The common factor data
The Great Psychotherapy Debate: Models, Methods and Findings (Wampold, 2001) (upon which this entire column is based) lends strong support for the common factor claim. This book based its conclusions on a hefty number of journal studies. That is, positive therapy outcome is far more associated with the professional relationship than any specific treatment intervention, strategy or technique.

Although Wampold builds a case for what he calls a contextual model (common factors) that holds more relevance than the medical model (specific driven therapies), a major conclusion from his research is that the very heart of counseling is embodied in the therapist. Yet, this conclusion is not to be interpreted such that the addiction counseling, or any counseling, should run head long into the humanistic or experiential camps. That is not the case. His data indicates that unquestioning adherence to any form of therapy does not make for better outcomes.

Wampold’s evidence points out that good counselors have solid therapeutic skills. Have you ever noticed that certain counselors in your program seem to get better results than the others? That’s because they are more likely to:

• Have the ability not only to empathically listen, but to empathically respond to clients (Recall that a critical element of empathy means to drop your preconceptions and theories, and openly listen to what is being said.)
• Be able to develop a professional and productive alliance with most of their clients
• Work through their own personal issues, so those issues are not apt to impinge on the counseling process and alliance
• Have the ability to understand the unique dynamics that exist within a client, and the dynamics that exist between the client and others
• Have the ability to reflect on their work. That is, for each case the counselor analyzes what went well, what didn’t, and adjusts accordingly for the next session.

Another important common factor
Another notable research supported elements is the counselor’s belief in and allegiance to a particular form of therapy. Studies note that this belief factor accounts more for the outcome than the form of therapy itself.

However, that data suggests that simply believing what will work is not the total answer. The client has to believe as well. That is, clients have to ‘buy’ your proposed explanation for their problem, why it happened, and what will fix it. The meaning a client gives to the therapeutic experience and therapeutic approach are important. So, the counselor needs to use a form of therapy that dovetails with the client’s personal characteristics, his/her view of the problem. Most importantly, the client has to feel that all this is meaningful. And, this meaning has to include the client’s ethnic and cultural background.

If you don’t have a strong belief in a certain form of therapy; if you don’t complement a selected therapy with the client; and if the client doesn’t find meaning within the
overall experience, chances are the outcome will not be favorable. You can see the problems counselors will have if they try to force a therapy on clients, especially if clients (or even counselors) have little confidence in it or don’t buy it.

One more interesting item should be noted with regard to this belief element. Research indicates that a selected therapy does not have to have mountains of supported research behind it. Therapies with little empirical support may work with a client, but only if the client and you believe it will. But, do not take this to mean that any kind of therapy can then be used in addiction counseling. It doesn’t. Again, if the client and the counselor believe in a particular therapy, then it stands a chance of being effective. Yet, such a therapy has to correspond to that client’s view of the world, as well as his or her own values and attitude.

Last thought and a clinical suggestion
To put this column in perspective, it is important that you appreciate a core message from Wampold’s book — that it does not work to simply train counselors with an emphasis only on learning evidence-based therapies and ignoring the ability to demonstrate the core therapeutic skills common to all therapy. The success behind specific therapeutic approaches comes from the common factors of alliance building and faith that that process will work.
In light of these research findings, addiction professionals need to hone those alliance skills, and then spend time on learning a particular school of therapy. The message is not to do away with specific treatments; it means directing education, training and supervisory efforts to what has the biggest effects in terms of client outcome.

Try it
Using this research in real practice may sound straightforward. And for those of you who already use the above bullets in your everyday practice, it is. You are used to it, you know it, and you trust it.

For counselors not accustomed to using these alliance suggestions, these research findings may prove problematic in terms of translating them to practice. For example, certain professionals accustomed to doing addiction counseling in a certain way will often have a difficult time trying something new. If suggestions above are viewed as something new, and if they don’t meet with the belief system of the counselor, more than likely they won’t even be attempted.

However, should you have the remote belief that building a professional alliance and engendering belief in something could prove beneficial to the overall outcome, simply follow the bullets outlined above and see what happens.

Research projects
As always, this column encourages you to try a basic research project meant for internal use, not necessarily publication. Project suggestions for the common factor research are comprised of two broad approaches.

The first approach involves a before and after design (pre- and post-test). The idea here is to first establish a baseline that could consist of how the client perceived a series of sessions. For example, you can measure: how strong/weak the alliance is; whether or not treatment goals are being met; whether or not the client believe the process and/or counseling strategies really work. (See Duncan, Miller, & Sparks, 2004 for more details.) Or, simply create a likert scale for each of these items and have the client score this assessment at the end of each session. After a few weeks you will have a baseline.

Next, change your form of counseling to include some or all of the bullets above. Do that kind of therapy for a few weeks, measuring the outcomes with the same scale you used for the pre-test portion of this project. Lastly, compare your results. If you really want to get ambitious, add an extra set of outcome variables. For example, note how well clients are doing by measuring variables, such as amounts of substance use in the allotted time (pre and post); emergency room visits; encounters with the law; or any similar variable.

A second project entails asking clients which element of therapy has meaning for them. Use a before and after design like the one above. In this case, what you are looking for is a measure of the belief and/or level of meaningfulness from client. To do this, you can simply create a short set of questions about that belief, and add a likert scale to each question. One example might be, “How strongly do you believe in the therapy that is being offered to you?” As before, find a baseline, make a change in how you conduct treatment, and collect a second baseline. Finally, compare your results.

I remain interested in your findings.

Michael Taleff, PhD, CSAC, MAC is an instructor at the University of Hawai’i at Manoa and West Oahu campuses, and an instructor at National University (Hawaii branch). He can be contacted at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
Duncan, B.L., Miller, S.D. & Sparks, J.A. (2004). The heroic client. San Francisco: Jossey-Bass.
Taleff, M.J. (June, 2003). Develop and Maintain A Professional Relationship For Better Treatment Results. Counselor, Vol. 4, No. 3, pp. 48-50.
Wampold, B.E. (2001). The great psychotherapy debate: Models, methods and findings. Mahwah, NJ: Lawrence Elbaum Associates.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2005, v.6, n.5, pp.63-65.

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