or her own material into the therapy process unless such actions are deliberate and therapeutic.
  13. The effective therapist is aware of the best research evidence related to the particular client, in terms of treatment, problems, social context, and so forth.
  14. The effective therapist seeks to continually improve.






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