There are some problems. The common factors research has failed to support the bedrock assumption that the particular techniques the clinician chooses to employ are highly influential in determining treatment outcome. What clients take from treatment is based on their active construction of meaning and selective extraction of messages the therapist shares. We have trouble predicting what elements of a session clients will remember and use. Psychotherapy is an art because we do not yet have a sufficient language to describe all the subtle factors that shape how messages can be tailored to be received most optimally.
Clients are idiosyncratic individuals, looking to feel understood, affirmed, normal yet special.
Safeguarding against this risk requires considerable therapeutic finesse. The nature of the therapeutic relationship is riddled with ambivalence. Clients seek an expert evaluation, yet they resent being held to a standard. These pushes and pulls often make a straightforward, rational therapy plan unworkable. Managed care systems' insistence on brief, directive therapy compels greater empirical assessment of the limits of very time-limited therapy.