This happens in several ways. For example, paying attention to a person increases his morale and self-esteem. This is called the Hawthorne effect. "Anyone who has been in therapy can appreciate the gratification that comes from having a competent professional give undivided attention for an hour."[[16]] Also, the expectation on the part of a therapist that positive results will follow itself can influence a client's attitudes and his belief that he will get better, that emotional suffering will lessen and end.
[[16]] James O. Prochaska, Systems of Psychotherapy: A Transtheoretical Analysis (Homewood, IL: The Dorsey Press, 1979), p. 5.
The strength of a client's belief that he can change, that he can improve, is the major single force in psychotherapy. The client has to feel that his belief is warranted. Many factors play a role here: the client's education level and the respect he may feel toward the therapist's training and experience; the intangibles of therapy—the therapist's integrity, authenticity or convincingness, the client's sense that he is understood, that the therapist cares, that the therapist himself has learned how to cope with living and can communicate this, etc. Psychotherapy can be successful when this sense of promise is present in therapy sessions.
CLIENTS LOOK BACK
I know myself better than any doctor can.
Ovid
If most emotional difficulties are not illnesses at all but problems of living, and if problems of living cannot be treated medically, then the hundreds of evaluative studies of therapeutic effectiveness have been looking for something that simply is not there: an objective standard against which to judge therapeutic success. It makes very little sense to speak of standards in connection with problems of living that come about from demoralization. The only standard we can reasonably appeal to is the subjective judgment of clients themselves, who have experienced periods in therapy.
[Therapy] is a purely individual affair and can be measured only in terms of its meaning to the person, child, or adult, of its value, not for happiness, not for virtue, not for social adjustment but for growth and development in terms of a purely individual norm.[[17]]
[[17]] J. Taft, The Dynamics of Therapy in a Controlled Relationship (New York: Macmillan, 1933), quoted in H. H. Mosak, "Problems in the Definition and Measurement of Success in Psychotherapy," in Wolff and Precker, eds., Success in Psychotherapy, p. 7.
A few representative and specific evaluations of their experiences in psychotherapy by former clients follow. They are included here not as proof of the effectiveness of psychotherapy, because to search for objective proof in this area is a mistake, but rather as illustrations of different ways people believe themselves to have been helped:[[18]]
[[18]] Most evaluative studies of psychotherapy have attempted in some way to take into account the judgment of clients. One study in particular, however, has made clients' evaluations of their experiences in therapy its main focus, in fact, for a book-length treatment. That is Hans H. Strupp, Ronald E. Fox, and Ken Lessler, Patients View Their Psychotherapy (Baltimore: Johns Hopkins Press, 1969). Some of the patient evaluations included here are based on transcripts from the Strupp-Fox-Lessler study; they have been paraphrased and condensed for use here.