Psychotherapy, according to the Spanish Federation of Psychotherapists’ Associations (1992), consists of a scientific treatment of psychological nature that promotes the achievement of changes in the way of acting, the physical and psychological health, the coherence and integrity of the identity and the well-being of both groups and individuals.
Its effectiveness lies in the therapeutic change that allows patients to live their lives in a more functional and healthy way. What factors encourage this change?
Numerous studies indicate that the quality of the therapeutic alliance, which is the relationship established between the patient and the therapist in therapy, is the most robust predictor of treatment, with the type of therapy used being less important as there are no significant differences between them, since they are fundamentally moderated by contextual and relational factors.
Thus, different characteristics, attitudes and therapeutic skills are especially relevant in the effectiveness of the intervention. Which are the most important?
Characteristics of the therapist
Among the personal characteristics of the professional that favour the change of their patients, the following stand out.
- Cordiality : to express (verbally and non-verbally) interest, appreciation, encouragement and approval by the patient.
- Competence : ability to help people solve their problems and improve their self-confidence.
- Trust : patient’s perception that the therapist will work to help them, without deceiving them or trying to harm them.
- Attraction : can be physical or interpersonal. The first one has a special influence on the initial phase of the therapy, while the second one is much more important throughout the whole process.
- Directivity : degree to which the therapist gives instructions, delimits tasks, asks questions to obtain information, provides information and feedback Both over- and under-directivity are negative in therapy.
Essential Therapeutic Skills
The fundamental attitudes for the establishment of the therapeutic alliance are active listening, empathy, unconditional acceptance and authenticity.
1. Active listening
Knowing how to listen is fundamental in therapy as it encourages patients to talk about themselves and their problems, increasing the possibility of understanding them and encouraging them to be responsible for their process of change, seeing the therapist as a collaborator rather than an expert .
Active listening involves three activities: receiving the message (through verbal, non-verbal and vocal communication and attitude), processing the information (knowing how to discriminate what is important and establish its meaning) and making listening responses.
Empathy is the ability to understand people’s thoughts and feelings from their own frame of reference. It implies attending to the manifest and also to the latent , capturing and understanding the meaning of the emotional, cognitive and behavioural implications beyond what is expressed. In addition, it requires knowing how to communicate to the other person that we understand them.
Some empathic strategies are: active listening (previously defined), clarification (formulating questions to know what the patient is expressing), the use of paraphrases, syntheses and recapitulations (gathering and shaping the ideas previously expressed by the patient) and reflection (gathering and shaping the emotional component presented).
3. Unconditional acceptance
Accept the patient as he is , assess him without judgement.
Among the components of unconditional acceptance are: commitment to the patient (interest and willingness to help), effort to understand the patient and a non-valuable attitude.
Authenticity implies being oneself, communicating one’s inner feelings and experiences . The therapeutic situation requires knowing what to say or express, how and at what moment so as not to harm the patient or the therapeutic relationship.
Some of its main elements are: non-verbal behaviors (such as smiling, eye contact and body orientation towards the patient), the lack of emphasis on the therapist’s role of authority, spontaneity (ability to express oneself naturally, without deliberating on everything one says and does) and self-revelation (controlled offering, by the therapist, of information about oneself and one’s reactions to the situation in therapy).
- Campbell, L. F., Norcross, J. C., Vasquez, M. J., & Kaslow, N. J. (2013). Recognition of psychotherapy effectiveness: the APA resolution. Psychotherapy, 50(1), 98.
- Corbella, S. and Botella, L. (2004). Research in Psychotherapy. Process, results and common factors. Madrid: Visión Net.