Counselors spend a fair amount of time debating the relative effectiveness of various models of treatment– cognitive-behavioral therapy versus motivational interviewing versus 12 step, etc. That’s fine, but to what extent does the approach used affect the outcome of treatment? That’s where some surprising findings have emerged.
Psychologist Bruce E. Wampold has reviewed the literature on the subject, not just with reference to substance abuse but to therapy in general. His conclusion: Effectiveness is determined largely by three factors.
First, therapeutic alliance, or the working relationship between client and clinician. Counseling works best if it’s based on mutual respect, trust, and confidence, and agreement about goals and tasks. According to Wampold, the quality of the therapeutic alliance determines 60% of the effectiveness.
Next, therapeutic allegiance, or the degree to which the counselor believes that the treatment he or she is delivering will be effective. A clinician’s allegiance reflects the counselor’s training, experience, and personal preferences, and determines about 30% of effectiveness.
Last, the model or technique used: 8%. Not all that much.
In other words, we spend a lot of time arguing about something that ultimately isn’t that important. A competent practitioner of CBT or MI or 12 Step Facilitation, who believes in what he or she is doing, can deliver about the same outcomes.
Provided there is a solid working alliance with the client. The challenge is to develop that relationship quickly enough to engage the client and create an environment that promotes success.
Clinic settings, which can be hectic, often make that difficult.
Maybe the question is better put like this: how does a clinician quickly establish respect, trust, and confidence with a new client?
