Four factors that produce change in a helping relationship
Many years ago, as a new graduate in counselling, I remember having two very rude awakenings.
Initially, I believed that all of my clients would see the need for change, would be happy to work with me, and motivated to help themselves.
While this was true for many of my clients, it was a shock to realize that there were some who were dragged in by others to see me, many who did not see any problems with their very problematic behaviour, and those only saw the need for others to change.
I also quickly realised that the training I received in various models of counseling did not always produce the outcomes they promised. At first I thought I was not using the models skilfully enough or simply needed to learn additional ways of helping people. Over time, I worked out that good outcomes were not produced by blindly following a recipe.
In 1992, a social scientist call Lambert conducted some meta-research to identify what was most effective in producing good outcomes in helping relationships. He expected to find some models of helping superior to others. To his surprise, he found that there is a general equivalency in the outcomes achieved by the mainstream counselling approaches.
He called this the Dodo Bird effect – a reference to a line from ‘Alice in Wonderland’ where, after a race, the Dodo Bird says , “Everybody has won and all must have prizes”. Lambert found that the majority of helping approaches were equally effective.
There are a few exceptions, of course, with some models of helping being more effective for particular types of problems. But otherwise, there is a general equivalency in the outcomes achieved.
However, the question was then posed as to why the models of helping were producing good outcomes although they are significantly different. It seemed to be factors, apart from the model being followed, that were achieving improved outcomes.
Lambert identified four ‘common factors’ that are present whenever improvement occurs:
The Strength of the Relationship: Here Lambert is referring to how well the helper is connecting with the client they are working with. The better the connection, the greater the trust, and the more open people will be. Lambert said this one single factor accounts for 30% of any change that occurs.
Having said that, there are some people you connect better with than others. This explains why a referral to another helper can often be more helpful than simply persevering when change is not taking place.
Client Strengths and Outside Factors: I confess to being a little disappointed when clients report progress and it had nothing to do with me. I am joking, of course. But, apparently, progress due to the client themselves, and factors outside of the helping relationship, is not unusual.
People have their own ideas, strengths and abilities, which they often make use of to address their concerns – a client decides to start taking their medication, gets themselves a new job, or ends a conflicted relationship, for example. Smart helpers actively seek out and make use of clients’ ideas, strengths, support people, and factors outside of the helping relationship, that are supportive of change.
Hope: Sometimes my clients say to me that their situation started to improve soon after they had made an appointment to see me. This is a classic example of hope working – their belief that coming to see me would be helpful in some way.
When people have hope, their behaviour tends to follow. Effective helpers take a real interest in why clients are hopeful, knowing the more people speak about why they are hopeful, the more amplified it becomes.
But it is not just the client’s hope that counts, but other people’s hope as well. You can amplify the hope of others by asking clients who has hope for them and why this is so. The more clients speak of the reasons why others are hopeful, the more hopeful they become as well.
Your hope, as a helper, also counts. If you are genuinely hopeful for your clients, this will certainly come across with how you relate to them. Some of my clients say to me that that the hope I have for them is one of the most helpful things I do.
You can also tell clients why you are hopeful for them. It might be due to the fact they are determined to take action, you see strengths that are working in their favour, or that they have stopped their situation from being worse than what it is.
Lambert says that hope, whether it comes from the client, you or other people, accounts for 15% of any change that takes place.
The Approach Used: If you are doing your maths, you will have worked out that Lambert found that the actual model of helping we use only accounts for 15% of any change that occurs.
This finding is very unsettling for various schools of therapies, which imply that the real hero of any improvement is the helper or model of helping used. However, the approach used is still important in that it needs to be a good fit for the client.
For example, a client who thought they were depressed because of their relationship difficulties is more likely to benefit from an approach that helps them to resolve these difficulties, rather than a cognitive-behavioural approach (typically recommended for depression), which focuses on changing thoughts and actions.
While some clients are clever enough to adapt themselves to the model of help that is being offered, smart helpers adapt their approach to what the client is needing.
This willingness by helpers to make it easy for the clients to give them feedback and adapt their approach accordingly, can improve outcomes by up to 65%. Making it easier for clients to let us know what helps and what doesn’t is something we all need to be working on.
The challenge for all of us in helping roles is to continually reflect on how we can take advantage of the above common factors. As we do so, our clients feel more satisfied with the experience of receiving help and we feel better about the outcomes achieved.