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While much attention has been paid to the effectiveness of various "brands" of therapy there is a growing understanding that therapeutic change occurs due to a number of nonspecific factors that are not exclusive to any one approach.
These factors have a much greater influence on outcome than the contribution made by approach-specific theory and technique; in Lambert's (1986) review of empirical studies, common therapeutic factors accounted for 30% of the therapeutic effect, technique 15%, expectancy (placebo-effect) 15% and spontaneous remission 40%.
List of nonspecific factors
- Therapeutic alliance
- Therapy credibility
Jerome Frank's work
In the various editions of his book "Persuasion and Healing" Jerome Frank argued that psychotherapeutic change is predominantly due to a number of nonspecific factors which are focused by the development of the relationship between the patient and the healer. Frank thought that the clients demoralization and hopelessness resulting from their failure to tackle their symptoms was one of the main obstacles to enabling them to unlock their own resources and improve. He felt that a benign helping relationship boosting their morale would enable them to hope again and recommit themselves to the changes necessary. He identified the nonspecific factors in the therapeutic relationship as:
- Feeling understood
- Being respected
- Having someone be interested
- Being encouraged to face the difficulties and overcome them.
- Being accepted
- Being forgiven
Studies of trained vs nontrained therapists
Strupp and Hadley (1979) explored the relative contribution of therapist's technical skills and the qualities inherent in any good human relationship to outcome in time-limited individual psychotherapy. They compared two groups of therapists, one made up of highly experienced psychotherapists and the other of nonclinically trained lecturers, chosen for their ability to form understanding relationships. Each group of therapists treated 15 patients drawn from a relatively homogeneous patient population classified as suffering from neurotic depression or anxiety reactions. The fact that obsessional and borderline features were common suggests degree of clinical severity. Patients treated by professors showed, on the average, as much improvement as patients treated by professional therapists. This suggests that non specific factors in the helping relationship are an effective contributor to symptom change.
- ↑ Lambert, M. J. (1986) Implications of psychotherapy outcome research for eclectic psychotherapy. In Handbook of Eclectic Psychotherapy (ed. J. C. Norcross), pp. 436–462. New York: Brunner Mazel.
- ↑ Frank, J. D. (1973) Persuasion and Healing . Baltimore, MD: Johns Hopkins University Press.
- Miller,S.D. Duncan,B.L. & Hubble,M.A. (1997).Escape from Babel: Toward a Unifying Language for Psychotherapy Practice.W W Norton, New York.ISBN 0393702197
- Frank, Jerome D; Frank, Julia (2004).Therapeutic components shared by all psychotherapies. In Freeman, Arthur [Ed]; Mahoney, Michael J [Ed]; DeVito, Paul [Ed]; Martin, Donna [Ed]. Cognition and psychotherapy (2nd ed.). (pp. 45-78). xviii, 381 pp. New York, NY, US: Springer Publishing Co; US.
- Oei T.P.S.; Shuttlewood G.J.(1996) Specific and nonspecific factors in psychotherapy: A case of cognitive therapy for depression. Clinical Psychology Review, Volume 16,2,83-103(21)
- Omer,H and London, P (1989)Signal and noise in psychotherapy. The role and control of non-specific factors. British Journal of Psychiatry 155: 239-245
- Parloff MB (1986). Frank's "common elements" in psychotherapy: nonspecific factors and placebos.Am J Orthopsychiatry,56(4):521-30.
- Strupp HH (1970). Specific vs nonspecific factors in psychotherapy and the problem of control.[Arch Gen Psychiatry]. Nov;23(5):393-401.PMID 5478565
- Strupp HH, Hadley SW.(1979).Specific vs nonspecific factors in psychotherapy. A controlled study of outcome.[Arch Gen Psychiatry].,36,10):1125-36.
- Wilkins,W. (1985).Therapy credibility is not a nonspecific event.Journal Cognitive Therapy and Research Vol9, Number 2