Therapy Today

Viewpoint
Hope – the neglected
common factor
Of the four factors
generally accepted
to be common
across all therapeutic
approaches, hope is
the least researched.
Denis O’Hara believes
it’s time for a clearer
exposition of how
we conceptualise
and practise the
work of hope in our
different approaches.
Illustration by
Geo Grandfield
One of the exciting and gratifying aspects
of being a therapist is the fact that therapy
makes a real difference to people’s lives
most of the time. In fact studies have
shown that therapy is around 80 per cent
effective compared to no treatment. 1
This confirms that counselling and
psychotherapy are more successful than
other healing therapies and treatments,
including standard medicine. This fact
has led researchers to ask the question:
What is it about psychotherapy that
facilitates therapeutic change?
We know that therapy works, but how
does it work? The immediate assumption
was that good theory facilitates
therapeutic change: the better the theory,
the greater the likelihood of therapeutic
change. This was an appealing
assumption, but in their search for an
answer to the question, researchers
came across a surprising finding: most
bona fide therapies provide about the
same amount of therapeutic effect. 2, 3
This intriguing finding is now so
well established that it is humorously
referred to as the ‘Dodo bird effect’
after the comment by the Dodo in
Alice’s Adventures in Wonderland:
‘Everybody has won and all must have
prizes.’ The discovery of the Dodo bird
effect led to the realisation that if most
major therapies provide about the
same therapeutic effect, then there
must be something common among
these therapies that is responsible
for producing therapeutic change.
The common factors
In examining the features of therapy that
appear to be common across approaches,
researchers identified four major factors:
••
Extra-therapeutic factors (ie factors
external to therapy, eg relational and
social supports)
••
The therapeutic alliance or relationship
••
The theory of practice
••
Hope and expectancy.
These important factors found across
theories and approaches have become
known simply as the ‘common factors’.
The first of these, extra-therapeutic
factors, is highly significant but is one
that exists whether a person seeks
counselling or not. This is not to say
that capitalising on these various extratherapeutic
factors within therapy,
and encouraging the benefits of such,
is not an important therapeutic task.
However, much of the action of this
factor occurs outside of therapy itself.
Factors two and three have received
the most research attention. The
therapeutic alliance has consistently
been shown to be an active ingredient
in the therapeutic change process.
Factor three, the theory of psychotherapy,
whilst not the central component of
change as once assumed, does play
an important part in orientating the
therapist in the work of therapy. The
fourth factor, hope and expectancy,
has been well acknowledged but is the
factor which has captured the least
research attention. The remainder of
this article explores the significance
of hope and expectancy as an essential
ingredient in therapeutic change.
The necessity of hope
The importance of hope should not
be underestimated. The renowned
psychotherapist Jerome Frank stated,
‘Hopelessness can retard recovery or
even hasten death, while mobilisation
of hope plays an important part in
many forms of healing.’ 5 Hope, it
seems, is essential to life and is
therefore a fundamental human need.
Without hope, despair and depression
take hold with devastating effects.
But what is hope? One simple
definition is that hope is a confident
expectation of a good future. Without
a belief that good things and good
experiences are still available to us,
November 2010/www.therapytoday.net/Therapy Today 17