What Makes Talk Therapies Work or Fail, and What Can We Do at Home?
47% of New Zealanders will experience mental distress in their lifetime, and 77% of people know someone who has experienced or is currently experiencing mental distress (1).
Our quest for mental wellbeing is more important than ever. We know that talk therapies work—they are widely recognised as effective, efficient, and long-lasting, with strong evidence backing their legitimacy. Some therapies date back to the 19th century. But why do some people get better while others don’t? Why is it that some therapies succeed while others seem to fail? Before you invest your time and money, consider these factors.
Research by Asay and Lambert (2) identifies four key factors that contribute to the success of therapy:
1. Relationship (30%):
The relationship between you and your therapist, coach, or practitioner is one of the most critical determinants of a positive therapy outcome. Feeling supported, understood, and in collaboration is vital for success. These relationships often take time to form, and it’s essential to provide feedback to your therapist about your needs and experiences. Don’t hesitate to express what’s working for you or what might not be, as this allows your therapist to tailor the process to fit your unique circumstances.
Choosing the right therapist matters. It’s not just about finding any therapist or coach but one whose approach resonates with you. Ask yourself:
Do I trust this person?
Do I think this person genuinely cares about me?
How does this person make me feel?
Do I resonate with their teachings and approach?
Take time to explore—attend a workshop or watch videos to see if they’re the right fit for you.
2. Extratherapeutic Change (40%):
This factor is incredibly powerful. Many of us go to therapy expecting that the therapist will “fix” us, but research shows that a significant portion of our healing comes from within and outside the therapy room. Extratherapeutic change refers to the improvements that happen in our daily lives. Factors such as resilience, coping skills, and motivation (a big one) play huge roles. Life events like job changes or relationships can also impact therapy, for better or worse.
Having strong social support and engaging in self-help practices like mindfulness, attending workshops, or—my personal favourite—journaling, can lead to real, positive changes. These can be developed in therapy, but if therapy isn’t accessible to you, these are also strategies you can learn and cultivate on your own.
This ties in with Carl Rogers' concept of the actualising tendency, which highlights your innate ability to grow, heal, and reach your potential. Rogers likened this tendency to a potato sprouting in the dark—just as the potato strives to grow, even in less-than-ideal conditions, we too possess an innate drive toward healing and growth.
3. Expectancy and Hope (15%):
Do you believe therapy is going to work? This doesn’t mean you need to be 100% certain, but having a general expectation that therapy will be helpful is important. When hope falters, a therapist who holds that hope for you can be vital. Hope becomes the foundation for your healing journey.
4. Techniques Used (15%):
While specific therapeutic techniques are important, research by Lambert (1992) and Norcross & Lambert (2019) suggests they contribute only about 15% to the overall effectiveness of therapy. This is interesting because there’s often an emphasis on finding the “best” type of therapy. But just as no single diet works for everyone, no single therapeutic technique is the “holy grail.” Many other factors also play significant roles in therapeutic success.
Talk therapies offer a powerful path to healing, but their effectiveness relies on more than just the therapist or techniques used. You are a crucial part of the process. Reaching out for help is essential—you don’t have to go through it alone. However, it's equally important to have tools like journaling and mindfulness in your toolkit, empowering you to tap into the incredible healing power that already exists within yourself.
Mental Health Foundation of New Zealand. (2022). Mental distress prejudice and discrimination in Aotearoa: Key statistics 2022.https://www.mentalhealth.org.nz
Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J. C. Norcross & M. R. Goldstein (Eds.), Handbook of psychotherapy integration (pp. 94–129). Basic Books.
Norcross, J. C., & Lambert, M. J. (2019). Psychotherapy relationships that work: Volume 1: Evidence-based therapist contributions (3rd ed.). Oxford University Press.
