The Common Core of Psychotherapy

We now know the key ingredients for psychotherapy.

Reviewed by Tyler Woods

If you've ever thought about starting therapy, you might have felt overwhelmed by the number of approaches. Should you go with a cognitive-behavioral therapist who can help you think more adaptively, a psychodynamic therapist focused on defense mechanisms and relationships, or perhaps someone in the humanistic tradition who can help you get better in touch with your feelings?

With so many options, it’s easy to feel confused. But here’s the good news: research shows that most legitimate therapeutic approaches lead to similar outcomes, especially for common issues like anxiety, depression, and adjustment challenges. This is often called the “dodo bird verdict,” and it is a robust finding in psychotherapy research.

So, what does this mean for choosing therapy? When seeking help for general concerns like mild depression, anxiety, or relational issues, it’s more about engaging in the psychological healing process than picking the "right" intervention that fixes a diagnosable problem.

To illustrate, imagine Heather gets a call from her 22-year-old son, Jeff, who is feeling lost after a recent breakup. He’s withdrawn and unsure of his purpose. Heather wonders: what kind of help does Jeff need?

One approach would be to view Jeff’s struggle as a mental health condition that requires a specific diagnosis and intervention. If we view the situation this way, it would be important that Jeff gets the right diagnosis and a matched, scientifically validated intervention. This is called the “medical model,” and it is the way health insurance generally decides what to reimburse.

However, it is not necessarily the right way to frame the healing that takes place in psychotherapy. Bruce Wampold and Zac Imel make the case in The Great Psychotherapy Debate. They argue that for most problems, psychotherapy is less about matching a specific diagnosis to a specific treatment and more about a psychosocial healing process that needs certain core ingredients to succeed. In our recent publication in the Journal of Psychotherapy Integration¹, we link their model to UTOK, the Unified Theory of Knowledge² and argue that the result provides the field with the "common core" of psychotherapy.

The Common Core of Psychotherapy

The common core consists of three main parts: (i) an initial societal and relational context that legitimizes the healing; (ii) three core process elements that facilitate adaptive change; and (iii) feedback on progress, based on prognosis.

To apply the common core to Jeff’s situation, we first need to consider the therapy in the social and relational context. This includes the legitimacy of the healing process, which involves society’s acceptance of therapy, It also includes Jeff’s own beliefs about its usefulness, and the therapist’s confidence and expertise that they can handle the problem. A hundred years ago in the U.S. (and in many cultures around the world today), psychotherapy was not seen as valid. In our modern times, however, it is widely accepted. This makes a huge difference in its effectiveness and it points to the importance of sociological factors. The legitimizing context can be thought of as the elements that are either facilitative of or barriers to the therapy process getting underway.

Once the therapy has started, research has shown that good therapy consists of three core elements. First, there is the quality of the therapy relationship. In this case, it means Jeff needs to feel the therapist is caring and competent, and can "see, know, and value" him as a human being, with all his vulnerabilities. This is what allows Jeff to feel safe, respected, and open during sessions.

The second core process element involves the therapist working with Jeff to develop a shared understanding of Jeff’s struggles and strengths. Therapy might help him see how inactivity fuels his depressed mood, or it might help reveal how his breakup challenged his core identity as a man. The key ingredient here is that the therapy helps Jeff develop a new perspective on himself, his problems, and his potential for growth and adaptive living.

The third core process element is that the therapy should involve some active elements that fosters new experiences, both inside the therapy room and out. In this case, Jeff might be encouraged to engage in enjoyable activities, learn to accept his emotions, or challenge harmful self-talk. These steps create new learning experiences and skill sets that foster growth and resilience.

Finally, therapy should be “outcome-informed.” This means the therapist should monitor both Jeff’s attitude about therapy and the progress toward reducing problematic symptoms and adjust as needed. It also means that the expected outcome should be based on the nature of the presenting problem. For example, if Jeff’s current struggles are his first serious challenge, then one might expect a fairly quick recovery. In contrast, if Jeff had a long history of depression and met the criteria for a personality disorder, then one would expect a more gradual path to improvement.

What Does This Mean for You?

If you’re considering therapy for challenges like anxiety, depression, or relational issues, don’t focus solely on finding the “right” approach to fix your problem. Instead, think about it more as a journey into the healing process. That journey should start with a therapist who is offering an approach that feels legitimate to you. After it begins, a good relationship should form that offers new insights and involves interventions that feel constructive and result in your relating to the world in a more flexible and adaptive way.

Returning to Heather and Jeff, we hope Heather encourages Jeff to find a therapist he trusts, who can provide insight, connection, and tools for navigating his life in a growth promoting, adaptive way.

To find a therapist near you, visit the Psychology Today Therapy Directory.