Common factors theory

In plain words

1. Frank's healing components1

   Jerome Frank's 1971 list: an emotionally charged confiding relationship, an accepted rationale, new information, expectation of help, success experiences, emotional arousal.

2. Wampold's contextual model2

   After an initial bond, therapy works through three pathways: the real relationship, expectations built by a convincing explanation, and doing health-promoting actions.

3. What techniques are for2

   In this model a therapy's specific ingredients matter because they create expectations and prompt healthy actions, not because they fix a specific deficit.

What common factors look like in a session

1. The first impression2

   Before any technique, the client is quickly judging whether this therapist seems trustworthy and competent; many who are not won over drop out after the first session.

2. The real relationship2

   The client can tell the therapist difficult things without the threat that the therapist will end the relationship, which most social relationships cannot absorb.

3. A believable explanation2

   For example, a client who arrives sure they are simply weak hears an explanation of their distress that points to something they can work on, accepts it, and begins to expect help.

4. A healthy action2

   Each therapy prompts its own: reframing unhelpful thinking in CBT, expressing difficult emotions in emotion-focused and dynamic therapies, accepting oneself more in self-compassion therapies and ACT.

5. Warmth without a real technique2

   In a sham-acupuncture trial for irritable bowel syndrome, a warm practitioner using active listening and appropriate silences got better results than a brief, non-conversational one; both beat usual care.

6. A shared ritual1

   For example, a relaxation exercise or a thought record works partly as what Frank called a ritual: a procedure that follows from the shared rationale and that client and therapist carry out together.

What the research says

1. Shared factors carry weight1

   Laska and colleagues (2014) put goal consensus at 11.5% of outcome variance, empathy 9%, alliance 7.5%, and treatment differences under 1%.

2. Removing ingredients changes little2

   Dismantling studies that remove a treatment's components find almost no loss (Cohen's d = 0.01); following the manual closely barely predicts outcome (d = 0.04).

3. Therapists differ2

   Which therapist you see matters: therapist effects reach d = 0.35 in trials and d = 0.55 in everyday settings.

4. Lambert's famous split1

   Michael Lambert (1992) estimated 40% outside factors, 30% common factors, 15% expectancy, 15% technique; an estimate, not a measurement.

Where to start reading

The line under a date fills as it gets older: empty when new, full at 2 years.

1. Oct 2015 · 11 years ago

   How important are the common factors in psychotherapy? An update2

   Bruce Wampold's free review in World Psychiatry, with the contextual model and the effect sizes.

2. 2015 · 11 years ago

   The Great Psychotherapy Debate (2nd ed.)3

   Wampold and Imel's book-length case for the contextual model over the medical model.