How Does Therapy Make You Better?

Eva Schildhause, LCSW (Fla. & N.C.) on Aug 25, 2022 in Treatment Orientation

If your roof has holes, you get it replaced. If you cut your finger, you apply a bandage. If you have an infection, you take antibiotics. It’s nice when you have a problem and there is a known solution. And you know how those solutions work. The new roof keeps your house protected. The bandage stops the bleeding. The antibiotics kill the bacteria. But when you have a problem like anxiety, depression, PTSD, or borderline personality disorder, there are no salves or patches that fix the problem in a tidy manner.

What are evidence-based practices?

The closest we have to such solutions in the mental health field are called “evidence-based practices.” Evidence-based practices are “clinically sound and scientifically based.” Fortunately, there are academics and clinicians who devote enormous time and resources to the study of how well different types of therapy work. There are types of therapy that are tested through study after study to prove their effectiveness. These therapies include cognitive-behavioral therapy, dialectical-behavioral therapy, narrative therapy, existential therapy, accelerated resolution therapy, EMDR, psychodynamic therapy, and many more. Some therapies are more manualized – meaning they have prescribed content, structure, and length. Some are more open-ended in their application. As a consumer of therapy, it is bewildering to approach shopping for a therapist and wonder what type of therapy may work for you. Perhaps your doctor or a friend said CBT works great for people with your issue, or maybe you heard from your cousin that EMDR worked like magic for her trauma.

Alphabet Soup

Through the alphabet soup of these named therapies (which have all different ingredients), there is a basic stock at the core of the concoction – the “common factors” that exist among all types of therapy. This is the backbone of all effective therapies. It is little talked about among consumers of therapy. The naming and branding of different therapy modalities are all layered on top of these common factors. Generally, different therapies have similar results. In 2012, the American Psychological Association published a resolution proclaiming that psychotherapy is effective and that “different forms of psychotherapy typically produce relatively similar outcomes.” How can these different types of therapy produce similar results? It’s because of those “common factors” that all good therapies include.

What are the common factors?

The concept of common factors has been around since 1936 when Saul Rosensweig observed similar effectiveness in various therapies. He hypothesized that there must be universal traits among all the treatments. A strong, recent common factors model is the “contextual model.” These are the basic ingredients of any therapy, no matter its name, that bring about improvement in clients. The healing happens through three pathways following the establishment of a basic bond between the client and therapist.

Pathway 1 – The real, personal relationship between the therapist and client. This is related to the “therapeutic alliance” between the two. The two parties in the therapy experience each other genuinely and the client experiences a connection to “a caring and empathetic person.”

Pathway 2 – The client’s hope and expectations about the therapy. Successful treatment includes a client who has hope that they will improve. The client believes that they will be able to cope with their problems by way of an explanation and rationale for their condition as provided by the therapist.

Pathway 3 – The “specific ingredients” of the therapy. This is where the techniques and approach of the therapist’s modality come into play and support change.

So how exactly does therapy make you feel better?

There is ongoing debate in the clinical and academic worlds of therapy regarding what actually makes therapy work. And it’s still not really known how therapy makes you better. It’s not a problem like a leaky roof or a wounded finger where we know an exact mechanism of repair. As a consumer of therapy, it is helpful to know that, in general, if some basic ingredients are there, therapy works, no matter what label it has. If you have a good relationship with your therapist, have some hope you can get better, and the therapist is applying some techniques, you have a good chance of getting better. However, there are specific modalities that are considered the “gold-standard” for certain issues, which you can discuss with your therapist or doctor to obtain referrals for specialized providers.


Eva Schildhause is a Licensed Clinical Social Worker in Fayetteville, NC.

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