What Works in Therapy: Returning to the Basics
As I reconnect with my clinical roots (and I have profoundly enjoyed the journey so far!) I’ve been catching up on current trends and research in psychotherapy. What struck me most is a tension that feels a bit paradoxical.
On one hand, the integration of technology into treatment (AI, telehealth, EHRs) and the widespread encouragement of measurement‑based care have reshaped the clinical landscape. It’s exciting, although AI’s rapid encroachment raises understandable concerns both in psychotherapy and beyond. These developments will undoubtedly continue to grow and shift the way we practice.
On the other hand, psychotherapy research has become increasingly complex and sophisticated, asking more nuanced questions and using more advanced methods. Yet despite this evolution, there is a “Days of Our Lives” quality — after stepping away for years to work as an administrator, there is also much that has not changed. We are still wrestling with many of the same core questions, and real‑world outcomes have not meaningfully shifted.
While recently texting with Dr. Duncan about the state of the research, he said something that cut straight to the heart of a belief about therapy that we both share. Much of the literature still implies that the magic of client change lies in the therapist’s approach or the therapist themselves, “…not in the beautiful individuality of the client in collaboration with the therapist, a fellow human being.” That is an eloquent statement, texting or any other format.
My two cents is this, and they are borrowed from the great Dr. Gerry Egan, author of The Skilled Helper: the most important things we learned about therapy came at the very beginning of the journey. To be fully present. To be curious. To demonstrate empathy through active listening. To be client‑centered. These skills are often labeled “basic,” as if they are simple — like basic math before algebra or calculus. But they are not simple. They are foundational.
These foundational skills form the bedrock of any therapeutic model. And too often, they are overshadowed or underutilized in the beautiful, complex process of therapy. We encourage clients to return to the basics when they feel stuck; the same wisdom applies to us. It is difficult to be successful without a firm grounding in the fundamentals.
Good therapy begins — and ultimately ends — with tending to the individual client in front of us, with their unique preferences, beliefs, and values. When we are anchored in the fundamentals, we gain the flexibility needed to respond authentically and effectively to those differences. Amid all the technological advances and research sophistication, the heart of psychotherapy remains the same: two human beings working together, guided by presence, curiosity, empathy, and collaboration.