What Works in Therapy?

Listening to clients...no, really listening!

Studies show a 65% improvement in outcome

Evidence-based practice is, as you know, "all the rage." Like bell-bottoms and skinny ties, listening to clients in therapy is out of fashion. Treatment manuals and fidelity measures are "in." Most of the push for field-wide adoption of specific treatments for specific disorders comes from the top. Government funders, policy think tanks and professional organizations are promoting evidence-based practice as the cure-all for what ails the field--namely, a continuing lack of respect and lingering perception of mental health as the "soft" of science.


A number of researchers have, over the last decade, been using the client's rating of the therapeutic alliance and progress in treatment as a way of improving retention and outcome in treatment. Interestingly, such research shows that providing therapists with real-time feedback regarding the client's experience of the therapeutic alliance and outcome cuts attrition rates in half and improves outcome by as much as 65%.

By the way, such results were achieved without training therapists in any new treatment procedures or limiting the sample diagnostically. As you know, most randomized clinical trials exclude subjects that do not meet narrow inclusion criteria thereby making the applicability of any study findings to real-world clinical settings exceptionally questionable. Bottom line: therapists were encouraged to listen--especially when what they were doing wasn't working or did not fit for the individual client--and the hoped for improvements in retention and outcome followed.

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