Relationship factors and outcome in brief group psychotherapy for depression

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Relationship factors such as a psychotherapy group's cohesion and interpersonal climate have been touted as being analogous to the therapist-client alliance in individual psychotherapy, and as such should predict treatment outcome. However, predicting and explaining contributors to outcome in group psychotherapy remains unclear. This series of studies examined therapist-client alliance, group cohesion and climate, self-other differentiation processes (using a repertory grid method) and mastery of Core Conflictual Relationship Themes (CCRT) in brief dynamic group therapy for depression. These studies also integrated qualitative-phenomenological and clinical-quantitative research methodologies to examine in detail significant helpful and hindering psychotherapy events. It was found that therapeutic alliance is not analogous with group cohesion, but is associated with group member's engagement in therapeutic tasks. Perceived levels of conflict and group developmental processes helped explain the dimensions of cohesion. How group members defined themselves in relation to others meaningfully changed over therapy. Changes in perceived conflict in the group, and an individual's mastery of their CCRT patterns predicted outcome. In particular, through the experience of telling their stories, clients were able to change their responses to conflicts both within the group and in their wider interpersonal circle.

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This article provides commentary on Saul Rosenzweig's classic 1936 paper, "Some Implicit Common Factors in Diverse Methods of Psychotherapy," with particular emphasis on his clever and prophetic invocation of the dodo bird verdict from Alice in Wonderland. The impact of this seminal contri- bution is discussed by a comparison of Rosenzweig's original common fac- tors proposal with modern formulations of common factors. The paradox inherent to the tenacious veracity of the dodo bird verdict and the pursuit of empirically validated treatments are explored. In the spirit of Rosenzweig's legacy and the wisdom of the dodo, this article suggests that psychotherapy abandon the empirically bankrupt pursuit of prescriptive interventions for specific disorders based on a medical model of psychopathology. Instead, a call is made for a systematic application of the common factors based on a relational model of client competence.
Four key areas of research work are identified: efficacy, effectiveness, practice, and service system. These research areas are placed within the paradigms of evidence-based practice and practice-based evidence. This article provides an introduction to these two paradigms and these four research areas together with examples of current work. From this basis, we argue for a knowledge base for the psychological therapies in which each area has a place within an overall research model and in which the interdependence of each area on the others is acknowledged. A cyclical model exemplifying the complementary relationship between evidence-based practice and practice-based evidence is presented as a means for furthering the delivery of a rigorous but relevant knowledge base for the psychological therapies. Copyright © 2003 John Wiley & Sons, Ltd.