Psychotherapy, according to the Spanish Federation of Psychotherapist Associations (1992), consists of a scientific treatment of a psychological nature that promotes the achievement of changes in the way of acting, physical and psychological health, consistency and integrity of the identity and well-being of both groups and individuals.
Its effectiveness lies in the therapeutic change that allows the patient to live his life in a more functional and healthy way. What factors are driving this change?
Numerous studies emphasize that the quality of the therapeutic alliance, which is the relationship established between the patient and the therapist in therapy, it is the most robust predictor of treatment, being less important than the type of therapy used because there are no significant differences between them, as they are fundamentally moderated by contextual and relational factors.
Therefore, the different characteristics, attitudes and therapeutic skills are particularly relevant in the effectiveness of the intervention. Which are the most important?
Characteristics of the therapist
Among the personal characteristics of the professional who they promote change of its patients stand out.
cordiality: Express (verbally and non-verbally) the patient’s interest, esteem, encouragement and approval.
competition: Ability to help people solve their problems and improve their self-confidence.
trust: Patient’s perception that the therapist will work to help him, without deceiving or trying to harm.
attraction: It can be physical or interpersonal. The former particularly influences the initial phase of therapy, while the latter is much more important throughout the process.
directivity: Degree to which the therapist gives instructions, delimits tasks, asks questions for information, provides information and feedback … Both excess and lack of directivity are negative in therapy.
Essential therapeutic skills
The fundamental attitudes for establishing the therapeutic alliance are active listening, empathy, unconditional acceptance and authenticity.
1. Active listening
Knowing how to listen is essential in therapy because it encourages patients to talk about themselves and their problems, increasing the possibility of understanding them and encouraging them to be responsible for their process of change, seeing the ‘ therapist as a collaborator rather than as an expert.
Active listening involves three activities: receiving the message (through verbal, non-verbal and vocal communication and attitude), processing information (knowing how to discriminate what is important and establish its meaning), and listening responses.
Empathy is the ability to understand people’s thoughts and feelings from their own frame of reference. involved deals with what manifests and also with the latent, Capture and understand the meaning of emotional, cognitive and behavioral implications beyond what is expressed. In addition, you have to know how to communicate to the other person that you understand them.
Some empathic strategies are: active listening (previously defined), clarification (asking questions to find out what the patient is expressing), the use of paraphrasing, synthesis and recapitulation (collecting and capturing ideas previously expressed by patient) and reflection (collecting and capturing the emotional component presented).
3. Unconditional acceptance
Accept the patient as he is, by valuing it without judging it.
Among the components of unconditional acceptance are: commitment to the patient (interest and willingness to help), the effort to understand him, and the non-evaluative attitude.
Authenticity involves being yourself, communicate their own inner feelings and experiences. The therapeutic situation requires knowing what to say or express, how and when so as not to harm the patient or the therapeutic relationship.
Some of its main elements are: non-verbal behaviors (such as smiling, eye contact and body orientation towards the patient), little emphasis on the therapist’s role of authority, spontaneity (the ability to expressing – is natural, without deliberating above all is said and done) and self-disclosure (controlled provision, by the therapist, of information about himself and his reactions to the situation in therapy).
Campbell, LF, Norcross, JC, Vasquez, MJ and Kaslow, NJ (2013). Recognizing the effectiveness of psychotherapy: the APA resolution. Psychotherapy, 50 (1), 98.
Corbella, S. and Botella, L. (2004). Research in psychotherapy. Common processes, results and factors. Madrid: Net Vision.