MODELS
THE COMMON FACTORS MODEL
The Common Factors of Successful Couples Therapy
The common factors theory of therapy effectiveness is a widely accepted framework for understanding why therapy works.
This theory posits that there are certain factors that are common to all types of therapy that promote positive outcomes. And these factors have a corresponding impact percentage on the outcome.
These factors include the quality of the therapeutic relationship (40%), the client's resources and strength (30%), the client's expectations and motivation for change (15%), and the therapist's chosen therapy model (15%).
The Biggie! The Quality of the Therapeutic Relationship… 40%
The therapeutic relationship is considered one of the most important factors in therapy effectiveness.
Research has consistently shown that the quality of the therapeutic relationship is strongly correlated with positive outcomes (Norcross, 2011).
A strong therapeutic relationship is characterized by empathy, warmth, trust, and collaboration between the therapist and client.
Through this relationship, the therapist can help the client feel safe and supported, and can create a space where the client can explore their thoughts, feelings, and behaviors without fear of judgment or criticism for those thoughts and feelings…
but please remember a good therapist looks at behavior differently. Don’t hire a chickensh*t therapist who can not confront damaging, destructive behavior…
The Client’s Resources… 30%
Another important factor in therapy effectiveness is the client's resources and strengths.
Clients who are blessed with a strong sense of resilience, self-efficacy, and social support are more likely to have positive outcomes in therapy (Wampold, 2015).
This is because these clients are better able to cope with stress and adversity, and are more motivated to make changes in their lives…
Resources come in all shapes and sizes. Some are also disguised as problems, limitations, and afflictions…( read The Obstacle is the Way by Ryan Holiday).
Expectations and Hope… 15%
Let’s be blunt about this. This is the Placebo effect, plain and simple.
The client's expectations and hope for change are surprisingly small factors in therapy effectiveness.
Clients who have high expectations for therapy, are somewhat more likely to have positive outcomes (Lambert, 1992).
This is because these clients are more likely to engage actively in the therapy process, and to make use of the tools and strategies that the therapist provides.
The Model of Couples Therapy used… 15%
For many couples therapy single-model devotees, it's particularly galling that the Common Factors advocates considers any particular couples therapy model with the same level of significance as the Placebo Effect. In the realm of common factors, nobody gives a rat’s ass about EFT vs. Gottman…
However, couples therapists who have a strong understanding of the client's needs, and who are able to use evidence-based interventions that are tailored to the client's specific situation, are more likely to have positive outcomes (Hubble et al., 1999).
This is because highly trained, science-based couples therapists are better able to help you achieve your goals, and to provide the support and guidance that you will need to make positive changes in your intimate life.
Finally, according to promoters of the Common Factors Model, if the therapist's chosen model of couples therapy, and their level of expertise and knowledge in that model, are surprisingly less important factors in couples therapy effectiveness than most thought leaders and therapists would suggest… then what is the relationship between the model of couples therapy employed, and the common factors that indicate success?
Common Factors advocates would tell you that the couples therapy model is the vehicle by which the common factors are manifested.
In the context of couples therapy, the common factors theory is particularly relevant
Couples therapy can be a complex and dynamic process that requires the therapist to navigate multiple layers of relationships and emotions simultaneously.
It’s fu*king exhausting sometimes.
I’ve joked with my colleagues that science-based couples therapy sometimes feels like 3 dimensional chess.
But by focusing on the common factors of therapy effectiveness, couples therapists can create a strong therapeutic relationship with both partners, help the partners to identify their strengths and resources, and motivate them to make positive changes in their relationship.
More than Models
The common factors theory of therapy effectiveness offers an explanatory framework for understanding precisely why good couples therapy works. It’s more than the model you’re using.
Critical awareness of the therapeutic relationship, the client's resources and strengths, their expectations and motivation for change, and the therapist's expertise and knowledge, does not require an adherence to any particular couples therapy model.
Couples therapists consistently endeavor to create a strong and effective framework for improving relationship satisfaction and the all-important marital communication skills.
Can We Get Over Ourselves?
Some therapists see the Common Factors Model as eclipsing the egos and existential dilemmas of couples therapy models.
But I think it’s healthier, kinder, and simpler to see any given couples therapy model as the framework in which the common factors manifest themselves.
Although most couples therapists are focused on their favorite theoretical model, an awareness of the common factors of therapy effectiveness can help couples therapists achieve a more fulfilling therapeutic relationship with their clients that is grounded in empathy, understanding, and respect.
RESEARCH
Lambert, M.J. (1992). "Implications of Outcome Research for Psychotherapy Integration." In J.C. Norcross & M.R. Goldfried (Eds.), Handbook of Psychotherapy Integration (pp. 94-129). Basic Books.
Norcross, J.C. (2011). "Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2nd ed.)." Oxford University Press.
Wampold, B.E. (2015). "How Important Are the Common Factors in Psychotherapy? An Update." World Psychiatry, 14(3), 270-277. doi: 10.1002/wps.20238
Hubble, M.A., Duncan, B.L., & Miller, S.D. (1999). "The Heart and Soul of Change: What Works in Therapy." American Psychological Association.
Lebow, J.L. (2014). "Research on the Treatment of Couple Distress." Journal of Marital and Family Therapy, 40(1), 11-28. doi: 10.1111/jmft.12039
Johnson, S. M., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6(1), 67-79. doi:10.1093/clipsy.6.1.67
Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145-168. doi:10.1111/j.1752-0606.2011.00249.x
Snyder, D. K., & Wills, R. M. (1989). Behavioral couples therapy: An overview. Journal of Marital and Family Therapy, 15(1), 3-16. doi:10.1111/j.1752-0606.1989.tb00731.x
Baucom, D. H., Epstein, N., & LaTaillade, J. J. (2002). Cognitive-behavioral couple therapy. In J. H. Harvey & A. Wenzel (Eds.), Cognitive therapy for challenging problems: What to do when the basics don’t work (pp. 191-214). Washington, DC: American Psychological Association.
Baucom, D. H., Shoham, V., Mueser, K. T., Daiuto, A. D., & Stickle, T. R. (1998). Empirically supported couple and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology, 66(1), 53-88. doi:10.1037/0022-006X.66.1.53
Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225-235. doi:10.1037/a0018605