All therapists need a theory of counseling, but how to choose? The SAGE Encyclopedia of Theory in Counseling and Psychotherapy identifies the existence of over 300 counseling approaches.¹ On its face, this would seem a perilous number for any well-intentioned therapist attempting to select only the best treatment approaches to elicit positive change in their clients' lives. So what's a well-intentioned therapist to do?

It may come as a surprise (and with perhaps a bit of disbelief) to learn that a litany of research supports the idea that a therapist's theoretical orientation has only a minor effect on treatment outcome, independent of the presenting diagnosis.^2,3 This idea has a name: the "dodo bird verdict." A comical label for what may initially appear to be a dubious claim, psychologist Saul Rosenzweig coined the term in reference to Lewis Carrol's Alice in Wonderland in which an avian creature of the same name famously declared, "Everybody has won and all must have prizes."^4,5 The dodo bird verdict contends that most all established psychotherapies are equally effective; they are all winners. So what is it about therapy that leads around 75% of people to experience its postitive effects?.⁶

Proponents of the dodo bird verdict often point to research whose more intuitive findings suggest that qualities of the therapist, client, and their therapeutic relationship play a determining role in treatment outcomes. This idea — also known as common factors theory — proposes that a significant portion of the effectiveness of various modes of therapy is attributed to common factors shared between them, rather than factors which are unique to each modality.⁷ Examples include the bond between client and therapist, agreement upon treatment goals, client expectations for therapy, therapist-expressed empathy, culturally-adapted treatment methods, and therapist expertise (to name a few).⁸

On the surface, it may appear that an apsiring therapist need do little else but pull a random, bona fide treatment modality out of a hat, put on a smile, and get right to the business of changing lives (maybe with an added slap on the behind and a "go get 'em, sport!" for good measure), and be successful at it. And indeed, this is what the bulk of common factors theory seems to suggest; be a good person, believe in your counseling theory, have your client buy into it too, and you'll probably do just fine. But while we would hate to disappoint any of our readers who may now be considering a prompt career change, we regretfully must inform you that there's a bit more to it than that.

To start, many of the common factors demand a certain skillset. Relationship buildling is difficult if you're a poor listener, cultural-adaptability requires knowledge of various demographics, and therapist expertise necessitates a healthy degree of mastery over some form of recognized treatment method, regardless of how random it is. It is important to note that common factors theory itself is not a treatment method, but rather common factors are those which make other psychotherapies effective, and these psychotherapies must provide both a valid explanation for a client's condition as well as structured interventions that are consistent with it⁹.

Furthermore, it turns out that there also exists research which suggests that factors unique to certain treatment modalities do account for a significant degree of treatment effectivness for some disorders, and therefore may be superior to others under certain conditions. For example, cognitive behavioral therapy (CBT) has been shown to be more effective than other therapies for certain treatment outcomes in clients with anxiety and depressive disorders.¹⁰ On the other end of the spectrum, we must also be aware of evidence which suggests that certain psychotherapies are actually harmful in some situations.¹¹

In the end, selecting a counseling theory to apply in a therapeutic setting isn't so much about selecting one as it is building one. Early in their careers, aspiring therapists may set off by selecting and applying one of the major counseling theories before integrating elements from other theories to construct a personal theory of their own.¹² Having multiple theories to pull from throughout the course of treatment can make therapists more effective with a broader range of clients,¹³ and it is critical that therapists integrate their selected theories with their own personal beliefs, values, and worldviews¹⁴.

MindVault Health primarily utilizes elements of acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT) in its approach to treatment. Each has been described as part of the "third generation" of cognitive behavior therapy (CBT),¹⁵ which some believe to be the "gold standard" of psychotherapeutic treatment due to both its extensive research support and its comparability/favorability to other treatment modalities.¹⁶ Underlying each of these systems is the concept of "mindfulness", the act of being aware of one's internal processes and environment. Below, we take a deeper look into mindfulness, ACT, and MBCT to explore why these are foundational to our treatment model.