Wilmington NC Counseling Blog

How Exactly Does Therapy Help with Issues?

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I recently had a question asked of me and I would like to share the answer here with you. It is a common question that I get about three of four times a year from students and folks interested in counseling. I hope you find the answer helpful.

The question is: “How exactly does therapy help with issues?” Here is my response

Hi, thanks for the question. In addition to being a counselor I am also a professor and I research how counseling works.

I am going to give a very quick overview of the process with some quick research in a clear way (I hope).

First thing to understand is that counseling is effective. The average effect size is .8. What that means is that a person who goes to counseling for a problem is going to be better off than 80% of those who have a similar problem but don’t go. This effect size is very good. To give an example, it is a better effect size than fluoride for teeth, or aspirin for reducing heart attacks,

So, counseling works.

How does counseling work? Based on research there are common factors in all models of practice that contribute to outcome. These are:

  1. The relationship between the counselor and client. Simply put, if you like the counselor and conversation flows easily, and you feel heard and understood, this contributes to change.
  2. The alliance between the counselor and client. This means that you both agree on what to do in counseling and it makes sense to you. There are well over 300 bonafide models of talk therapy and they are all different. So a model that makes sense to you is the one that best fits you. If a counselor is using a model of practice that doesn’t fit you the outcomes will be negatively impacted.
  3. Hope and placebo impact outcome. If you and your counselor believe change can occur this impacts the outcome.
  4. The skills of the counselor have a strong impact on outcome. These skills are connection and interpersonal skills, not skill in a specific clinical approach. Skills such as listening, empathizing, tailoring treatment to you, moving at your pace or challenging you in the right way.
  5. What the client does outside of the counseling room is a major factor in change. The counselor is like a coach and the the two of you come up with a theory of what occurred and a theory and plan for change. It is important to begin doing something a little differently in your life, at your own pace, to make the change occur. The counselor collaboratively works with you to find the things that you are comfortable in doing.
  6. Reflecting on that change and modifying counseling approaches is very important. Just like driving to Asheville from Wilmington you put a plan together, monitor progress (speed, fuel, route, etc), the same is true with change. How are things going? What is helpful, what is not? Are we on the right path, are we making progress, are we going too fast? What else can be done, are we having at least some fun on the trip? Are you excited to get there? What other supports do you need in your life? And so on.

This is the change process in a nutshell and how a counselor can help. I hope this helps, please let me know your thought or questions.


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