Did you know that you may soon be able to get therapy for such issues as anxiety through an application on your smart phone? It’s true. A recent article in the New York Times (Feeling Anxious? Soon there will be an app for that) explains that there are actually apps being developed for smart phones and tablets which will help reduce anxiety.
As I read the article I could not help but feel a little bit offended. First of all I was incensed because there is one part of the article which describes current, traditional therapy as “pop mysticism, soothing thoughts [and] confidence boosters.” As a counselor I like to believe that what I do is a little more than pop mysticism. But more than that I was offended by the fact that someone out there is attempting to replace me with a simple game on a cell phone. After all, I went to school for 8 years to learn how to help someone with anxiety. A phone app should not be able to do that so easily.
You can understand, then, why I felt so vindicated when it turned out (spoiler alert!) that the positive effects of the program really just boiled down to placebo and expectancy. “Ha ha,” I thought, “people just think your silly little program works, when it doesn’t really do anything.” Just then I remembered something that caused me to eat my words.
I remembered that very little of what I do actually has to do with me. M. J. Lambert published a study of psychotherapy outcomes in 1992 which broke down and ranked the factors which contribute the client change. It turns out that 40% of client change is due to client and environmental variables (in other words things the therapist has no control over), 30% is attributed to the quality of the therapeutic relationship, 15% is a result of individual techniques and approaches, and the other 15% is just placebo.
That means that the client’s own expectations for therapy to work are just as influential in it actually being effective as whatever techniques, tools or theories I might use. It also means that a full 55% of the efficacy of counseling is attributable to factors outside of my control.
Where I have the most control in actually helping a client improve is not in my special techniques, or the new theory that I learned, but in the relationship itself. The best way for me to assist my clients is to invest in the therapeutic relationship.
So, really, the only thing that makes me better than a simple game on a smart phone is the fact that I can have a relationship with my clients. I can show them respect, empathize with them, and give them positive regard.
It’s good for me, and I’m guessing probably all therapists out there, to remember that, when it comes down to it, it’s not about the theory or techniques. Those play a relatively minor role in client change. It’s about the relationship. So when I am thinking about how to best serve my client, I should be thinking most about how to build a strong therapeutic bond with them, how to show them respect, and how to encourage them to grow.