One of the most frustrating things about graduating from school with a degree to provide psychotherapy is that you're immediately inundated with pressure to specialize in a specific modality. From conversations with colleagues to your social media feeds, all you keep hearing is how ‘this new modality is the true and quickest answer to all that ills your clientele’, and if you learn it, you are staying abreast of the current cutting-edge research, and if you don’t, well, you have fallen behind.
This experience eroded my self‑trust in treating trauma because there are ‘trauma modalities,’ and it pushed me to rush into a PESI training that ended up functioning more as a 20‑hour test of knowledge I already had than giving me my money’s worth in skills. Turns out that a library card and a podcast can give you a world of knowledge!
So, to new therapists who are caught up in the therapy-modality marketing schemes, I am here to assure you what my decade of experience has taught me about what actually creates change in psychotherapy.
There was an article in Behavioral and Brain Sciences by Lane et al. (2015), where the researchers conducted a theoretical review of multiple therapy modalities, including psychodynamic, cognitive, affective (Emotion Focused), and behavioral approaches, to see what is the core process that helps people change in therapy. What they discovered across the board was that all of these modalities focus on what they call “memory reconsolidation,” which is that old emotional memories are reactivated and introduced to new experiences that “recolor” the original memory. Drawing on neuroscience, affective science, and memory research, the authors demonstrate that change is not about intellectual insight alone; it’s about altering the emotional meaning embedded in autobiographical memory. In short, people heal when they can revisit the past with new emotional truths that feel more aligned, compassionate, and livable.
Therapy is effective when it creates conditions for this process to happen. It has to be a safe enough space for emotions and memories to be expressed. It has to be open enough to allow a new emotional experience that contradicts or expands the original one to constitute a “corrective experience.” Lastly, it has to be an environment of ‘play,’ where the new way of responding can be practiced, so the updated memory structure generalizes to daily life.
This paper put together what so many of us know, that whether the modality advertises itself as “top down” or “body up,” no matter its focus, this process of change is possible through each of them.
To create that environment, the therapist needs a set of specific characteristics. This is where the lifelong work of a therapist lies, and the schools we learn this in are our personal therapy and supervision sessions.
Bruce Wampold’s work (e.g., Wampold, 2015) explains that therapy works because of common relational factors, the human experience that show up across all effective therapies. He argues that decades of research show that people get better mostly because of the relationship, the sense of hope, and the therapist’s ability to create a meaningful, attuned healing experience.
The therapeutic alliance is the most researched common factor of effective therapy. The alliance doesn’t mean "we like each other," or that you enjoy each other’s company; it means there is enough mutual investment in the relationship to keep meeting. There’s a sense of collaboration between the two minds in the room.
The next vital component of creating a therapeutic environment is, of course, empathy. Empathy is far from a simple skill to cultivate; it is the effort to truly walk in someone else’s shoes. As Teri Quatman says, "Listening deeply is a contact sport; it is not an intellectual exercise. It takes the whole of us: physically, mentally, emotionally. If we don't show up with our hearts, our stomachs, our nervous systems, our muscles, our eyes, and ears. Mirror neurons and right brains open and ready for the receptive task of taking in the other, we can miss the deepest, most unworded parts of them.”
The third really important therapeutic factor is the expectation for treatment. That includes the client’s belief in therapy’s ability to help, but also the therapist’s ability to create mutual understanding of the client’s suffering and the kind of help that they need. To make attuned choices in their responses to the client’s culture, history, and emotional reality.
As a highly specialized therapist myself, I am not negating the rich theoretical background and specific personalities that different theoretical models are created by and for. I’m simply saying that if you have chosen one evidence‑based practice or theory to focus on or are practicing an integrative model that you learned in school, you already have a toolbox that can help many people. The common factors of effective psychotherapy give us more than enough to work on!
To maintain a license, every therapist has to get continuing education, and I recommend that new therapists really use the opportunity to explore and learn different skills, to try everything on the buffet before making any large commitments. Remember that marketing preys on insecurities, and trust me, no certification will replace the need for real‑life experience, time spent in the therapy chair, providing psychotherapy.
"Practical medicine is and has always been an art, and the same is true of practical analysis... That is why I say to any beginner: Learn your theories as well as you can and master all the techniques. But bring your soul when you touch a living soul." – Carl Jung
Reference List:
Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L. (2015). Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science. Behavioral and Brain Sciences, 38, e1. https://doi.org/10.1017/S0140525X14000041
Quatman, T. (2015). Essential psychodynamic psychotherapy: An acquired art. American Psychological Association.
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238
Addendum: I’m writing to demystify the therapy experience for clients curious about therapy and to support new clinicians learning the practice. Articles about therapy are not therapy; they’re my thoughts written in solitude, not the living work of listening to you. If you are my client or student, know that I will never write about you or a specific case you bring without your explicit consent.
I welcome questions and comments below within the limits of this topic and format.
Brooklyn
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