Chapter 7 of Jeffrey Kottler’s “Change”, entitled “Changing in Psychotherapy”, would be where you might expect Kottler to say that change on your own doesn’t work and you really need a psychotherapist to help you. However, that expectation would be wrong, particularly as that would belie Kottler’s premise that basically we don’t know how change happens. Early on in the chapter, he dispels the “one true way” myth:
Psychotherapy is usually a last resort after all other options have been tried and failed…As we’ve already seen, most changes that people make in their lives take place in the outside world, as a result of circumstances, challenges, adventures, disappointments, conflicts, transitions, traumas, opportunities, and other critical incidents.
Consistently (and incredibly) more recent studies have found that the therapist’s techniques account for only about 15% of a client’s improvement, compared with triple that figure (45%) for so-called “common factors” that are evident in almost all approaches. This includes things like the quality of the relationship, client expectations and characteristics, the opportunity to talk openly about their concerns, feeling supported, taking constructive risks, and developing new understanding of themselves and the source of their difficulties.
Psychotherapy is often a significant part of [the change process], but one that represents only one piece of the puzzle. There are all kinds of other forces and extraneous events (improved economy, family support, new opportunities, spontaneous remission of symptoms, self-initiated actions, impulsive gestures, random conversations, films, and books) operating outside of sessions, and within the client, most of which we will never identify, much less understand.
And if that is all true, it leads to a question put succinctly by Kottler as why do paid psychotherapy if you can just do it yourself?
Some of the answer is speed of success, effectiveness and efficiency if you will. I crunched my psyche for 4 years on my own so to speak, and a trained professional could have perhaps stopped me from going down unproductive avenues. In some cases, picking up on an earlier point, I made myself feel worse about myself (or an aspect of myself) so that I could critically examine it, turn it around in my hands, and decide if it was something worth putting back in my psyche or if I should jettison it.
On page 158, Kottler has an incomplete list of 38 factors that can make a difference in promoting change in therapy. It’s a long list, but I think it could have been grouped and consolidated into a lot fewer headings:
- Hopeful intent / willing to do the work — a positive mental outlook that you are capable of some change that the psychotherapy will help you get through, along with active engagement, willingness to model new behaviours, perhaps a public commitment to your change, and a willingness to consider new options, alternatives and solutions with adjustment over time.
- Emotional honesty / know what you want — it doesn’t work if you’re not willing to be open and transparent, candid, emotionally true to yourself, trusting, disclosing and facing your past / present / future fears, challenging your old beliefs, having integrity and respect for your therapist and yourself, and accountability for the outcomes you generate.
- Try new approaches / take action — even if you’re willing to do the work and know what you want, if you take no action to change, you’ll get the same outcomes you already get. The personal narrative has to change too, and it can be a chicken and egg situation if the story changes before the behaviour or the behaviour changes before the story, but you’ll need to face your fears, rehearse new skills, devote new resources to the effort, and take constructive risks.
There are certainly other factors around support, planning, etc., but for me, those three elements are the ones that resonate.