I hope anyone reading this has had or is still having a good holiday...still got New Year's Eve to look forward to, although I'm looking forward to some more personal celebrations as lots of my friends have birthdays in Jan and Feb.

Anyway, back to matters therapeutic. I recently read about some research that I'd like to share about what clients say were the most important factors in their therapy. First cab off the rank was having a relationship with a wise, warm and competent professional. I've harped on about the importance of the relationship before, so I won't belabour the point again too much here!

The second theme identified was having a relationship with continuity, safety and hope when feeling inner discontinuity. One participant of this study, who had been hospitalised for long periods as a child, described periods in her therapy where the most important thing was not what the therapist did or said but that she was there. This point seems to me to also be about the importance of the relationship between client and therapist...again. Apparently I am labouring the point.

However, this theme does reflect the fact that most of the participants had been in long term therapy (not just my opinion, it's explicitly stated in the study), and that's something I ask people to consider when they ask me about what sort of therapy they should be looking into, or what might be right for them. I work in a number of different settings, one short term, offering clients 6 sessions and in most cases it brings a lot of stuff up to the surface and before you know it, the 6 sessions are up...no continuity and no safety. Creating continuity and safety takes time, it takes those moments when you test your therapist to see if you can still trust him/her, bit by bit. It's no wonder that people can leave therapy thinking it wasn't helpful at all.

The third theme identified in this study was having beliefs about oneself and one's world view corrected. This aspect forms a core part of most "brands" of therapy but usually if you're a client looking for a therapist what you're really concerned about is that someone can help you with what's bothering you right now. How your beliefs about yourself and your worldview are corrected will depend on the orientation of your therapist but something really simple I often attend is the language clients use - always, never, should, ought, but, because and so on. The first four are judgments ("I always do x, y and z" to which I usually respond "Really? Always?) and the latter change the direction of a sentence. Most of all, I'm interested when clients talk about themselves in general terms, they start describing what's going on for them using "you", for example; "when you're in this type of situation you can't help but feel angry". This sentence makes it sound like it's true for everyone...which it likely isn't so I encourage clients to say I instead of you. Small things like this can help clients challenge their world views in small but impactful ways...you can even try it out on yourself, just by paying attention to the language you use.

The final theme the study identified was the creation of new meaning and seeing new connections in life patterns. This is very true of the way I work with clients. We spend a lot of time together trying to identify what is most important to the client, what they most value in life, what they want their life to be about. Once we've defined some of those points, it's often the case that the client realises that she has been living in ways that fundamentally contradict what is most valued to them.

For example, a client might have been brought up believing that being a doctor or a lawyer is important, goes to university, law school, magic circle law firm and then discovers that he hates it there. He's become a lawyer for his parents, not for himself. In being encouraged to find new meaning, his own meaning and not anyone elses' (for only your own will do), he realises that what he values most is making the most of his creativity. Lawyers get a bad rap...we could reverse this situation...our hypothetical client could have been brought up by very creative parents who valued creativity, our client might actually want to pursue a career that's much more structured than the life of the artist. The point is once you've been encouraged to question some of the meanings you've ascribed to your life, you can chuck them out or own them for yourself and once you've done that, you can make decisions that you're at the heart of.

In the interest of proper crediting, the article I've talked about was published in Counselling and Psychotherapy Research, December 2009 by PE Binder et al.