6 Essential Elements of Effective Psychotherapy

Set yourself up for success by becoming an informed consumer on the process of therapy.

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Finding a Therapist

While not technically an element of the counseling process, it's important to take the time to find the right therapist. This typically starts with an initial phone inquiry.

Before the phone call, make a list of questions you want to ask your prospective therapist. Don't be shy about asking questions, and talk to several therapists before deciding on who to hire. For more on selecting the right therapist, see my post, 5 Ways to Make the Most of Counseling. 

It may take time to find the right therapist, but once you do, look for the following six essential elements to occur during the therapy process.

Element #1. The Assessment Phase of Psychotherapy

A proper assessment means gathering information on things like sleep, substance use, and basic mental health history. Without this overview, the therapist might miss the information necessary to map out a successful treatment plan.

It can be tempting for a therapist to skip the assessment phase and jump right into problem-solving mode. However, an experienced therapist knows that an assessment is necessary to see the big picture.

If your therapist doesn’t perform even a brief assessment, this could be a red flag. The assessment phase of therapy should happen during the very first therapy session, or least by the second session.

Element #2. Defining the Problem

After the assessment phase, you and the therapist define the problem you want to address. Sometimes the problem is obvious, and sometimes it is obscured. In any case, there should be an attempt to narrow down the problem to something definable and workable.

The problem might be specific, like arguments with your spouse, or the problem could be more symptom-based, like anxious worrying, feeling depressed, negative thinking, or perfectionism.

You should have a sense that your therapist was helpful in the problem defining process, meaning they listened to you carefully and provided guidance if necessary.

Element #3. Setting Goals for Therapy

It's essential to set goals for therapy as soon as possible, even if you're not sure exactly what your goals are. Remember, you can always adjust your goals for therapy as you go. They're not set in stone.

Why are goals important? Therapy without goals is like is going for a drive without a destination. It might be enjoyable but you don't arrive anywhere. Likewise, just sitting around talking to a therapist might make you feel good for a day or two, but ultimately you’re not creating any real change.

If your therapist has not defined any goals with you, this is a problem. Ask for goals.

Element #4. Measuring Behavioral Change

Once goals are defined, the work begins.

The work comes down to changing behaviors. While it’s all well and good to achieve insight, ultimately therapy is about creating sustained behavioral change, in the real world.

Change is not easy. If you’ve ever tried to start an exercise program and failed, you know how hard it is to change behavior.

The key to creating lasting change is to accept that your old behaviors may never completely go away. You’ll never be perfect. But that’s not the goal.

The goal is to catch yourself every time you fall into old patterns, then recommit to the new behavior. It’s like lifting weights: the more reps you do, the bigger the new muscles get. With persistence, the desired behavior becomes the new default.

If your therapist is not measuring your behavioral change, this is a problem. Request some sort of homework or behavioral experiments to try outside of therapy. This could be setting a boundary at work, validating your spouse’s feelings, or anything that pushes you to change in a positive way.

Tracking the progress toward your desired behavioral outcome makes it more likely your behaviors will change for good.

Element #5. Practicing New Skills

There's a big difference between talking conceptually about changing your behavior and actually changing your behavior. As mentioned previously, your therapist should give you some sort of homework or new skill to practice between sessions.

Ideally, new skills should first be practiced in the therapist's office (or virtually online). For example, your therapist could do a hypothetical role play where you practice listening and reflection skills. That way, you'll have had the entire experience of practicing the skill (conceptually, physically, and emotionally) before trying it out in real life.

You can also ask your therapist about strategies for sleeping better, ways to resist distractions, or how to be more decisive. Therapy isn't just about healing; you can also learn some practical tools.

Element #6. Graduating From Therapy 

By graduating from therapy, I mean ending therapy at the right time. It shouldn't last forever, nor should it end too soon.

One of the biggest problems in therapy is when clients stop too soon. In fact, research shows that one in five clients drop out of therapy before they accomplish their goals.

While clients are at liberty to end therapy whenever they want, therapists are often remiss at providing enough education about when it's appropriate to terminate treatment.

Clients may think it's okay to end therapy "when I feel better" or "when I'm happy." Instead, therapists needs to help clients articulate something more along the lines of “when I have chosen my new, healthy behaviors over my old behaviors eighty percent of the time, for at least three months.”

As a therapist, I also encourage several "taper-off sessions" after goals are met, in order to ensure changes made in therapy are sustained. It's akin to tuning a piano. For more on this, read my blog post, You are a Piano: Understanding the Process of Change.

Conclusion

So, in summary, the six essential elements of effective psychotherapy are:

1. The Assessment Phase
2. Defining the Problem
3. Setting Goals for Therapy
4. Measuring Behavioral Change
5. Practicing New Skills
6. Graduating From Therapy

While there are other important elements beyond this list, in my experience these are the essential ones.

In short, effective psychotherapy is about clear expectations between the therapist and client. As a client, don’t assume the therapist will take the lead on setting expectations.

I like to tell clients that working with a therapist is not unlike a hiring a plumber or an electrician. You, as the consumer, have every right to ask plenty of questions.