The Common Factors

Ninety years ago, Saul Rosenzweig’s research noted that various types of psychotherapy are all equally effective. Referencing Lewis Carroll’s Alice in Wonderland, wherein a dodo bird proclaimed, “Everyone has won! All must have prizes!”, Rosenzweig labeled it the “Dodo Bird Verdict”. His landmark study showed that fruitful psychotherapy relies more on certain Common Factors rather than on the unique theory or technique.

Here we discuss six common factors that are crucial for driving change in a client during the therapy process.

These include

• The therapeutic relationship

• Explaining the rationale for psychotherapy

• Having positive expectations about psychotherapy

• Collaborative goal setting

• Role preparation for the psychotherapy process

• Being able to talk about feelings

Remember, while the common factors transcend theoretical orientation, it doesn't mean that all theoretical orientations are equally effective for every individual or every presenting issue.

The therapeutic relationship

The therapeutic relationship refers to the interpersonal attachment between a therapist and their client. It provides clients with an empathetic, caring and genuine human connection, something that they might be lacking in their social relationships. A healthy therapeutic relationship is not only essential for beginning psychotherapy, but also allows clients to develop and grow as individuals during the process. This relationship does not always steadily improve in quality, rather it can undergo periods of decline and improvement as psychotherapy progresses. In fact, clients tend to repeat patterns from other relationships with the therapist - focusing on these patterns and the therapeutic relationship can allow for significant insight and change.

Explaining the rationale for psychotherapy

It is important that potential clients gain a real sense of how psychotherapy works before they sign up for regular sessions. While offering a rationale, therapists usually give clear information about the purpose of therapy, the frequency of sessions, and a concise explanation of their theoretical orientation and how they believe it will help the client.

Having positive expectations about psychotherapy

From the moment a client first calls them, therapists assure people of the effectiveness of psychotherapy and confidently express that their work together will bring the desired change and relief in the client’s life. This is because having hopeful, positive expectations at the beginning ensures that clients experience a greater degree of change during psychotherapy.

Collaborative goal setting

Once the client consents to starting sessions, a consensus needs to be reached about reasonable goals for psychotherapy. Therapists listen to what the client thinks is going wrong and understand what they would like to work on right now. Goals can be layered, prioritizing more urgent issues and leaving others for later. Sometimes the goal is specified, say wanting relief from symptoms of anxiety, and other times it can be a little broader, improving interpersonal relationships or body image issues. In both cases, it is important to remember that, no matter how concrete, it is highly unlikely that the goals will be achieved overnight. Setting clear goals can define the structure of the sessions, instills hope and be a therapeutic activity in itself for the client.

Role preparation for the psychotherapy process

Before diving into the first session, therapists take some time to prepare themselves and their clients for each of their roles and role expectations. This helps set the stage for a collaborative and productive therapeutic relationship.

The therapist’s role has two parts: function and responsibility. Conducting assessments, providing empathetic understanding, coming up with interpretations, and being non-judgmental are all functions. These overlap with responsibilities, which include duties like setting ethical boundaries, showing up on time, explaining the therapeutic process, not being distracted, and remembering things that clients share. Although seemingly obvious, responsibilities are among the most essential aspects of a therapist’s role.

Clients also have roles within the therapy room: These include thinking about goals and expectations, communicating about preferences and concerns, attending sessions regularly, being open and honest in sharing their experiences, thoughts and emotions, respecting the therapist’s boundaries, and actively participating in therapeutic exercises.

Being able to talk about feelings

It is essential that therapists make a space safe enough for clients to talk about all kinds of feelings. People often come into therapy with bottled-up feelings, perhaps because they don’t know how to express emotions, are ashamed of them, or lack a confidante to talk to. Therefore, helping clients introspect, open up and talk about their feelings is extremely therapeutic.

Overall, the Common Factors are an indication that the therapist is empathetic, reliable, and listening to the client’s needs, and ensure that the client remains optimistic throughout the process of therapy. While a rapport between a client and their therapist begins to form in the first session, and rationale and goals can be determined in the first few weeks, it is important to note that change does not happen rapidly. The Common Factors are not fixed milestones to be ticked off. Rather, they represent certain processes that occur as soon as therapeutic contact is established and continue to evolve, strengthen and transform as psychotherapy progresses.