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Lesson 1: Abnormal Behavior
Common Factors Model
The Common Factors Model (Frank & Frank, 1991) conveys that any psychotherapy theory can work as long as the therapy incorporates some universal, effective factors. Imagine a stew that will taste good as long as it includes four key ingredients. The four common factors are as follows:
Therapeutic Relationship
The therapeutic relationship is considered by many psychotherapy researchers to be the most important determinant of positive change (Lambert, 2004), and it is the most important of the four common factors. A strong therapeutic relationship is a foundation of trust that allows psychotherapy to be more fruitful (regardless of theory). For example, clients are less resistant or defensive and interventions work better when a strong therapeutic relationship is in place. Doing certain interventions or techniques without a strong therapeutic relationship in place is like taking food out of an oven before it’s cooked or walking a tightrope without a safety net.
Healing Setting
This refers to a comforting, healing place in which a client can get into the “mode” of working on oneself. It’s an atmosphere that creates a relaxed and open feeling within the client, which subsequently facilitates dialogue and disclosure. An ethical, empathetic therapist can create this by making the client feel welcome and safe. An example from my own career when there was not a good healing setting was when I was attempting to use relaxation techniques on a client with panic disorder but the clinic was under construction and workers in the next room were using loud drills and other construction tools, which exacerbated my client’s nervousness. That was definitely not a healing setting!
Accepted Rationale
This basically means a shared belief between client and therapist; both the client and therapist must be optimistic about the prognosis to a reasonable degree and must believe in the style of therapy being used and/or the content of each session. This does not mean that the client and therapist have to have the exam same worldview or life philosophy, but it does mean that they need to be “on the same page” regarding the therapy taking place. For example, if a therapist uses guided meditation for a client’s anxiety both the therapist and client must believe that the technique will be helpful.
Rituals or Procedures Requiring Active Participation
This refers to the events and/or techniques that take place in a therapy session; ideally, the client must actively participate in the techniques and activities rather than being passive or disconnected. For example, if a therapist challenges a client’s negative, irrational beliefs the client must actively work with the therapist in coming up with ways to refute those negative beliefs. The term “ritual” refers to repeated things performed in session. An example of a ritual in therapy is the “check in” and “check out” procedure during a typical group therapy session, which is when each client in the group talks about how their week was and so forth (check in) and then when everyone at the end processes how the session went (check out).
Now that we have established ways in which psychotherapy works, let’s discuss an important goal of mental health treatment: moving a client to a higher stage of change.