I want to share a trade secret with you. Here it is: psychotherapy works. Well, to be honest, that's not all there is to this secret. Let me explain.

Often therapy works as well as medication. If you want to just mask the symptoms until the situation that produced them fades away, then take the pills. However, if you want a lasting result that goes to the source of the symptoms, then get therapy at least in connection with taking medications. Or just get therapy. There are many conditions that are basically biological to begin with, so taking medication for them makes as much sense as taking insulin for a diabetic. However, when the reason for the symptom cannot be linked directly to some biological cause, there is no impetus for taking medication alone.

That gets us back on track. What is it that makes psychotherapy work? This is where we get more deeply into the trade secret ? and a kind of family squabble. Some psychologists believe you cannot say any given intervention or technique in clinical psychology "works" until you've actually tested that thing out in the lab. The problem with that approach is that such tests require conditions that do not exist in the real world; that is, no one who exactly fits the description of the test population, under the strict conditions of the lab, is likely to walk through the doors of the clinic, or if they did, they would do so in such small numbers as to make the whole enterprise untenable.

That leads to the second major group of psychologists who believe psychotherapy works; these people adhere to the existence of common factors that are present in all effective therapy whenever therapy works. It doesn't matter what kind of therapy a psychologist practices (cognitive-behavioural, psychodynamic, Gestalt, etc), as long as that psychologist employs these common factors.

So what are these common factors? According to Gaie Houston, an experienced therapist who practises in England and has trained psychotherapists all over the world, the common factors can be organised into four categories (as seen in her book '):

: Positive expectations, hope or faith, their own distress and their eagerness to seek help. When these things are present in a client, the therapist can feel encouraged by a more likely positive outcome to therapy.: Warmth and positive regard for the person coming for therapy, the cultivation of hope and positive expectation, empathic understanding, being a recognised, socially sanctioned healer of some experience and competence, being non-judgmental and accepting. When these things are present in the therapist, a client might believe they have found someone who is more likely to be of real help.: The building of insight, awareness, the discharge of emotions (catharsis), the provision of a rationale for understanding, and the provision of information. When people can increase their awareness and begin to make sense of what is going on in their lives, they can begin to make adjustments in their best interests.

: The use of techniques and procedures organised by the adherence to an established theory of psychotherapy, including the creation of a healing setting and relationship between the two people involved ? therapist and client.

These are the kinds of things that make psychotherapy work. Since it does work, it seems a tragedy when people suffer with emotional and psychological pain, because finding a competent therapist is certainly a real alternative. But please don't tell anybody!