“A psychiatrist in my country is very critical about mental health care and says that human contact is the most important change factor in treatments. He says that the personal story of patients does not get enough attention in treatments.”
Do personal stories get enough attention?
The psychiatrist who says this seems to refer to biological psychiatry, where treatments mostly consist of medication. When psychiatrists consider mental health problems as a biological disease that can be ‘solved’ with medication, they indeed run the risk of simplifying the personal stories and mental health problems of patients.
However, mental health care is much broader than just the medical approaches of psychiatrists. Especially psychologists and psychotherapists are trained to listen to the personal stories of patients.
Most patients who go to mental health care have an intake of multiple sessions, in which all details of the problems, the history of the patient and their environment are described elaborately. Stating that the personal story of patients does not get enough attention is simply not true in specialized mental health organizations. It may be true for the small group of very biologically oriented psychiatrists, but certainly not for most mental health professionals.
Is human contact the most important change factor?
But when psychotherapists treat patients, is it true that human contact is the most important change factor? The answer is a clear ‘no’. This assumption can only be made by someone who does not understand the basics of psychotherapy and the power of psychotherapy to help patients change.
The Dodo bird verdict
There is of course the so-called ‘Dodo bird verdict’, the hypothesis that all therapies have comparable effects, and that it is the ‘common factors’ instead of the specific techniques that help people solve mental health problems. I wrote a separate blog about the question of whether all psychotherapies are equally effective.
First, it is not clear if the ‘Dodo bird verdict’ is correct. For example, there is pretty strong evidence that psychotherapies for PTSD that focus on the trauma are more effective than non-trauma-focused therapies. Also in several other disorders, it is not yet clear if all therapies have comparable effects.
The alliance is a skill, not just contact
But what is more important: the Dodo bird verdict does not say that anything works, or that it is the human contact about the personal story that makes a difference. Most researchers examining the Dodo bird verdict say that the alliance between therapist and patient is important.
One could say that ‘human contact’ is an essential element of the alliance. But the alliance is much more. It is a therapeutic skill in which therapists are trained, and that they can also develop with patients in difficult circumstances (think for example how complicated the alliance can be in people with borderline personality disorder).
The alliance is also not the only common factor that matters. Other common factors are, for example, the expertise of the therapist. Patients go to an expert in dealing with mental health problems and place their trust in them, which in itself is a helping factor.
The most prominent supporter of the common factors, Professor Bruce Wampold, also says, for example, that specific techniques are important as a common factor. He assumes that it is not the specific factors themselves that make the difference, but that the fact that a therapist uses specific techniques (regardless of the content) can give patients hope, clear guidelines on what to do, and a way to understand their problems.
So, is the Dodo bird verdict all about ‘human contact’? Clearly not. If the Dodo bird verdict is true (which is uncertain), then it is a strong simplification of what therapy is to say that it is all about human contact.
Carl Rogers and client-centered therapy
Saying that therapy is mostly about human contact goes back to the work of Carl Rogers (1902–1987). He developed client-centered therapy, a humanistic approach in which a therapist provides empathy, unconditional positive regard, and genuineness to help clients understand themselves, grow, and reach their potential. This comes close to the assumption that therapy is all about human contact.
But client-centered therapy is not ‘just good human contact’. It is a specialization of therapy, based on a strong theoretical foundation, that requires many years of training and practice in understanding the stories of patients to help them with mental health problems.
There is quite a lot of research on client-centered therapy, which is often called counseling. Most research says that counseling is as effective as other therapies, but only when it is conducted well. If therapists only try to listen well and be empathic, it is clearly not enough, and research shows that the effects are smaller in these cases.
Carl Rogers (1902–1987) developed client-centered therapy, emphasizing empathy, unconditional positive regard, and genuineness.
His work is often cited when people argue that therapy is mainly about human contact—but Rogers himself saw it as a structured, theory-driven approach.
In summary
Is human contact the most important change factor in treatments? The answer is a clear ‘no’. It is an underestimation of the strength of psychotherapies. Human contact is an important basic requirement for therapy, but therapy has much more to offer, and can help many people with mental health problems that cannot be helped with ‘regular’ human contact or biological approaches to mental health problems.
- For the question behind the Dodo bird verdict, see Are all psychotherapies equally effective?
- For more on the alliance as a change mechanism, see Is the therapeutic alliance the most important part of therapy?
- For the evidence that therapy works at all, see Does psychotherapy work?
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.
Literature
- Cuijpers P, Reijnders M, Huibers MJH. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207–231.
- Cuijpers P. (2016). Are all psychotherapies equally effective in the treatment of adult depression? The lack of statistical power of comparative outcome studies. Evidence-Based Mental Health, 19, 39–42.
- Wampold BE. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.
