by Keith Sonnanburg, Ph.D.
Clinical Psychologist
Psychotherapy is a highly personalized and collaborative effort, engaging a trained professional with one or more individuals who are experiencing distress and disruption in their lives. Several concepts will be useful to understand the bewildering array of services that go by the name of therapy. Most important among these are: "common elements," "theory," "technique," and "social processes."
The common elements of psychotherapy include the ingredients of the process which remain the same regardless of the participants, the culture, the focus, or the understanding reached by those involved. In recent psychological literature, these have also been known as "placebo effects" and the "non-specific effects" of therapy. Examples of such components include: the rationale accepted by the participants, their expectations, the exchange of information or social/emotional cues, the norms of interaction defined by social roles, and the agreed upon rules for recognizing significant changes.
The theory is the explanatory narrative used by the practitioner. This is believed to guide therapeutic choices made, and to account for the efficacy of the procedure. The theory may or may not describe what the therapist actually does or why. It may also be more or less accurate in describing the significant factors which effect the outcomes of psychotherapy.
Techniques are the specific maneuvers enacted by the practitioner during the course of therapy. These can follow a well-defined protocol or be invented on the spot. Techniques may be helpful in themselves, or serve as the vehicle for common elements and unintended by-products of therapy. Both practitioners and consumers expect some change to result (if only to increase "understanding"), but there is a wide range of definitions for desired changes. Though it is generally accepted that psychotherapy can produce desirable outcomes, why it works, how to best effect change, and what constitutes an important target for change are matters of continuing professional controversy. Specifically defined techniques have only recently been tested within well-controlled research (arguably within the last 15 to 30 years).
Psychotherapy is essentially a social process. Though there is much helpful
information available in the media, self-help is inherently limited by the
fact that nobody can fully apprehend all of the influences that affect them
at a given point in time, and nobody in isolation can create the social
influences that naturally promote growth and change. Caring, compassion,
empathy, timely coaching, encouragement, corrective feedback, negotiating
goals, and careful assessment are among the factors absent from reading
books or talk-show advice. Some problems in living simply
cannot be solved alone. Though there are benefits possible from community
resources other than psychotherapy, therapy is a powerful and valuable tool for enhancing the quality of life.
