Life, complexity, and psychotherapy: A systemic perspective on the elusive construct of extra-therapeutic factors

Study aims: Despite being mentioned in well-known models of psychotherapeutic change, the concept of extra-therapeutic factors seems to have left the scene across time, eaten away by the progressive refinement of the construct of common factors. Aim of the present study is to better understanding the historical evolution of the concept of extra-therapeutic factors and its importance for psychotherapy today.

Methods: This is a position paper based on a literature review on extra-therapeutic factors and psychotherapy outcome and process.

Discussion: There is growing evidence of the decisive role of clients' and therapists' characteristics, as well as of the importance of therapeutic alliances and relationships in promoting change. Within this context, the concept of extra-therapeutic factors still deserves proper attention, rather than being relegated to a residual and vanishing category.

Conclusion: A renewed interest on extra-therapeutic factors could reinvigorate the debate over the relationship between psychotherapy and life contexts and conditions. In terms of complexity and systems thinking nothing, a priori, really falls outside the realm of psychotherapy and, in turn, psychotherapy is not a practice that could be abstracted from the context in which it is practiced or from clients' and therapists' lives.