Some people who seek help with personal struggles from a counselor get help resolving their problems while others do not. Some clients in psychotherapy overcome depression and anxiety. Some couples in marriage counseling resolve their differences. Some alcoholics in AA learn to live sober and healthy lives. Some people being discipled by their pastor learn to rejoice in trials and bless those that curse them. Others who seek help in ways like these ways do not experience healing or growth.
What’s the difference? Why is it that some people who seek help are able to make substantial changes in their life experience and character, but others get stuck? What are the key factors in personal transformation?
If you Google “psychotherapy research” nearly 300,000 thousand articles come up. That’s because a number of scientific studies over the last sixty years have investigated the outcomes of psychotherapy to help us understand what factors determine its effectiveness. Therapists from from various schools of psychology (e.g., psychodynamic, humanistic, and cognitive-behavioral) have been included in research studies. Many clinicians are surprised to learn that their theoretical orientation for therapy makes no difference in the outcome! Furthermore, their techniques are the least important of the four factors that help people change. The first three factors all have to do with the client.
The Factors that Explain Effective Therapy
Four key factors were identified as explaining the extent to which therapy was successful for clients.
1. Client Motivation
40% of why someone is helped by counseling is explained by what they bring into the process. For instance, clients who get well are likely to desire to change, have faith in God, take personal responsibility, and to utilize resources outside of therapy like friendships, groups, reading, and spiritual disciplines. They are quick to follow through on “homework” that emerges from their therapy sessions.
2. Therapist-Client Relationship
30% of therapy’s positive impact is from the quality of the helping relationship. When clients benefit from counseling they describe their therapist as warm, empathic, caring, and genuine. The counselor and client have a good “therapeutic alliance” in that they are working together to care for and help the client. I like to tell people in therapy, “You’ll get help when you and I join God in caring for you.” Often people don’t know how to receive care and have to be taught how.
3. Client’s Hope
15% of the effectiveness of therapy comes from the client’s attitude. If they have positive expectations and beliefs for getting well then this helps them to change. Having an optimistic (not unrealistic) outlook has huge benefits on our experience, other people, and our performance. The power of placebos in medical studies is an example of this.
4. Therapist Techniques
The last 15% of the reason for successful treatment in psychotherapy is the skilled interventions and advice that the counselor provides. For instance, the most important techniques that counselors use include listening, asking the right questions, empathizing, and offering timely insights. But there are many other techniques that may be employed like “empty chair” conversations or meditation.
This means that according to the psychotherapy research, 55% of the reason why someone receives help from therapy is up to them, 30% is about the relationship, and only 15% is up to the counselor alone. So the way that the counselor can have the most impact on clients is through promoting a personable and collaborative relationship with them and cultivating their motivation.
The factors that make psychotherapy effective generally are probably similar for Christian psychotherapy and other forms of Christian care like pastoral counseling, spiritual direction/mentoring, healing prayer, support groups, and spiritual formation groups. For instance, alcoholics who are living in recovery are the ones who “work their program” (they’re motivated), participate with an AA group and a sponsor where they feel cared for and helped, bring a positive attitude into their recovery process, and rely on a group or sponsor to teach them tools for recovery.
Jesus, the Master Psychologist
In 2003 when I was listening to Dr. Siang Yang Tan with Fuller Theological Seminary summarize this psychotherapy research I realized that Jesus knew the results of these studies long before they were conducted! Two thousand years prior to this research he was applying the wisdom that science only recently “discovered.” He is the Wonderful Counselor (Isaiah 9:6).
But can we really say that Jesus is a psychologist? He doesn’t use the jargon of current psychology. He isn’t operating in one of the popular schools of psychology. His ministry doesn’t normally look like sitting down with people and having long conversations. He doesn’t even have a license to practice psychology! Most Christians have not thought of Jesus as having the knowledge and capacities of a great psychologist. But with person after person, including many who were very difficult to deal with, we see that Jesus is “moved with compassion” (e.g., Matt. 9:36). Furthermore, “In him are hidden all treasures of wisdom and knowledge” (Col. 2:3).
I think it’s important when we listen to Jesus and watch him help people that we think of him not only as our Lord, Savior, and Teacher, but also as our Master Psychologist. Otherwise, when we have a personal or relational struggle we’re likely to consult someone else as our expert! Or if you happen to have expertise as a counselor or minister then you may look merely to yourself as the source for helping others with their problems.
Jesus understands our needs, problems, and relationships better than anyone. He knows how to help us function at the highest level. Of course, it’s wise to seek help from competent and trustworthy counselors, but to do this in submission to the leadership of Christ. The Lord Jesus is our model in each of the four factors that contribute to effective helping.
Jesus expected people to take responsibility for themselves and drew out their motivation to act. For instance, he asked the two blind men beside the road, “What do you want me to do for you?” (Matthew 20:32). And he asked the paralytic at the Sheep Gate Pool, “Do you want to get well?” Then he challenged the man who had been lying on his mat as an invalid for 38 years to pick up his mat and walk! (John 5:1-14) It’s typical of Jesus’ healing ministry that he required people to act in a way that previously was impossible for them in order for them to be healed.
Whenever someone came to Jesus with a question or wanting to become his disciple he gave them something to do. He would not do something for people what they needed to do for themselves and was willing to let them walk away without receiving help if they would not do their part, as he did in the case of the Rich Young Ruler (Matthew 19:22).
Jesus established trust and collaboration with the people he helped. He graciously accepted the societal cast offs, put tense people at ease with his sense of humor, and offered compassion to everyone. A great example of Jesus forming a “therapeutic alliance” with someone who was hurting is his conversation with the Samaritan woman at the well (John 4:1-42).
Jesus inspired people to have hope that good things were possible for them, saying, “All things are possible with God” (Mark 10:27). Continually, he offered a hand up to those who were down trodden and taught that in God’s kingdom the last in the world’s order could be first (Matt. 19:30). He recruited the faith of the blind man that he healed at the Pool of Siloam by asking him, “Do you believe in the Son of Man?” (John 9:35)
Jesus used a great variety of interventions when offering care and counsel to people. He listened to the Samaritan woman at the well (John 4:1-42), offered empathy for Mary and Martha when Lazarus died (John 11:1-16), asked focusing questions of Nicodemus (John 3:1-21), gave an affirmation the Roman centurion’s faith that Jesus would heal his sick daughter (Matthew 8:5-13), used analogies like the parable of the Good Samaritan for the religious leader asking about love (Luke 10:25-37), prayed the Lord’s Prayer for his disciples who wanted to learn to pray like him (Luke 11:1), taught the Sermon on the Mount to spiritual seekers (Matthew 5-7), said no to his mother and brothers who wanted him to come home (Matt. 12:46-50), confronted (“care-fronted”!) the would be disciples who made excuses (Luke 9:57-62), and expected the woman caught in adultery to obey God and “Go and sin no more” (John 8:1-11).