The theoretical model or philosophical approach taken by your provider is not as relevant as competent demonstration of the common factors of a therapeutic environment. Theory or philosophical models assists in organizing and conceptualizing information the client/patient shares. Research shows that no one theoretical approach is more efficacious than any other. All approaches, executed well, share the same efficacy, suggesting that the “common factors” of mental health therapy are the significant features. Those common factors are hope, extratherapeutic activity, relationship, and structure. Each of the theoretical approaches contain these aspects, which is what makes them beneficial for the client. It matters not whether the professional is a psychiatrist, nurse practitioner, clinical therapist, caseworker, or an administrative staff. All are part of the therapeutic environment and have access to persons presenting for help. Any person with such access should encourage and facilitate an empowering therapeutic environment. It is necessary to utilize and implement the skills that foster hope, extratherapeutic activity, relationship, and structure. The concept of hope provides so much in life that it is very challenging to measure its daily effects.
What is life without hope? Ask any person who experiences psychiatric or psychological distress that has not received effective treatment. Hope is the expectation that the day will bring good things. It is the promise that life will remain good or the promise of better times to come. Hope isn’t an expectation of survival, but is a feeling and belief of mastery or advantage in the face of challenge. If persons in distress had hope they would likely not darken the doors of the mental health professional. Dr. Douthit of Texas Tech Pediatrics reported that his task, and the task of the mental health professionals is to give hope to those who are without. Think about the pain that is comes when there is no hope. What is there to do?
The mere thought of living without hope is painful. Loss of hope in life is the foundation and cornerstone of depression. Many psychiatric concerns, left untreated may result in a secondary outcome of depression. Of the multitude of realizations that are possible for persons with crises are: embarrassment and humiliation of hospitalization, realization of broken or strained relationships, disarray of the home, occupational strain, and/or legal involvements. Any one of these occurrences in life are stressful and may induce depression in anyone regardless of a history of mental health involvement. Loss of hope may occur when one’s life feels out of control. Instilling hope is only one of the factors common to all theoretical approaches. Homework or activities assigned by the professional are also important and common to all theoretical approaches.
Most theoretical approaches include some extratherapeutic activity. This shows that all of the approaches include homework or some aspect of a task to complete between sessions. For instance, you may ask your client to smile to at least four unknown people this week. The work that the client does in between sessions is very important and beneficial to the client’s progress. Moreover, it is a great fund of information as to whether the client completes the homework or how the client follows through with the task.
The aspect of relationship with the client is truly the scope of this section. Without the relationship (i.e. rapport, therapeutic alliance, and ongoing connection) work will be mechanical and less effective, if not generally ineffective. Mental health professionals are not robots. People will come because the professional offers hope and has empathy.
Building rapport, therapeutic alliances, and ongoing connections take time. Any therapeutic relationship needs time to develop. An important by-product of a well established therapeutic relationship is trust with honesty and vulnerability. Some may well be fearful of judgement, or even hospitalization. This is significant as in such cases there may be little connection between the provider and the client. A lack of honesty or transparency with the provider becomes apparent that there is a gap or distance between the two. Feelings of distance with the client, though an important information source about how the client interacts with others or especially those individuals in life that hold some power is a barrier to the best treatment possible. Gap, distance, smoke and mirrors, or simply lack of connection may reveal hesitancy on the part of the client, or provider. However, the power differential between the professional and the client is real and must be appreciated. The relationship or lack thereof must be attended and brought to the here-and-now with the client. A distance with the client will not fade on its own. Again the connection or lack of requires attention so that a connection may be built. That is not to say that all clients will be less than honest with their provider. Although there may be some that present their best side in session, there are some that are very honest with the provider and make the help work for them. Although there are those persons that own their own treatment and are active participators in their growth, there are those that require assistance with learning to interact with professionals. Of the diagnostic criteria for all mental disorders, one of the aspects is that of functioning socially or functioning with others. It is no surprise that some persons who come for treatment are empowered enough to seek help. They may have difficulties with learning to interact appropriately with others as well as professionals including mental health providers.
The primary goal is to help and do no harm. Clients come for help because they have been unsuccessful either on their own or their families and friends have not been enough to develop the empowerment in the person. Martin Seligman has researched the maintaining factors of depression and environment. His research indicates that a person with depression soon starts depressing those around that individual. As a result, those individuals surrounding the person with depression will soon become frustrated and not provide support or encouragement but rather distance and frustration, which exacerbate the depression and maintain the feelings. Besides the other common aspects of treatment, there is that of structure which gives a sense of process.
Finally, structure is needed. This is an important aspect of the “common factors of therapy.” Persons coming for assistance need to feel as if they are in a process of change or growth. People like to know that they are heading in a forward direction with purpose. That knowledge of structure or process is thought to be the key or last resort for bettering the situation which they have come to better. Essentially, a person merely darkening the door of the mental health professional is one of the first steps in the process of growth. The structure and process of treatment is necessary as many times it is empowering to know that one is on the road to recovery rather than sitting idly by hoping for some change to happen on its own. In short the structure of treatment itself provides hope that better days are coming. Therapy and treatment has a specific purpose and process. Regardless of theory or philosophy, all have a specific process and method of approach. At the beginning of any treatment or therapeutic process, the client should be indoctrinated into that process in which they may participate. If they wanted no direction they would stay home. They would continue the behaviors and cognitive activity, which continues their life in their cycle without the help of the professional. Again people come for help. Appreciate the courage it takes to come to the office of a mental health professional. With the stigma attached to mental health services, it takes a great deal of courage and more importantly desperation to present to the office of a mental health professional. Mental health professionals are there to assist, facilitate, teach, offer, and empower those individuals toward growth, direction, and empowerment.
Joel Meyer, LCPC