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Elisa Goldstein, Ph.D.Elisha Goldstein, Ph.D.
A blog about mindfulness, stress-reduction, psychotherapy and mental health.

Improving Therapy: What Can be Done?

Elisha Goldstein, Ph.D. Updated: Feb 9th 2010

psychotherapyIf you have ever gone to therapy, are in therapy or are thinking about going to therapy, you might find this interesting. It was contemplated early on that when people go into therapy the outcome of them getting better is not dependent on the actual approach of therapy. In other words, the theoretical orientation of our therapists didn't matter. In research, Michael Lambert found this in 1992 a similar finding.

Overall, the largest variance in outcome (about 40%) is determined by factors that have nothing to do with the approach (e.g., as age, gender, prior history of depression, social support and other extratherapeutic factors). Another 15% is determined by the patients belief that s/he will get better or the placebo effect and then 15%, is accounted for by specific techniques unique to the treatment modality.  So, at the end of the day, 30% of the variance in outcome is attributed to relationship factors that are present in most therapeutic encounters.

There have been arguments on the other side that say there are certain therapies that are better than others for specific issues such as Cognitive Behavioral Therapy for panic attacks or OCD.

However, what has long been speculated and is also true is that that percentage is attributed to the common factor of the relationship between therapist and client. T

In her book, The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions, Shauna Shapiro makes an argument for The Mindful Therapist. She makes the point that one of the most important qualities of a therapist is the ability to pay attention. But not just any kind of attention, attention imbued with qualities of non-judgment, kindness, non-attachment, curiosity, patience, acceptance and trust.

Mindfulness training has been shown to cultivate better attention and also helps people integrate the aforementioned attitudes. It has also been shown to engage the same social neuro-circuitry of the brain that lights up when we're having interactions with others. This leads to the assumption that the more attuned we are with ourselves, the better able we are to attune to others.  

In my own practice as a mindfulness-based psychotherapist I have found these skills essential in allowing me to connect with the people I'm working with and also able to recognize what I am experiencing and being able to bring that into the encounter. Mindfulness is the practice of cultivating pure awareness.

This is not to say that if a therapist did not have a mindfulness practice they are no good. Many skilled therapists embody the ability to be present with the attitudes I mentioned above. However, I would like to piggy back on Shauna Shapiro's point that cultivating a mindfulness practice could support many therapists in deepening their connection with qualities of attention that, I believe, facilitate that a positive outcome in the extra 30% that we have to work with.

One way the therapist and/or client can begin is with a brief practice, maybe focusing on the breath, grounding to the present moment and mindfully checking-in with what thoughts, sensations, or emotions are there. Shapiro mentions that it is even helpful to periodically ask the question, "Am I awake," during the session.

As always, please share your thoughts, stories and questions below. Your interaction here provides a living wisdom for us all to benefit from.

Elisha Goldstein, Ph.D.

Elisha Goldstein, Ph.D. is a clinical psychologist in private practice in West Los Angeles and is author of the upcoming book The Now Effect, co-author of A Mindfulness-Based Stress Reduction Workbook, Foreword by Jon Kabat-Zinn, author of the Mindful Solutions audio series, and the Mindfulness at Work™ program currently being adopted in multiple multinational corporations.

Check out Dr. Goldstein's acclaimed CD's on Mindful Solutions for Stress, Anxiety, and Depression, Mindful Solutions for Addiction and RelapsePrevention, and Mindful Solutions for Success and Stress Reduction at Work. -- "They are so relevant, I have marked them as one of my favorites on a handout I give to all new clients" ~ Psychiatrist.

If you're wanting to integrate more mindfulness into your daily life, sign up for his Mindful Living Twitter Feed. Dr. Goldstein is also available for private psychotherapy.

Reader Comments
Discuss this issue below or in our forums.

Outcome Informed approaches in Therapy - Daryl Chow - Feb 10th 2010

hi Elisha, 

  I am a psychologist practicing in a mental health setting in Singapore. I have been a fan of your writings since listening to you and your wife in ShrinkRap radio. U managed to make Mindfulness alot easier to comprehend.

  I got very excited when I read this blog of yours, especially when you cited Michael Lambert's work, who is a pioneer in outcome informed approached in therapy. May I recommend for you to take a look at some of these references if it peaks your interest:

Book: the Great Psychotherapy Debate, by Bruce Wampold (2001)

That said, I like what you quoted about the power of being attentive and staying in the present in sessions i.e. mindful and acceptive disposition w the client, in the moment by moment of the relational development in conversation.

Do you know of any outcome studies that found a correlate with mindfulness/attentiveness in sessions, in predicting good outcomes?

Once again, thank you for your wonderful work. Hope to hear from you.



Daryl Chow

I personally live in a delusion these days - - Feb 9th 2010

I find that I personally live in a delusion these days and ask myself often when will I snap out of this? When? What will it take for me to get back to the health person I was 5 years ago. What is it that makes me live this way and why? I know almost exactly what I have to do. I try different things but at the slightest sign of stress I fall back. I buy that pack of cigarettes and it's making me sad. I read books blogs whatever yet, my commitment isn't there. there's some sort of block on my will that I can't seem to unlock.

Maybe I put all my hopes in stoping smoking. I feel that I will be able to start then... everything depends on that... Sometimes I go, ok then, I'll start by taking walks instead. Or all start by eating better...But changing my strategy a bit does not help. MY brain seems to have a lot more tricks then my concsious self to keep me here in the hurt.

It is really leaving me sad and I don;t want to wait for an accident or something terrible to jolt me back.

Is it my goals that are too 'non-defined?' I don't know.

If you could talk about something that relates to that in your next blog, I would really love it.

thank you so much.

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