50+ years of research on psychotherapy has revealed some important findings. First, psychotherapy works. Studies have repeatedly shown that for dealing with mental health issues, individuals who engage in psychotherapy are better off than roughly eighty percent of people who do not. Second, all of the major “brand names” of psychotherapy (psychodynamic, humanistic, cognitive-behavioral, etc.) work about equally well. None of the major brands of psychotherapy has distinguished itself as being more effective than the others. Instead, the field has been moving to a recognition that the active ingredients in psychotherapy, the so called “common factors,” are those elements that exist in all forms of successful psychotherapy, regardless of theoretical orientation. Not surprisingly, common factors include such things as a positive therapist-client relationship, therapist competence, client motivation, and an agreement on the problems to be addressed, the goals, and the methods of therapy.
So, can the therapist operate without any kind of conceptual framework at all?
No. Having a coherent and consistent approach allows the therapist to continually work on the craft of psychotherapy in a non-haphazard way; to achieve higher levels of competence; and to conceptualize issues brought in by the client. Our conceptual orientation influences how we listen, and how we make sense of what we hear. But what we know now, more clearly than ever, is that the conceptual framework must be flexible and responsive to individual client needs.