What Leads to Improvement When Attending Therapy?

We have to first acknowledge that this subject is extraordinarily complex and is more suited to be explored in a book than a blog article. So for the focus of this article, we are not examining this topic with any one specific aspect of treatment, e.g. get better at managing anxiety. Rather, we’re going to look through the lens of improvement, however you, the reader may be thinking about it. This question has been asked by clinicians and researchers alike who want to make the world a better place. Many attempts have been made to answer this question, some of which are grounded in evidence. One of the things I want to do here is flesh out some of the components that I’ve come across in my own clinical practice; And, I want to share some of the observations by researcher-clinicians that I believe to be incredibly valuable. So, why do people get better in counseling?

You Have to Want to Be There

The literature on what leads to improvement in psychotherapy has been well researched: Client Characteristics, Therapist Characteristics, the Therapeutic Relationship, Dimensions of Expectancy, Non-Specific Mechanisms of Change, etc. Here I will be talking only about “Client Characteristics”. After all, current research suggests that, when combined with the therapeutic relationship, as much as 70% of the outcome variance is attributed to you, the client (Hubble et al. 1999).

“The research literature makes is clear that the client is actually the single, most potent contributor to outcome in therapy.”

-Miller, Duncan and Hubble (1997)

You, the client, are the major “hero” in any change that happens in “your story” during therapy. It’s really important that you have your own story, that you understand your life in the format of a story. I believe it was Carl Jung that said, “If you’re without a story, some other story is going to pick you up … and you should figure out what your story is, because it might be a tragedy.” And if it is, you may wish to rethink it.

Your motivation, expectations, awareness, and preparation are key! If you, the client, have no motivation to get better, you won’t get better. A person’s mental health doesn’t improve accidentally or randomly. If you are in therapy because someone else told you it would be a good idea, but you don’t believe you need it, or that it would benefit you, then it is unlikely you will get better. Important in this is being honest with yourself. If you don’t actually want to improve, or don’t feel you need to improve, it will be a waste of your time and money to attend counseling.

You Have To Believe That You Deserve To Get Better

Of course, there are things that impact how long it may take to get better. These can be referred to as “extratherapeutic factors” such as, social support, community involvement, stressful events, etc. One of the reasons people don’t make progress in treatment is because they sabotage themselves. If you don’t believe that you deserve to improve, you’ll unconsciously act out that belief and get better and better at becoming the obstacle in your own path for self-improvement. One reason why a person might not believe that they deserve to get better can stem from a deeper belief that they don’t have any value or worth. If that negative core belief exists in you, you must be open to challenging it. You must be willing to ask yourself the question, “Why should I treat myself like I have any value?”

 

You Must be Willing to See Your Own Fundamental Worth

Psychologist and best-selling author, Jordan Peterson speaks a lot on the subject of the sovereign individual. Our political system treats every individual as if they have divine sovereignty – it’s written right into our Constitution. Even if you’ve been found guilty of doing terrible things, you’re still protected by our laws. And this is because each of us has intrinsic worth. You can’t have a healthy relationship with yourself unless you make the assumption that you have intrinsic worth. Your worth is one of the cornerstones to our civilization; Therefore, you’re responsible for grappling with that. This is independent from what you think about yourself. For example, you might think that you know all of the ways in which you’re “unworthy”; Yet, you’re still morally bound to take responsibility for yourself as if you have some value. Because you do. You must be willing to see it

Treat Yourself Like You Were Someone You Are Responsible for Helping

There’s this old idea that generally gets attributed to Richard Wiseman referred to as the “As If” principle, sometimes known as “Acting As If”. Perhaps you know it as “Fake it till you make it.” It has its origins from Victorian philosopher William James, “If you want a quality, act as if you have it.” One of the things that improves people’s conditions in counseling is when they learn to take better care of themselves, their relationship, their family, etc. One way that you can learn to take better care of yourself is by imagining that you could take better care of yourself. Ask yourself like you were asking someone that you cared for, “If you could have what you needed and wanted, if you were taking care of yourself, what would that look like?” Your mind will answer the question. But you need to specify the answer. Make a plan. It can be a bad plan – because 1) you’ll be more likely to execute the bad plan than no plan, and 2) when you do execute your bad plan, it’s flaws will be revealed to you. 

Why Do People Get Better In Counseling?

  • They change the way that they view themselves and their lives. 
  • They’re motivated and engaged in treatment.
  • They persevere and cooperate with any out-of-session tasks the therapist may suggest.
  • They take seriously, the task of caring for themselves as they would someone who mattered to them.
  • They are able to adopt a self-observational stance which is sort of detached; This enables them to see more clearly the contents of their conscious experience. 

Therapy can help you. And if it’s successful, then it also helps the people who care about you. And when you get better, your family gets better, and your community gets better. Every single one of us – as sovereign individuals – makes up the foundation of the world. Here’s to all of the people who have improved their conditions and have made the world a better place for it. And here’s to readers who are in the “Preparation Stage”.

Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to The Couple and Family Clinic Blog.

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