What makes psychotherapy work?

With over 500 variations of psychotherapies, it can be a daunting task to find one that suits a client. Dr Steven Hayes has pointed out that list of evidence-based psychotherapy, maintained by scientific bodies and government agencies, do not require any knowledge of the processes of change, hence methods proliferated.

With his colleagues, Stefan Hofmann at Boston University / Philipps-University, Marburg, Germany; Joe Ciarrochi at Australian Catholic University; and our associates Baljinder Sahdra and Fred Chin, he set out to conduct a mediational study to identify the important pathways of change. 

Due to the size of all studies, 54,633 in total, they dubbed the project the “Deathstar”. This is in reference to the moon-sized space station with planetary destruction capabilities in Starwars movies. It took the team over 4 years to complete.

A few results I would like to highlight here. The result indicates that 55% of change is due to the skillset of psychological flexibility and mindfulness. And not the factors that people suspected such as self-esteem, or friends and family.

Psychological flexibility consists of 3 parts, awareness, openness and value-based engagement.

Awareness is the first pillar. It is our ability to notice what thoughts and feelings show up; What sensations we experience at each given moment. 

Openness is about being present with whatever we experience in a given moment; making room for it. This allows us to immerse ourselves in experience, without needing to avoid it or to engage with it. Instead, we learn to be with uncomfortable thoughts and feelings, letting go of the internal resistance to what is painful or what we would like to control. Voluntarily opening up to what we do not like has an indirect result of uncomfortable thoughts and feelings showing less frequently and with diminished intensity.  As a result, we are more likely to be able to move in a more meaningful direction in life.

The third pillar of psychological flexibility is value-based engagement. It is about freely choosing what matters to you and aligning your choices and behaviours to your values. A value is a quality of ongoing action. This means that you become patient by doing acts of patience. Values are not a goal as they cannot be achieved. Instead, they are a direction to point you in the direction of what is meaningful to you. By aligning your behaviour to them, your life will become more meaningful.

Awareness and openness together form an approach to mindfulness and together with value-based engagement, you can develop the skillset of psychological flexibility. And with it have the single most important skill for mental and emotional well-being.



Acceptance and Commitment Therapy, Steven C. Hayes, Kirk D. Strohsahl, Kelly G. Wilson, 2016, 2nd edition

Written by:
Allard Mueller
Counsellor and Psychotherapist
SACAC Counselling

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