The common core of psychotherapy

This blog is co-authored by Marcia Gralha, M.Sc.

If you’ve ever thought about starting therapy, you may have felt overwhelmed by the number of approaches. Should I go with a cognitive-behavioral a therapist who can help you think more adaptively, a psychodynamic therapist who focuses on protective mechanisms and relationships, or perhaps someone from a humanist tradition who can help you get in better touch with your feelings?

With so many options, it’s easy to get confused. But here’s the good news: Research shows that most legitimate therapeutic approaches produce similar results, especially for common problems like concern, depressionand adaptation difficulties. This is often referred to as the “dodo bird verdict,” and it is a solid conclusion psychotherapy research.

So what does this mean for therapy choices? When you seek help for common problems like mild depression, anxiety, or relationship problems, it’s more about engaging in a psychological healing process than choosing the “right” intervention that will solve a diagnosable problem.

For example, imagine that Heather receives a call from her 22-year-old son, Jeff, who is feeling lost after a recent breakup. He is withdrawn and unsure of his purpose. Heather wonders: What kind of help does Jeff need?

One approach would be to view Jeff’s struggles as a mental health condition requiring specific diagnosis and intervention. If we look at the situation in this way, it would be important that Jeff receive the correct diagnosis and appropriate, scientifically supported intervention. This is called a “medical model,” and it’s how health insurance typically decides what to reimburse.

However, this is not necessarily the correct way to describe the healing that occurs in psychotherapy. Bruce Wampold and Zach Imel are on the case The Great Psychotherapy Debate. They argue that for most problems, psychotherapy is less about matching a specific diagnosis with a specific treatment than about a psychosocial healing process that requires certain essential ingredients for success. In our recent publication in Journal of Psychotherapy Integration¹we link their model UTOK, The unified theory of cognition² and to argue that the result provides the field with a “common core” of psychotherapy.

The common core of psychotherapy

The common core consists of three main parts: (i) the initial social and relational context that legitimizes the healing; (ii) three main process elements that facilitate adaptive change; and (iii) feedback on progress based on the forecast.

To apply the Common Core to Jeff’s situation, we first need to consider therapy in a social and relational context. This includes the legitimacy of the healing process, which involves acceptance of the therapy by society. It also includes Jeff’s own beliefs about her usefulness and the therapist confidence and knowing that they can handle the problem. A hundred years ago in the United States (and in many cultures around the world today), psychotherapy was not considered effective. However, in our modern times it is widely accepted. This makes a huge difference in its effectiveness and points to the importance of sociological factors. The legitimizing context can be seen as elements that either facilitate or hinder the therapy process.

After starting therapy, studies have shown that good therapy consists of three main elements. First, it is the quality of the therapeutic relationship. In this case, it means that Jeff needs to feel that the therapist is caring and competent, and can “see, know, and value” him as a person with all his vulnerabilities. This is what allows Jeff to feel safe, respected and open during classes.

The second major element of the process involves the therapist working with Jeff to develop a shared understanding of Jeff’s challenges and strengths. Therapy can help him understand how inactivity is fueling his depressed mood, or it can help him discover how his breakup has challenged his core identity as a man The key ingredient here is that therapy helps Jeff develop a new perspective on himself, his problems, and his potential for growth and adaptive living.

The third basic element of the process is that therapy should include some active elements that facilitate new experiences both inside and outside the therapy room. In this case, Jeff can be encouraged to engage in interesting activities, learn to accept his emotions, or challenge harmful self talk. These steps create new learning experiences and skill sets that foster growth and stability.

Finally, therapy should be “informed about the result.” This means that the therapist must monitor both Jeff’s attitude toward therapy and progress in reducing problematic symptoms and make adjustments as needed. It also means that the expected outcome should be based on the nature of the problem at hand. For example, if Jeff’s current fight is his first major challenge, then a fairly quick recovery can be expected. In contrast, if Jeff had a long history of depression and met criteria for a personality disorderthen one would expect a more gradual path to improvement.

What does this mean for you?

If you’re considering therapy for problems like anxiety, depression, or relationship problems, don’t just focus on finding the “right” way to solve your problem. Instead, think of it more as a healing journey. This journey should begin with a therapist who offers an approach that feels legitimate to you. Once this begins, a good relationship should form, offering new insights and interventions that seem constructive and lead to a more flexible and adaptive way of relating to the world.

Back to Heather and Jeff, we hope Heather encourages Jeff to find a therapist he trusts who can provide insight, connection, and tools to navigate his life in an adaptive, growth-promoting way.

To find a therapist near you, visit Therapy Handbook Psychology Today.