To kick off Mental Health Awareness Month this May, we thought we’d talk some fundamentals of therapy. I mean, the whole point is to help people find coping tools and willingness to make life changes, right? So what accounts for people’s ability to make changes to improve their mental health? And how can we as therapists facilitate that process?
Research by the powerhouse researcher Sonja Lyubomirsky found that commitment and engagement in a brief positive emotion intervention predicted how helpful the intervention itself would be. The study instructed participants how to use strategies to maximize positive emotions over an 8 week period.
These strategies appeared helpful to reduce distress and improve mental health. Cool right? Research now finds multiple benefits of newer positive emotion approaches. But the active and voluntary use of those strategies by participants outside the study also accounted for their efficacy. Participants who committed most to learning and using those strategies experienced the most mental health benefits.
Clients who commit to their own power to actively engage in change processes and learning coping tools do well in therapy. Research finds that treatments imparting evidence-based tools to respond to stress help most to facilitate change (compared to simple listening). This engagement in learning specific coping tools is fundamental to therapy, along with a good therapeutic relationship.
Together, this suggests people don’t always improve when we as therapists solely “listen well”. Such listening is a necessary but not sufficient for change. (Note the exception of active listening with depression in particular, but also that Interpersonal Therapy, IPT, shows greater efficacy than listening.) Committing to and enacting change strategies outside the therapy session is a necessary component of a good alliance. Sometimes clients boast “my therapist gives me tools.”
Committing and enacting helpful strategies may be highly reinforcing for people. That is, executing instrumental change enhances the learning process for how to cope in the future. It also boosts self-efficacy to cope and promotes growth. This process may be why psychedelics “assist” change in therapy, but do not to lead to change on their own.
Therapists help clients facilitate the commitment and engagement process. First, if clients are not ready for change, therapists use approaches like Motivational Interviewing (MI) to help resolve ambivalence. Values clarification (e.g., as in ACT) also helps clients explore how their commitment to change helps live a life they desire.
When clients are ready, evidence-based therapy provides active coping tools. For example, emotion regulation, acceptance strategies, challenging thoughts/beliefs, working through feared memories, interpersonal/family skills, and more. Therapy also helps clients effectively re-engage when challenges that interfere with their goals. Flexible use of specific, evidence-based strategies and supportive relationships are not in opposition. They can be used “in concert” with each other to promote change.
Providing a supportive relationship while actively building coping skills is the “1-2 punch” to help clients live the lives they want. Now that’s something therapists are well-suited for.
