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The Therapeutic Pyramid: A Common Factors Synthesis of Techniques, Alliance, and Way of Being


  • Stephen T. Fife, PhD, Marriage and Family Therapy Program, University of Nevada, Las Vegas; Jason B. Whiting, PhD, Marriage and Family Therapy Program, Texas Tech University; Kay Bradford, PhD, Family, Consumer, & Human Development, Utah State University; Sean Davis, PhD, Marital and Family Therapy, California School of Professional Psychology, Alliant International University.
  • Portions of this article were presented at the AAMFT Annual Conference in Atlanta, GA, September 2004 and the NCFR Annual Conference in San Francisco, November 2009. The authors express thanks to Jaclyn Cravens of Texas Tech University for her review of a previous version of this article.


Common factors in therapy such as the therapeutic alliance and client motivation have been found to account for more change than therapy models. But common factors have been critiqued as only lists of variables that provide little practical guidance. Some researchers have demonstrated that certain common elements (e.g., the therapeutic alliance) account for more variance than others (e.g., techniques), suggesting that some factors should be emphasized over others. Such findings suggest the need for alternatives to model-based therapy, with one alternative being meta-models, or “models of models,” that focus on how therapeutic factors interact with each other to produce change. The purpose of this article is to propose a meta-model describing the relationship between two specific common factors—the therapeutic alliance and interventions. We also propose a new factor—a therapist's way of being—that we believe is foundational to effective therapy. The model is proposed in pyramid format, with techniques on top, the therapeutic alliance in the middle, and therapist way of being as the foundation. The hierarchical relationships between these three concepts are discussed, along with implications for training, research, and therapy.