Two kinds of change facilitating factors

A wide variety of conceptualizations exists to account for the facilitation of change in psychotherapy. These are usually related to advances in psychopathological and/or developmental formulations. The approach to the subject usually follows causal logic, in the spirit of the medical model. The present paper argues that although causal factors operate in psychotherapeutic practice, alongside them there is a class of non-causal factors whose impact and contribution to therapeutic progress should not be underestimated. The paradoxical effect of these factors may be better understood if we examine those features that pertain not to focal "psychotherapeutic action," but to what enables it, namely to the background factors inherent in the psychotherapeutic situation. Of these, abstinence and constancy are two factors singled out for discussion. With the help of clinical vignettes, it is illustrated how these two controversial psychotherapeutic tenets contribute decisively to the creation and management of the psychotherapeutic endeavor. These contributions are discussed and elaborated in light of two experiential modalities, of Being and Doing, which provide a framework for the coexistence and conjoint effectiveness of causal and non-causal factors in individual functioning and development, as well as in psychotherapeutic practice.