TABLE 1.

The Model of Therapeutic Effectiveness: Domains and Themes^a

Primary Domains	Overlapping or Hybrid Domains
A: Personal growth and self-care	AB: Therapeutic humility
1. Maintain a balanced life	26. Do not avoid emotion
2. Work at self-awareness	27. Tolerate clinical ambiguity
3. Acknowledge/work through our own fears	28. Be able to explore difficult topics
4. Acknowledge your own feelings of vulnerability or helplessness	29. Accept and honor client as expert
5. Debrief with colleagues	30. Be a catalyst for therapeutic change
6. Value professional development	31. Trust in the process
B: Therapeutic approaches	32. “Sit with” client emotional distress
7. Clarify and name sources of distress	33. Avoid urge to have to fix
8. Problem-solve	34. Model healthy processing of emotion
9. Educate, inform client	BC: Therapeutic pacing
10. Debunk myths	35. Listen attentively
11. Reinforce client strengths and positive ways of coping	36. Hold or ground client
12. Provide techniques (eg, mindfulness, Therapeutic Touch)	37. Keep client in the here and now
13. Advocate for client with the care team	38. Maintain slow pace—do not rush therapy
14. Foster positive relationships between client and family	39. Encourage client to talk about fear and distress
15. Elicit client needs	40. Normalize and validate client experience and distress
16. Probe for feelings underlying events and circumstances	41. Use skillful tentativeness, ie, be “purposefully hesitant” to be nonthreatening
17. Help client identify what they can and cannot control	AC: Therapeutic presence
18. Help client understand by mirroring and reflection	42. Being compassionate and empathetic
19. Use silence to encourage client expression	43. Being respectful and nonjudgmental
20. Explore image and metaphor	44. Being genuine and authentic
21. Offer comfort through touch	45. Being trustworthy
22. Acknowledge spiritual distress	46. Being fully present
C: Creation of a safe space	47. Valuing intrinsic worth of client
23. Provide privacy	48. Being mindful of boundaries
24. Provide calming environment	49. Being emotionally resilient
25. Assure confidentiality	ABC: Optimal therapeutic potential
	50. By skillfully combining elements contained within each of the domains, clinicians are able to achieve optimal therapeutic effectiveness

^aFor a schematic of the model, see Figure 1.