of the foregoing features of psychotherapy will
facilitate the achievement of greater effectiveness
and satisfaction. But beyond such elements as the
therapeutic relationship and anxiety reduction,
some forms of therapy have other features that are
applicable here. For example, therapy can be a set-
ting in which the client learns new things and cor-
rects faulty ways of thinking. At times, some forms
of therapy will take on distinct teaching overtones.
The client may be“tutored” on more effective
ways to find a job, or sexual information may be
provided to help alleviate past sexual difficulties and
promote a better sexual adjustment in the future.
Therapy, then, can be more than just exorcising old
psychological demons; it can also be a learning
experience in the direct sense of the word. Bandura
(1989) has emphasized the importance of feelings of
self-efficacy in promoting a higher performance
level in the individual. In short, those persons
who experience a sense ofmastery—who feel con-
fident, expect to do well, or just feel good about
themselves—are more likely to function in an
effective fashion.
Nonspecific Factors. Call it faith, hope, or expec-
tations for increased competence—successful therapy
tends to be associated with such nonspecific factors
(Kazdin, 1979). Numerous factors can conspire to pro-
mote such expectancies. First, there is often a mystique
to therapy—at least in the eyes of the general public.
Patients often come to therapy fully expecting to par-
ticipate in a process almost guaranteed to promote
mental health. Therapists often encourage such beliefs,
knowing full well that a believing, motivated client is
more likely to show progress than a cynical, recalcitrant
one. Furthermore, nearly every therapist is committed
to a theory of therapeutic change. Whether an operant
theory, a theory of the unconscious, or a belief in
growth potential, its ubiquitous presence in the thera-
pist’s explanations of how therapy works can ignite a
confidence that helps alleviate the client’searlier
feelings of despair. Although successful therapy can
almost always be characterized as having rekindled
the patient’s hope, faith, and morale (Frank, 1973), it
seems unlikely that therapy can be reduced to nothing
more than what some have disparagingly referred to as
a placebo effect. The expectations of the client help
make even more effective the specific techniques
applied in therapy. The successes of such techniques
then act to further increase the client’s expectations.
In Frank’s (1982) description of psychotherapy,
he notes that therapy involves a rationale, concep-
tual scheme or myth that provides a plausible expla-
nation for the patient’s difficulties and also
prescribes a ritual for restoring equilibrium. Such
explanations and rituals can, as Frank points out,
provide the patient with a face-saving reason to
abandon a symptom when ready to do so. To
cease complaining or give up a cherished symptom
without a good reason would imply that it was
trivial. So, whatever we call it—nonspecific factor,
placebo effect, or faith—it becomes an important
element in the therapy process.Nature of Specific Therapeutic Variables
It would be pleasant if psychotherapy were a simple
routine in which the therapist makes a diagnosis,
conveys it to the patient, gives a lecture or two,
and presto, the patient is cured. Unfortunately,
things do not work that way. Indeed, it is often
necessary to spend considerable time correcting
patients’expectations that they will be given a sim-
ple psychological prescription. Because psychother-
apy is an active, dynamic process, passivity and lack
of motivation can be obstacles. A number of factors
involving the nature of the patient, the therapist,
and the patient–therapist interaction affect the
process of therapy in important ways. Often, their
effects are felt over and above the specific mode of
therapy employed.The Patient or Client
Are there specific or general patient characteristics
that influence the outcomes of therapy? Such a
deceptively simple question really has no answerPSYCHOLOGICAL INTERVENTIONS 321