Editorial: Active components in psychotherapy: towards an integrative model of the mechanisms of therapeutic change

Abstract

Psychotherapy outcomes have long been a subject of debate regarding the relative importance of specific techniques vs. common factors. Advocates for the former position contend that techniques with demonstrated efficacy play a crucial role in modifying dysfunctional thoughts, behaviors, and emotions, and emphasize the importance of evidence-based protocols and manualized treatments in addressing specific symptoms or disorders (Giles, 1993; Pérez Álvarez, 1996; Tolin, 2010; González-Blanch and Carral-Fernández, 2017).

On the other end of the spectrum, a growing body of research emphasizes the significance of common factors – relational and contextual aspects shared across therapeutic modalities – in promoting positive outcomes (Lambert and Ogles, 2004; Karson and Fox, 2010; Wampold, 2017). Key among these factors is the therapeutic alliance (Araya and Porter, 2017; Norcross and Wampold, 2019), characterized by trust, collaboration, and a positive working relationship between therapist and client, which creates a safe and supportive environment where clients feel heard, understood, and able to explore and change. Client factors – such as motivation, self-efficacy, and expectations – as well as therapist factors – empathy, positive regard, and cultural sensitivity – are important contributors to the therapeutic process (Romero-Moreno et al., 2021). Taken to the extreme, this view might imply that specific techniques or theories play a secondary role compared to these common factors (Wachtel et al., 2020).