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It’s time to focus on the biggest change factor

Client factors are the least understood and least researched of the common factors.

Psychotherapy research has made a long-standing assumption that models, techniques, and therapists are the primary agents of change in psychotherapy. The long-standing belief that therapists and treatment models are the "active" agents has guided the focus of most psychotherapy research. However, research shows that clients are actually the largest contributors to successful psychotherapy outcomes (Norcross & Lambert, 2018). This requires therapists to rethink the centrality of their role and the treatment models and techniques they use. The question becomes – how do we best utilize the knowledge that clients are the main drivers of change in their lives?

What the Research Says...

The quality of the client’s participation in psychotherapy

is the most important determinant of outcome.

(Orlinsky, Rønnestad, and Willutski, 2004)


It is estimated that clients and factors outside of the therapy account for about 40% of the change that takes place (Assay & Lambert, 1999). The client change factors include the client’s level of motivation, perceptions of the therapy, commitment to the therapy framework, and integration of concepts into everyday life (Bohart & Wade, 2013).

"Therapists must show clients that they not only understand their experience, view of the problem, and potential solutions, but that they will also privilege those perspectives."
(Bohart & Tallman, 2010, p. 83)
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What it Means for Therapists

Therapists should recognize and deliberately mobilize a client’s strengths, resources, personal agency, and self-healing abilities (Bohart & Tallman, 2010).


Be comfortable with the fact that clients may find unique and unplanned ways to create positive changes that are not outlined by the therapy.


Therapists should promote the client’s active involvement in treatment and their recovery vs. a more passive patient role typical of the medical model.


The client should be viewed as an active learner and problem solver.


The treatment approach taken by the therapist should be responsive and individualized to the client to enhance their involvement, motivation, and strengths (Bohart & Wade, 2013).


The client's motivation level is crucial. If the client's motivation level is low, focus on strategies to increase investment in the therapy process.


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