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Common Factors in Psychotherapy Outcome: Meta-Analytic Findings and Their Implications for Practice and Research

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Abstract

It is often reported in meta-analytic studies of adult psychotherapy that psychotherapy produces positive change but that there are few significant differences between different types of psychotherapy. Because meta-analyses indicate more similarities than differences among therapies, the "active ingredients" of therapy appear to include important factors in addition to specific therapeutic techniques. Research on common factors across therapies has existed for more than 60 years but is rarely mentioned in the social work literature. Common factors include the client and the client's context, the therapeutic relationship, and expectancy. These studies support the worth of the efforts of social work practitioners, suggest avenues for future research, and have implications for policy and education. The author of this article describes relevant meta-analytic studies of adult psychotherapy, examines the common factors perspective on psychotherapy efficacy, and sets forth implications for social work.
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... According to , some common factor advocates consider them to be crucial in manual interventions, both prelude and outcome. In social work research, Drisko (2004) has argued that common factors should include policy and agency contact, the client's context, and the client's own motivations, capacities, and resilience. It is argued that a better understanding of common factors in social work would be beneficial to social workers, policymakers, funders, and clients. ...
... This approach emphasizes client involvement, practice-based evidence, and "flexibility within fidelity", which means that the client's perspective should be assessed with regard to the treatment that is being used, and that if the client's goals are not being met then there should be flexibility in changing the treatment Kendall et al., 2008). The common factor and common practice approach deliver an alternative way to practice social work, with an emphasis on effective and empirically supported practice (Drisko, 2004) which allows social workers to broaden their skills when meeting clients . ...
Thesis
Evidence-based practice (EBP) is increasingly becoming an important part of practices in the social sector, particularly in social work. There is a growing body of research on the concept of EBP, yet it is little explored among Norwegian social workers. To better facilitate the ideas of EBP, it is necessary to study how social workers understand and relate to the concept. The overarching aim of this doctoral dissertation is to explore social workers’ attitudes and knowledge utilization regarding EBP, using a theoretical basis that draws on the multicomponent model of attitude and the theory of planned behaviour as a framework to understand the formation of attitudes and behavioural change. The dissertation employs an explanatory sequential mixed-methods approach; first, quantitative data were collected and analysed, and then qualitative data were collected and analysed to elaborate the quantitative findings. The quantitative data consist of survey data from 2060 social workers registered as members of the Norwegian Union of Social Educators and Social Workers and from 114 social work students. The qualitative data consist of 30 interviews with 25 social workers and five managers in social services and child welfare services. The dissertation comprises four empirical studies responding to three empirical research questions. Study I examined social workers’ attitudes towards and utilization of EBP, as well as what factors predict EBP behaviour. The quantitative data consisted of survey data from 2060 Norwegian social workers. The results indicate that social workers in child welfare are generally less critical of EBP than those within social welfare, and that knowledge about EBP is a predictor of less critical attitudes. Additionally, the findings suggest that social workers who use manuals and standardized procedures are less critical of EBP. These findings highlight the importance of educational training that is specifically targeted at learning the EBP process. Study II further explored social workers’ and managers’ EBP attitudes and utilization of knowledge in practice, identifying benefits and barriers for practicing EBP behaviour. The data consisted of 30 qualitative interviews with social workers and managers in social welfare and child welfare services. The results reveal that the social workers and managers demonstrated positive attitudes toward EBP, although they lacked knowledge and were confused about the concept. Five barriers to EBP were identified: (i) concerns regarding a negative impact on the relationship with the client, (ii) lack of time, (iii) a top-down implementation approach, (iv) restriction of social workers’ autonomous decision-making, and (v) EBP models not always suiting the client’s/family’s need. These findings demonstrate the importance of understanding implementation strategies of EBP, such as actively engaging the social worker in the implementation process. Study III employed a mixed-methods approach examining social workers’ use of knowledge in practice, and which sources of knowledge are most frequently employed. The data consisted of survey data from 2060 social workers and 30 qualitative interviews with social workers in social welfare and child welfare. The quantitative results revealed that the three most common sources of knowledge among the social workers in this study were clients, work experience, and colleagues. Similarly, the qualitative data revealed that the social workers’ most common sources of knowledge were professional experience, colleagues, supervisors, and clients. The results highlight the importance of teaching social workers to critically appraise research in order to utilize the EBP process. Study IV examined social work and child welfare students’ attitudes toward research- supported treatments (RST). The quantitative data consisted of survey data from 114 social work students from bachelor’s and master’s programs in social work and in child welfare. The findings suggest that master students are more positive towards RSTs compared to bachelor students. Those with less educational training in EBP were associated with more sceptical attitudes towards the concept, suggesting that educational training in EBP contributes to facilitating positive attitudes toward RSTs. These findings indicate that there is a need to emphasize EBP in social work education to facilitate positive attitudes and practices, and a need to teach social work students to critically appraise research. This dissertation provides new insights and knowledge in this area of EBP, and demonstrates the importance of fostering social workers’ knowledge about the EBP process in order to strengthen the relationship between theory and practice. There is a lack of organizational support for implementing EBP, and managerial support is central in facilitating EBP behaviour. However, confusion and misrepresentations surrounding the concept are still apparent in the social sector. These findings demonstrate the importance of EBP education to increase social workers’ familiarity with the concept. In terms of the theory of planned behaviour, an important aspect of teaching EBP should entail teaching critical appraisal of research evidence to improve students’ readiness and EBP attitudes. The findings have implications for future practices, as they argue for the importance of utilizing research and evidence in practice and education as well as emphasizing the rationale for how this subject is integrated with current practice.
... Research indicates that some pantheoretical elements found in different effective psychotherapeutic models-called "common factors"-can offer psychotherapists a focusing point to maximize their effectiveness, regardless of their chosen approach (Ahn & Wampold, 2001;Drisko, 2004). According to Wampold and Imel (2015), psychotherapy is effective because of the elements that are common among seemingly disparate models. ...
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This study explores how aesthetic relational knowing (ARK), as assessed by the ARK-T scale, is used by psychotherapists of different psychotherapeutic models. The ARK-T, a tool based on Gestalt therapy principles, evaluates three core factors of this therapeutic competence: body awareness, affective empathy, and intuitive resonance. A sample of 158 therapists from various approaches, including Gestalt therapy, cognitive–behavioral, systemic–relational, and psychodynamic models, participated in the study. The results show that while body awareness and affective empathy vary in emphasis, depending on the therapeutic approach, intuitive resonance emerges as a shared competence among therapists across orientations. These findings suggest that ARK, particularly the therapist’s capacity to attune to the client’s emotional and relational dynamics, may be a core component of effective therapy. The study highlights the significance of these relational competences in fostering effective therapeutic outcomes across diverse psychotherapeutic frameworks.
... The paradox of CBT being designated the gold-standard (David et al., 2018) of psychotherapy while many studies continue to a rm Rosenzweig's conclusion that all therapies have similar effects is partially resolved by considering the therapist as the primary determinant of therapeutic e cacy (Drisko, 2004;Lambert, 1989;Wampold, 2001). The skills and knowledge of the individual therapist are critical to the psychotherapy outcome, perhaps more so than any theory-speci c factors (Wampold, 2001(Wampold, , 2015 and there is convincing evidence (Wampold & Imel, 2015) that the most signi cant factors in therapy outcome are the personal characteristics and skills of the therapist (Anestis et al., 2019), while the therapeutic approach often fades to insigni cance. ...
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Psychotherapy researchers have provided an expanding base of evidence that psychotherapy is effective in attenuating numerous psychological problems. Despite the extensive research demonstrating that talking can heal, it is still not precisely clear how it does so. The healing effect of psychotherapy has been attributed to two broad categories of interventions, the common factors and the specific factors. The common factors consist of all therapist actions or attitudes that promote a communicative relationship in which the client feels safe, understood, and validated. These factors are indeed common to all research-based psychotherapies, and any therapy modality that implements these factors tends to be effective. In contrast, specific factors are the interventions specific to therapeutic modalities. Despite extensive research into the specific factors of many therapies, the common factors were found to be at least as important in the therapy efficacy of all major therapeutic approaches. Given their role in therapy outcome, it would be beneficial to determine which common factors play the greatest role in therapy efficacy. Since most common factors are therapist attributes, this study explored which therapist attributes are preferred by clients. An online survey was conducted using a sample of 1011 North Americans who were questioned about their preferences. Psychotherapy clients preferred psychotherapists with empathic and emotional attributes, in addition to therapists with knowledge of neuroscience, personality psychology, and physiology. However, some groups, particularly those traditionally marginalized, seem to be even more sensitive to common factors, requiring therapists who are exceptionally empathic and able to sympathize with clients.
... The latter aspect of motivation also emerged as a facilitating factor regardless of the therapist's clinical approach (cf. Drisko, 2004). In addition to noting an initial difficulty in engaging in VP work, clinicians also articulated a difficulty on the closure side of therapy: The flexibility of the setting was, in fact, portrayed as a quality that postpones termination. ...
Preprint
Background. The exponential growth of videoconferencing psychotherapy (VP) due to pandemic restrictions has required a more specific conceptualization of the therapeutic relationship in VP. We, therefore, investigated the nature of the therapeutic relationship in VP from the clinicians’ perspective. Methods. We conducted three focus groups with 27 VP therapists of different orientations through a semi-structured interview focusing on their experience of the therapeutic relationship in VP. Data analysis relied on inductive thematic analysis. Results. Results comprised the following themes: construction and management of the online setting, meaning construction of the request for help and the therapeutic process, patient and therapist involvement in the online relationship, new elements of the therapeutic relationship introduced by VP, nonverbal aspects and corporeality in VP, differences in the quality of the emotional and relational level of VP, treatment satisfaction and drop-out, and personal characteristics of the patient and therapist that influence VP. Conclusion. These results suggest that the therapeutic relationship in VP has some specific features that distinguish it from the therapeutic relationship in face-to-face psychotherapy. Future research should consider this specificity to more adequately investigate the therapeutic relationship in VP, for example, through the development of specific measures or by investigating it with reference to different therapeutic approaches.
... The elements of the massage encounter and its associated 'culture of care' describe the interconnected and complex web of participation between the healer, the patient, and the environment (Sayre-Adams & Wright, 1995); this represents a whole system of massage care (Verhoef et al., 2005b) which it has been proposed may enhance healing by increasing the "capacity of the organism to heal itself" (Walach, 2001, p. 217). These factors may be some of the critical components i.e. common factors of the treatment (Moyer et al., 2004) or core sources of therapeutic change (Drisko, 2004), and provide insight into the non-specific effects of massage treatment. As the quality of the therapeutic encounter was a key feature in satisfaction of homeopathy clients (McIntosh & Ogunbanjo, 2008), the valued elements of the massage therapy encounter described in this section could provide a useful framework for devising an instrument for assessing patient satisfaction with massage care. ...
Thesis
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Background The use of massage therapy, a complementary and alternative medicine modality, is widespread and growing. However, little is known about why consumers choose and continue to use massage therapy, in most cases at their own expense. In addition, the characteristics of the therapeutic encounter and outcomes that provide satisfaction to the client, and encourage them to return for further treatment are unknown. Aims and objectives The purpose of this thesis was to determine why repeat users of massage therapy use and choose massage therapy, and investigate what they value in the therapeutic interaction and outcomes to return to massage therapy. The primary aim was to investigate: (1) the elements of the therapeutic encounter that are valued by clients and therapists; the importance and influence of comfort, contact, connection, and caring within a massage therapy session; and the importance of health outcomes for massage therapy clients; and (2) explore the drivers for why people continue to seek or reinitiate massage therapy. As a precursor to this, the utilisation and practice patterns of massage therapy in New Zealand by qualified massage therapists were investigated. Methods A two-phase, sequential mixed methods approach was adopted. Initially, a qualitative approach was used. Two telephone focus groups (n = 16) were conducted with providers (massage therapists) and three telephone focus groups (n = 19) were conducted with repeat users (clients) of either relaxation, remedial or sports massage services. Subsequently, themes were used to develop two specifically designed questionnaires. Practising members of Massage New Zealand (MNZ) (massage therapists: n = 66) and their clients (n = 646) were sampled. Results Focus group findings identified six valued elements of the culture of massage therapy care as well as four key drivers for repeat use of massage therapy. The survey response rate was 71.7% (n = 92) for massage therapists and 57.4% (646/1125) for massage clients. The survey of therapists highlighted a number of practice patterns: most therapists are female, NZ European, and hold a massage diploma; and massage therapy was both a full and part time occupation. The majority of massage therapists practised solo but used a wide and active referral network, and commonly used therapeutic / remedial / deep tissue, relaxation, neuromuscular therapy, and sports massage techniques. Common issues or conditions for which massage therapy was used by clients were neck / shoulder pain/problem, relaxation and stress reduction, back pain/problem, and regular recovery or maintenance massage. The essence of massage therapy involved a client-centred partnership approach to massage care, modulated by comfort, contact, connection, and caring. Drivers for returning to, or continuing with massage therapy were a regular appointment, positive expectation, positive experience and positive outcome. Data were used to build a descriptive model of the valued elements of massage therapy encounter: purposeful, participatory, process factors, person centered partnership, and product categories were highlighted. Conclusions This thesis provides an informative insight into the practice and repeat utilisation of massage therapy by MNZ therapists and their clients. Furthermore, the description of and insight into the massage therapy encounter highlights elements of process, product, and the therapeutic relationship in massage therapy. These make an original contribution to the literature on massage therapy and provide the foundation and direction for subsequent studies.
... However, CBT's recent adoption of mindfulness and emergent evidence of the quantifiable influence of the therapeutic alliance on the efficacy of psychological treatments (Goldsmith, Lewis, Dunn & Bentall, 2015) suggest that a wider range of psychotherapies could be useful for those experiencing psychological trauma. Indeed, given the common factors theory (Drisko, 2004) that views most therapies as sharing effective characteristics rather than any one approach having uniquely superior procedures, the case for exploring treatment options for trauma is evident. ...
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The intergenerational impact of psychological trauma and the repercussions that trauma can have upon an entire family system suggests individual therapy alone may be insufficient. The aim of this paper is to critically examine the Family Constellation Therapy approach as a potential therapy option for responding to intergenerational trauma. This paper initially discusses the challenges of responding to trauma and then describes Family Constellation Therapy within a practice context. The underpinning philosophy of the therapy is also forwarded. To establish the potential worth of the approach, this paper then reports on the findings from a narrative review of the international peer reviewed literature on Family Constellation Therapy, following with a discussion on its application to intergenerational trauma. The limited evidence available suggests there is worth in integrating Family Constellation Therapy into other therapeutic approaches. There is also a clear need for creating a wider and deeper evidence base for Family Constellation Therapy.
... For å oppnå dette må ytterligere variabler kontrolleres, og funn bør støttes av eksperimentell forskning og et støttende teoretisk rammeverk. Til tross for at fellesfaktortilnaermingen er sjeldnere omtalt og undersøkt i sosialt arbeids litteratur (Drisko, 2004), har kjerneprinsipper i fellesfaktortilnaermingen som «allianse», «aksept», «empati» osv. overførbarhet til sosialt arbeids praksis (Cameron & Keenan, 2010) og er viktige elementer i eksisterende intervensjoner i sosialt arbeid. ...
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Blant forskere og praktikere har det de siste tiårene vært et økende søkelys på evidensbasert praksis (EBP) i sosialt arbeid. EBP vært gjenstand for omfattende kritikk, blant annet har forskere og sosialarbeidere hevdet at det tilhører positivistiske tradisjoner, og utgjør en trussel mot tradisjoner i sosialt arbeid. Dette har ført til forvirring, misforståelser og barrierer for implementeringen av modellen. EBP har også vært gjenstand for nytolkninger i implementeringsøyemed. I denne artikkelen redegjør vi for to overordnede tolkninger av evidensbasert praksis: den kritiske vurderingstilnærmingen og retningslinjetilnærmingen. Den kritiske vurderingstilnærmingen forutsetter at sosialarbeidere skal kritisk vurdere best tilgjengelig forskningskunnskap og inkorporere denne kunnskapen med sin praksisutøvelse, samtidig som de ivaretar klientenes verdier og preferanser. Tilhengere av retningslinjetilnærmingen mener at kritisk vurdering av forskning i hovedsak bør overlates til eksperter på området. I denne artikkelen redegjør vi for forståelser og fortolkninger av EBP-modellen, presenterer vitenskapsteoretisk kritikk av de to tilnærmingene og diskuterer hvilken innflytelse de kan ha på sosialt arbeids praksis.
... This advantage was accepted against the disadvantage of a possible investigator effect. Since many therapy studies suggest effects of therapists particularly with regard to their attachment styles and quality, 63 the apparent limitation can be interpreted as a methodological and clinical strength. ...
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Chapter
An important variable relating to both the course and outcome of psychotherapy involves the patient and the characteristics he or she brings into the therapeutic situation. Past research in this area has attempted to relate patient variables such as motivation, expectancies, demographic characteristics, diagnosis, severity of maladjustment, and personality traits to continuation in therapy, therapy outcome, and in-therapy patient behavior.