Editorial: Common factors in the art of healing

Abstract

Meta-analyses have consistently shown a wide variety of psychotherapeutic and pharmacological interventions to yield similar effect sizes, suggesting the possibility that those interventions share common factors that account for the vast majority of variance in clinical outcomes. Although mediation analyses are needed to know definitively whether factors common or specific to the interventions are responsible for clinical improvement, a large number of association studies suggest that a common set of characteristics representing the ways in which clinicians relate to their patients, and not the technical expertise of clinicians or the therapeutic modality in which they work, account for the majority of therapeutic change across all medical disciplines and cultures. These characteristics include clinician empathy, warmth, and genuineness, a capacity to maintain a positive regard for the patient in moments of vulnerability, and an ability to establish a strong therapeutic alliance and clinical narrative through which the patient understands their suffering and is challenged to change through health-promoting activities. These common factors are amenable to study to improve our knowledge of precisely how they produce clinical change. They can be taught across all medical disciplines, in order to deepen the shared understanding, interpersonal attunement, and alliance between clinicians and their patients, which together constitute the true science and art of healing.