No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
A new therapy for each patient: Evidence‐based relationships and responsiveness
Abstract
In this study, we introduce the journal issue devoted to evidence‐based responsiveness and frame it within the work of the third interdivisional APA Task Force on Evidence‐Based Relationships and Responsiveness. We summarize the meta‐analytic results and clinical practices on the adaptations of psychotherapy to multiple transdiagnostic characteristics of the patient, including attachment style, culture (race/ethnicity), gender identity, coping style, therapy preferences, reactance level, religion and spirituality, sexual orientation, and stages of change. We then discuss the clinical and research process of determining what works, and what does not work, for whom. The limitations of the Task Force’s work are outlined and frequently asked questions are addressed. The article closes with the Task Force’s formal conclusions and 28 recommendations and with some reflections on fitting psychotherapy to the individual client.
... However, different treatment methods might differ in their effectiveness for different subgroups of patients with specific characteristics (aptitude-treatment-interaction; Cronbach & Snow, 1977). 'What works for whom?' is the well-known question in psychotherapy research that aims to tailor a treatment to the individual needs and characteristics of a patient and the idiosyncrasies of their context (Norcross & Wampold, 2018). For which patients might we reasonably expect GIP to be more effective than the already evidence-based psychodynamic therapies? ...
... Several researchers question whether ICD/DSM disorders by themselves can serve as meaningful indicators for or against the use of a given treatment (e.g. Dimidjian, 2019;Norcross & Wampold, 2018). Recent studies point to a trend away from traditional single-moderator studies towards an investigation of multiple patient characteristics (demographics, diagnostics, personality) to find subgroups of patients that respond to a treatment method in a similar way (e.g. ...
... This suggests that it might not be as important to choose a specific therapy per se, but rather to find the approach which matches the patient best. This finding further speaks for a personalization of therapy which is already starting to take place (Norcross & Wampold, 2018). ...
Guided imagery psychotherapy (GIP) is an established therapeutic method using creative mental imagery within a psychodynamic frame of reference. Although there is evidence for the method’s general effectiveness, it is yet unclear under which conditions and for which patients it should be used. The aim of this study was therefore to empirically identify indication criteria for the use of guided affective imagery (GAI) as part of psychodynamic therapies. We conducted semi-structured interviews with N=15 psychodynamic therapists also qualified as GAI training therapists. We asked them to recollect cases in which they had decided either for or against the use of imagery. The therapists described a complex interplay of different factors. Using grounded theory coding supplemented by elements of Consensual Qualitative Research we reconstructed from their accounts a sequential model of their indicative decisions. First, there is a consideration of clear contraindications related to reality testing and destructiveness. Second, there are aspects requiring a modified application of GAI such as emotional instability and post-traumatic stress disorder symptoms. In a final step, there are a number of characteristics of the patient, the therapist, the therapeutic relationship, the patients’ initial imagery and different therapeutic goals and foci which are weighed relatively to each other in order for therapists to reach an indication decision. We end by discussing ways in which the indicative decision model may be used to improve GAI training as well as the method’s differential efficacy and effectiveness.
... We agree with many authors (e.g. Duncan et al., 2010;Norcross & Lambert, 2018, 2019Norcross & Wampold, 2018, 2019 who believe that the theory of common factors and the "contextual model" based on it (Wampold & Imel, 2015) represent a qualitative new level of synthesis of scientific findings that can significantly help answer the question of how psychotherapy works. The empirically supported contextual model is increasingly gaining ground in psychotherapy and other conversational forms of help as more appropriate than the medical model on which Empirically Supported Treatments (EST) and Evidence Based Practices (EBP) are based. ...
... Nekateri avtorji (npr. Duncan, Miller, Wampold in Hubble, 2010;Wampold in Imel, 2015;Norcross in Lambert, 2018, 2019Norcross in Wampold, 2018, 2019 namreč predlagajo, da namesto nadaljnjih poskusov dokazovanja, da lahko določen pristop zaradi specifičnih dejavnikov zasenči drugega (kar bi sistemski psihoterapevti imenovali strategijo "več istega", glej Watzlawick, 1994), bi ravno skupni dejavniki lahko omogočili novo smer razvoja PDP. Drugi avtorji (npr. ...
... Soglašava s številnimi avtorji (npr. Duncan in dr., 2010;Norcross in Lambert, 2018, 2019Norcross in Wampold, 2018, 2019, ki menijo, da teorija skupnih dejavnikov in na njej temelječi "kontekstualni model" (Wampold in Imel, 2015) predstavljata kvalitativno novo raven sinteze znanstvenih izsledkov, ki lahko bistveno pripomore k odgovarjanju na vprašanje, kako psihoterapija deluje. Empirično podprti kontekstualni model se na področju psihoterapije in drugih pogovornih oblik pomoči vse bolj uveljavlja kot ustreznejši od medicinskega modela, na katerem temeljijo empirično podprte terapije (angl. ...
Teorija skupnih dejavnikov temelji na izsledkih raziskav, da k učinkovitosti psihoterapije prispevajo predvsem značilnosti, ki so skupne vsem psihoterapevtskim pristopom, kar velja tudi za partnersko in družinsko psihoterapijo (PDP). Potem ko opiševa razloge za relativno prezrtost teorije skupnih dejavnikov v zgodovinskem razvoju PDP, prikaževa širše in ožje konceptualizacije skupnih dejavnikov v PDP ter opiševa skupne dejavnike, ki so v primerjavi z individualno terapijo za PDP edinstveni. Ob navedbi glavnih kritik na račun teorije skupnih dejavnikov na področju PDP hkrati opozoriva, na katerih točkah je ta kritika neutemeljena. Zavzemava se za preseganje polarizacije med zagovor-niki specifičnih in skupnih dejavnikov, saj kontekstualni model, ki je nastal na podlagi teorije skupnih dejavnikov, vključuje tudi specifične dejavnike. Potem ko opiševa pomen teorije skupnih dejavnikov za izobraževanje iz psihoterapije nasploh in iz PDP, zaključiva s ključnimi vodili za partnerske in družinske terapevte, ki izhajajo iz teorije skupnih dejavnikov.
... Como será demonstrado neste trabalho, desde os anos 2000 percebe-se um enfraquecimento da valorização dos fatores específicos e um consequente enaltecimento dos fatores humanos e relacionais -os fatores comuns -como elementos que propiciam resultados terapêuticos mais efetivos (Elkins, 2019;Norcross & Lambert, 2018;Norcross & Wampold, 2018;Wampold, 2015). Em consequência dessa mudança de foco, a preocupação com as habilidades terapêuticas interpessoais passou a ser um importante eixo de pesquisa e treinamento de novos profissionais da psicologia (Barrett-Lennard, 2015;Parrow et al., 2019). ...
... Segundo Hoffman et al. (2015), até há bem pouco tempo, os métodos específicos de avaliação psicoterápica que objetivavam evidenciar a eficácia da prática da psicoterapia estavam muito associados à investigação de técnicas específicas para transtornos específicos; ou seja, durante um longo tempo a preocupação com o tipo de técnica que funciona para qual paciente foi o foco central das investigações em psicoterapia. Na virada dos anos 1990 para os anos 2000, essa ênfase na técnica enfraqueceu; percebeu-se que não são os fatores específicos que determinam bons desfechos psicoterápicos, mas sim os fatores comuns (humanos e relacionais) que levam o tratamento a resultados efetivos (Elkins 2019;Jardim et al., 2009;Norcross & Lambert, 2018;Norcross & Wampold, 2018;Wampold, 2015). ...
... Desde a publicação desses documentos, há pouco questionamento sobre a afirmação de que os fatores humanos e relacionais são mais capazes de influenciar os resultados clínicos em psicoterapia se comparados aos fatores específicos (Mourato, 2019;Norcross & Wampold, 2018;Norcross & Lambert, 2018;Wampold, 2015). Segundo Mourato (2019) e Pieta e Gomes (2017), é inegável a associação positiva entre a qualidade da relação terapêutica e os benefícios para a psicoterapia; entretanto, "as técnicas específicas de cada abordagem têm um impacto consideravelmente menor nos resultados psicoterapêuticos, representando cerca de 15%, o que reforça a ideia de que os fatores comuns poderão explicar melhor estes resultados" (Mourato, 2019 p. 14). ...
Abstract
Interpersonal expertise is one of the central elements of clinical expertise
for evidence-based practice in psychology. Recent research shows a greater appreciation of the relational factors involved in the psychotherapeutic process, such
as, the value currently given to empathic understanding as a facilitator of psychotherapy. This work aims to demonstrate the existence of a convergence between
the Rogerian assumptions and these recent evidences. To this end, it is proposed
to analyze this confluence based on the resumption of the necessary conditions
for psychotherapy postulated by Carl Rogers, as detailed in three elements that
involve the complexity of interpersonal therapeutic skills: the person of the therapist; the way the client perceives the therapist’s attitudes; and the therapeutic relationship per se. Finally, it points to the potential of the humanistic approach and
mainly of Rogerian assumptions, which show a proposal of alterity and dialogicity for the psychotherapeutic process, for understanding and effecting relational
factors in clinical practice, as newly endorsed even by the most recent scientific
evidence of effectiveness in psychotherapy, present in the latest recommendations
of the APA, valid, therefore, for the entire psychological clinic, regardless of the
theoretical approach of choice of the therapist.
Keywords: interpersonal therapeutic expertise; evidence-based practice in psychology;
clinical expertise
... V okviru Ameriškega psihološkega združenja je bila ustanovljena poseb na skupina (Interdivisional APA Task Force on EvidenceBased Relati onships and Responsiveness), katere naloga je bila identificirati učinkovite sestavine terapevtskega odnosa (Norcross in Wampold, 2018). Namen sku pine je bil obenem odkriti učinkovite metode dela v terapevtskem odnosu, ki jih prilagodimo posameznemu pacientu na podlagi njegovih transdia gnostičnih značilnosti. ...
... Povzetek pregleda raziskav učinkovitih elementov psihoterapevtskega od nosa kaže, da so dokazano učinkoviti (Norcross in Wampold, 2018): ...
... Kot obetavne kvalitete oziroma sestavine delovnega odnosa, ki jih je tre ba še podrobneje raziskati, pa avtorji navajajo samorazkritje terapevta in povratne informacije klientu, kako ga terapevt doživlja v danem trenutku (angl. immediacy) (Norcross in Wampold, 2018). ...
Monografija Raziskovanje v psihoterapiji in integracija psihoterapevtskih pristopov podaja podrocni pregled raziskovanja in integracije v psihoterapiji. Avtorja v monografiji obravnavata metode psihoterapevtskega raziskovanja, raziskave ucinkovitosti in izidov psihoterapije ter raziskave procesov psihoterapije. Pri tem se se posebej usmerjata na podrocje skupnih faktorjev psihoterapije, ki predstavlja osnovo za integracijo psihoterapevtskih pristopov. Osredotocata se na pomemben premik v paradigmi raziskovanja psihoterapije, ki se namesto raziskovanja ucinkovitosti posameznih smeri psihoterapije usmerja na raziskovanje principov in procesov, ki so v ozadju razlicnih psihoterapevtskih pristopov. Premik v pradigmi raziskovanja k procesom spremembe je skladen tudi z vse bolj vplivnim gibanjem psihoterapevtske integracije, ki se ukvarja z odprtim raziskovanjem podobnosti in razlik med razlicnimi psihoterapevtskimi pristopi.
V monografiji je podan pregled gibanja psihoterapevtske integracije od njenih zacetkov do sodobnih pristopov. Avtorja predstavita temeljne sodobne integrativne pristope, ki skusajo na razlicne nacine integrirati spoznanja razlicnih psihoterapevtskih smeri. V zadnjem poglavju se usmerita na raziskave psihoterapevtske integracije in predstavita slovensko raziskavo integrativne psihoterapije, ki jo je izvedla Karmen Urska Modic. Monografija v Sloveniji predstavlja pomembno novost, saj na celosten nacin obravnava raziskovanje in integracijo v psihoterapiji, pomembna pa je tudi mednarodno, saj avtorja predstavita rezultate lastnih raziskav integrativne psihoterapije. /
The monograph Research in Psychotherapy and Integration of Psychotherapy Approaches brings a review of the field of research in psychotherapy and psychotherapy integration. It is focused on research methods in psychotherapy, outcome studies, and process research. The authors focus in particular on the common factors in psychotherapy, which are the basis for psychotherapy integration. They describe an important paradigm shift in the psychotherapy research, which, instead of focusing on the effectiveness of particular psychotherapy approaches, concentrates on the principles and processes of change that underly different psychotherapy schools. This paradigm shift toward the processes of change is congruent with the increasingly influential movement of psychotherapy integration, which is interested in exploring commonalities and differences between different psychotherapy schools.
The book explores the field of psychotherapy integration from its historical roots to its contemporary concepts, identifying the key current integrative approaches that aim to integrate insights from different psychotherapy schools in various ways. The final chapter discusses research in psychotherapy integration and outlines the research on integrative psychotherapy conducted by Karmen Urska Modic. The monograph brings important new insights into the Slovenian field of psychotherapy as it comprehensively discusses research and integration in psychotherapy, while also being important internationally as the authors present their research findings related to integrative psychotherapy.
... Less understood is the relationship between the quality of the therapeutic alliance and perceived treatment helpfulness and its contribution to a recoveryoriented, person-centred approach as recommended in guidelines [23]. In broader psychotherapy contexts, the therapeutic relationship has been found to account for at least as much of client improvement as treatment method selection [24]. In a qualitative metasynthesis, individuals with a lived experience of AN preferred treatments in which the therapist treated them holistically and believed in their ability to re-establish sustainable identities beyond their diagnosis [25]. ...
... Participants had high levels of anxiety (median 13, IQR 10-15) however lower levels of depression (median 7, IQR 4-11). The median EDE-QS score was 21 (IQR [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], which is at a likely clinical level of severity in ED symptomology. All other descriptive statistics for demographic and clinical features of participants are contained within Table 1. ...
Background
Although eating disorders cause significant impairment to an individual’s function, many people disengage from treatment. There is a paucity of literature that focuses on both positive and negative aspects of eating disorder treatment experiences as perceived by the experiencing person. This study aimed to identify the associations between features of therapy with perceived treatment helpfulness across individuals’ most and least helpful treatment experiences.
Methods
An online cross-sectional survey was developed and disseminated, with the data of participants (n = 235) being utilised for statistical analyses, including multiple linear regressions.
Results
As predicted, factors in the therapeutic relationship such as the therapist’s ability to instil a sense of hope, provide freedom of choice, understand the person, and address participant concerns had significant explanatory value in perceived treatment helpfulness. Contrary to our hypothesis, change being retrospectively identified as important or possible by the participant did not have a high degree of relation. These outcomes highlighted the significance of the therapeutic relationship in governing positive treatment experiences and responses. The results also suggested motivation to change when commencing treatment may not be strongly related to perceived treatment helpfulness and support further exploration.
... As research on the importance of the relationship and adapting to client factors continues to grow, the counseling relationship and responsiveness to the client is now considered evidence-based practice (Norcross and Wampold 2019). Norcross and Wampold (2018) indicate adapting to the client's personal and cultural characteristics further expands the possibility of positive outcomes. As we consider the client's characteristics, culture, and preferences, which are all part of providing evidence-based practice, we are being responsive to the client. ...
... As we consider the client's characteristics, culture, and preferences, which are all part of providing evidence-based practice, we are being responsive to the client. Specifically, being "relationally responsive" and adapting treatment for clients are considered evidence-based practices themselves and may account for more of the positive outcome with clients than the treatment (Norcross and Wampold 2018). Further, Hook et al. (2019) found that adapting for spirituality and religion has a strong evidence-base. ...
There is a strong tradition of attention to relationship factors in the field of counseling. The research on the importance of the relationship and adapting to client factors continues to grow, supporting the importance of professional multicultural competence. The field of counseling, specifically within the United States context, has focused on Multicultural Counseling Competencies with more recent emphasis on social justice through the Multicultural and Social Justice Counseling Competencies. Within these competencies, spirituality and religion are mentioned as multicultural components to consider as potentially salient to clients. Yet, there has been less emphasis on ways to adapt counseling to a client’s spirituality and religion compared to other multicultural components of one’s identity, such as race, gender, and culture. Historically, a lack of training, fear of causing offense, or concerns about influencing clients, resulted in clients’ spirituality and religion being overlooked far too often in counseling. Despite this tendency, recent clinical evidence on relational responsiveness identifies the adaptation of counseling to a client’s spirituality and religion as highly effective. In this article, the authors discuss how adapting counseling to a client’s spirituality and religion, in relation to all multicultural factors salient to the client, enhances relational responsiveness and treatment effectiveness. The authors also discuss the implications for training, supervision, and practice.
... Other relational elements, such as congruence and the real relationship, are deemed to be probably effective. Moreover, tailoring the therapy to specific client characteristics enhances the effectiveness of psychological treatment (Gelso et al., 2018;Kolden et al., 2018;Norcross and Lambert, 2018;Norcross and Wampold, 2018). Our findings support these basic tenets and expand understanding by providing concrete descriptions of how the processes and choices are experienced during clinical work with reluctant adolescents. ...
... Our findings address the concept of therapist flexibility, albeit within locally specified boundaries. Therapist flexibility is not necessarily a good thing in itself, but it can be vital for good outcomes when used judiciously (Norcross and Wampold, 2018). Kendall and colleagues attempted to integrate this knowledge and bridge the gap between manualized treatment and therapist responsiveness using the phrase "flexibility within fidelity" (Kendall et al., 2008;Kendall and Frank, 2018). ...
Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task.
Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process.
Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements . The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – “You are not trapped here”; Sharing definitional power – “What does it look like to you?”; Practicing transparency – “I want you to know what I see”; and Tailoring as ideal – “I will design this therapy for you.”
Implication and conclusion: Therapists want to understand their adolescent clients’ position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment.
... This finding is in line with previous research, indicating that especially reasons reflecting the perceived ability of the treatment to work seem to be important drivers underlying this preference (Etingen et al., 2020). Our findings support research approaches that stress that a "one size fits all" approach to therapy does not adequately consider individual patient needs and thus might diminish therapeutic success (Cloitre, 2015;Norcross and Wampold, 2018). To conclude, our study expands the existing literature on the treatment preferences of PTSD patients and highlights the need for patient-centered care, which includes informing patients about different treatment options. ...
... For a better match between patient needs and evidence-based practice, it might be beneficial to inform patients about their general treatment options. Forward-looking, our results underscore the importance of the recommendations by Norcross and Wampold (2018), who suggested tailoring psychotherapy to the patient and his or her wishes, not only to the disorder, which is especially viable in PTSD treatment, as different treatment options have been proven to be effective (Watts et al., 2013). However, incorporating patients' treatment preferences into clinical practice will raise new challenges for clinicians that also need be considered in the future (Légaré and Thompson-Leduc, 2014). ...
Several psychotherapy treatments exist for posttraumatic stress disorder. This study examines the treatment preferences of treatment-seeking traumatized adults in Germany and investigates the reasons for their treatment choices. Preferences for prolonged exposure, cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), psychodynamic psychotherapy and stabilization were assessed via an online survey. Reasons for preferences were analyzed by means of thematic coding by two independent rates. 104 traumatized adults completed the survey. Prolonged exposure and CBT were each preferred by nearly 30%, and EMDR and psychodynamic psychotherapy were preferred by nearly 20%. Stabilization was significantly less preferred than all other options, by only 4%. Significantly higher proportions of patients were disinclined to choose EMDR and stabilization. Patients who preferred psychodynamic psychotherapy were significantly older than those who preferred CBT. Reasons underlying preferences included the perceived treatment mechanisms and treatment efficacy. Traumatized patients vary in their treatment preferences. Preference assessments may help clinicians comprehensively address patients' individual needs and thus improve therapy outcomes.
... Although the technique used had traditionally been considered to have the main responsibility for the healing process (Critelli and Neumann, 1984), research on psychotherapeutic effectiveness has shown that the common variables are that which explains the greatest percentage of therapeutic change. These common variables may be related to: the patient (expectations of healing and faith in the therapist, etc.); the therapist (empathy displayed and listening skills, etc.); and the therapeutic interaction (therapeutic alliance) (Nathan et al., 2000;Wampold, 2001;Lambert and Ogles, 2004;Cuijpers et al., 2012;Norcross and Wampold, 2018;Sommers-Flanagan and Sommers-Flanagan, 2018;Eubanks and Goldfried, 2019). ...
Background: The aim of this manuscript is to analyze the degrees of responsibility for healing that psychotherapists attribute to a set of emotional variables of the therapist involved in the therapeutic process. Such variables, framed within the well-known common factors in psychotherapy, have been proven to be essential in making the therapeutic process effective, as has been shown by research in psychotherapy in recent decades.
Materials and Methods: Based on an extensive literature review, the responses from a sample of 69 psychotherapists to a tool created ad hoc are analyzed to verify whether their attributions are in line with the results of said review.
Results: The therapists have doubts about the factors responsible for psychotherapeutic effectiveness, as well as about the value of common variables, including those of an emotional nature, not valuing them above those of a specific type. They also argue against the similar effectiveness of different psychotherapeutic models.
Conclusion: Discrepancies have thus been found between the conclusions reached by research on therapeutic processes and the statements made by the therapists studied, which could indicate an insufficient impact of psychotherapeutic research on clinical practice. We also propose courses of action such as establishing training programs for the acquisition and development of emotional skills for therapists that could increase the effectiveness of their interventions.
... We agree with many authors (e.g. Duncan et al., 2010;Norcross & Lambert, 2018Norcross & Wampold, 2018 who believe that the theory of common factors and the "contextual model" based on it (Wampold & Imel, 2015) represent a qualitative new level of synthesis of scientific findings that can significantly help answer the question of how psychotherapy works. The empirically supported contextual model is increasingly gaining ground in psychotherapy and other conversational forms of help as more appropriate than the medical model on which Empirically Supported Treatments (EST) and Evidence Based Practices (EBP) are based. ...
The common factors theory is based on the findings of studies claiming that characteristics common to all psychotherapeutic approaches account for most of the effectiveness of psychotherapy, which also applies to couple and family therapy (CFT). After describing the reasons for the relative neglect of common factors theory in the historical development of CFT, we present broad and narrow conceptualisations of common factors in CFT, and describe common factors that are unique to CFT compared with individual therapy. Citing the main criticisms of common factors theory in the field of CFT, we identify those elements of the criticism that are unfounded. We strive to overcome the polarisation between the advocates of specific and common factors, since the contextual model that was created on the basis of the common factors theory also includes specific factors. After describing the importance of common factors theory for education in psychotherapy in general as well as in CFT, we conclude with key guidelines for CF therapists based on common factors theory.
... Si plusieurs items ne sont pas ressortis comme significatifs, il apparaît cependant important que l'item sur le sentiment d'impuissance ait, lui, obtenu une certaine significativité statistique, suggé rant que l'é valuation par le thé rapeute de son degré de sentiment d'impuissance pourrait contribuer à l'é valuation de l'amé lioration de l'é tat clinique du patient. Ces ré sultats vont dans le sens d'une ré cente mé ta-analyse qui situait la gestion du contre-transfert comme un dé terminant « probablement » efficace des psychothé rapies [32]. ...
Résumé
Les psychothérapies psychodynamiques font l’objet d’un regain d’intérêt dans le traitement de la dépression, mais les études d’efficacité des thérapies psychanalytiques et psychodynamiques de groupe sont encore peu nombreuses. Notre article consiste en une évaluation quantitative des effets d’une intervention psychodynamique brève en groupe de thérapeute menée sur une cohorte de 32 patients volontaires. Les résultats montrent une amélioration significative de l’intensité dépressive et en particulier une plus grande capacité d’initiative du patient, à laquelle correspond un contre-transfert plus positif et plus engagé de la part des thérapeutes. Nous proposons une hypothèse explicative pour discuter nos résultats : l’intervention psychodynamique brève permettrait, par l’augmentation de l’insight, un « dégel » de l’activité psychique et motrice du patient, résultant en une sortie de la crise dépressive au profit de la reprise d’un travail thérapeutique individuel.
... therapeutic relationship (Norcross & Wampold, 2018), and the therapist (Kim et al., 2006;Lutz et al., 2007;Nissen-Lie et al., 2013;Wampold & Brown, 2005). ...
Scholars note that therapist performance is one of many factors that contribute to client treatment outcomes. Given that the performance of therapists matters, researchers have identified several methods and models for improving therapist effectiveness. However, scholars have yet to explore highly effective therapists' perspectives on their motivation to develop, the methods they use, and the impact of their efforts to develop. The present study used a consensual qualitative research (Hill & Knox, 2021) approach to explore dynamics underlying therapist development of expertise. Semistructured interviews were conducted with 12 therapists whose outcome data placed them in the top 25% of clinicians of their respective clinics, according to their supervisors. The researchers reached consensus at each stage of analysis as they organized data into domains, core ideas, and cross-analysis. Domains and corresponding subdomains were: (a) struggle with personal, external, and response to barriers subdomains, (b) therapist characteristics with striving, presence, skills, and values subdomains, and (c) development with early career, formal, feedback, relational, personal/identity subdomains. Implications for practice and areas for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Thus, a large body of research emerging worldwide establishes that various aspects of the therapeutic alliance correlate positively with treatment outcomes [33,34]. Thus, developing a close patient-therapist bond is considered a crucial component of successful psychotherapy [35][36][37][38][39][40][41]. ...
In recent decades, the study of psychotherapy effectiveness has been one of the pillars of clinical research because of its implication for therapeutic cure. However, although many studies have focused their interest on the patient’s perception, there are no instruments oriented to the study of psychotherapists’ attributions of effectiveness: to what factors psychotherapists attribute responsibility for the cure of the therapies they provide. The present study aimed to develop and validate an instrument for assessing the attribution of the effectiveness of psychotherapy in a population of 69 psychotherapists of different theoretical orientations. After an initial process of inter-judge content validation, 12 items were selected for validation in the targeted population, adequately fulfilling the quality requirements in the validity–reliability tests, and grouped into four factors after principal component analysis. These factors were as follows: (1) therapeutic alliance enhancers; (2) psychotherapist emotional characteristics; (3) therapy-specific variables; and (4) facilitators of patient engagement with therapy. This four-factor structure also showed a good fit for the fit indices checked in confirmatory factor analysis. In summary, we can conclude that the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) developed in our research can be helpful if tested on a larger number of individuals. The results can be replicated in other populations of psychotherapists.
... By apprehending and accounting for individual differences in patients/clients, we may be better able to determine therapy readiness, type of therapeutic modality, clinician fit, and therapeutic outcomes (Cozen et al., 2016). Furthermore, in obtaining more nuanced information about individual characteristics and background variables, the mandate for individualizing therapy to optimize treatment efficacy-an endeavor the research demonstrably supports (Norcross & Wampold, 2018)-can be better implemented. Such a methodology can make significant contributions to the broader mental health field by allowing clinicians to better assess the depth of their psychotherapeutic work. ...
Transformative learning (TL) goals are becoming commonplace in higher education, continuing education, and other adult learning contexts; however, valid and reliable assessments of TL are not so common. This imbalance begs the development of assessment methods that allow for a deeper understanding of how, when, and why deep reshaping of self takes place. We believe the Beliefs, Events, and Values Inventory (BEVI) to be an effective quantitative measure of TL based on the alignment of its scales with constructs identified by Hoggan’s meta-analysis of TL research. In this article, we summarize the theoretical crosswalk between Hoggan and the BEVI, offer statistical evidence of construct validity for the BEVI as a measure of TL, and provide guidance for interpreting TL scores. We discuss implications of this methodology for higher education as well as other adult learning contexts such as mental health and wellness.
... Considering the research on alexithymia and the outcome and process research on psychotherapy (e.g., [46]), some considerations can be made regarding better ways to address alexithymia in psychotherapy. The following suggested guidelines are based on the accumulated empirical research. ...
Despite being a longstanding and well-established concept, alexithymia is unfamiliar for many clinicians. This paper aims to address the alexithymia concept from a clinical perspective based on a review of the research on alexithymia intervention. Several strategies are proposed to help clinicians better work with alexithymic clients in psychotherapy. Alexithymia assessment, its impact on the therapeutic alliance, and the difficulties in emotional tasks are highlighted points. Considering alexithymia will inform clinicians’ current diagnosis and conceptualization and provide specific targets and venues for intervention, increasing the effectiveness of psychotherapy.
... These results not only represent benefits on a personal level but also indirectly benefit patients through improvement in the therapeutic alliance (McCollum & Gehart, 2010;Razzaque et al., 2015). It must be highlighted that a therapeutic alliance is a significant predictor of the user's recovery (Priebe et al., 2011) and could be more effective than the type of intervention in any psychotherapy model (Norcross & Wampold, 2018). ...
... Methodology within future studies could be well served to include mixed-methods design, including qualitative components assessing how well responses align with current research on individualized approaches. This choice of methodology could be informed by the work of Norcross and Wampold (2018), who described how individual differences, cultural disparities, and client preferences mean that it is not appropriate for clinicians to apply a universal approach to treatment. ...
Examining trends in mental health services through periodic surveys can provide a useful overview of a variety of data that can supply researchers, administrators, and practitioners with information that contributes to the building of theoretical frameworks, the creation of practical operating models, and the means to address overarching problems in the field. We collected data on the demographic, professional, and clinical characteristics of a random sample of 205 counselors at U.S. university counseling centers. Findings indicated that participants use diverse clinical approaches and spend the majority of their time providing direct treatment to clients. Implications for practice and future research are discussed.
... This shaping of therapy by the medical models of 'mental health' and neoliberal goals can be glimpsed in a recent 'deconstruction' of psychotherapies, in which Guerin (2017a) made a study of 19 common psychotherapies by comparing their goals and their practices when their different jargons were removed to equate the variety of seemingly different therapies (cf. Frank, 1961;Heinonen & Nissen-Lie, 2019;Norcross & Wampold, 2018;Shedler, 2018;Wampold, 2015Wampold, , 2018. It was found that the main thrusts of almost all the western therapies for goals and activities, once the varying jargons and theories were removed, were to: (1) form a quick working relationship with a client within a stranger/ contractual relationship; (2) solve smaller or more localized conflicts in the client's life which are amenable through talk within an office; (3) act as a new audience to train new behaviours and skills where appropriate; (4) find out their talk and thinking around the problems and suffering they have; and (5) attempt to act as a new 7 audience to change those thoughts and talking in ways that should be beneficial and reduce the suffering, especially for broader life conflicts Different mainstream therapies focus more or less on different aspects of these, and use different jargons to 'explain' them, but they either all cover much the same ground when the jargon is removed, or else they specialize in only certain types of problems and suffering. ...
Therapies have developed over the last hundred years within a milieu of medical models explaining the foundation of ‘mental health’, and within a modernist/ neoliberal milieu that what counts as the goal of therapy is a functional and productive life within the current society. The assumptions of these are currently being challenged and alongside this has been a rise in different types of ‘alternative therapies’ which might seem radical, but this is only if you stay within the two milieus. This paper provides rationales for some of these new therapies when they are properly considered outside of the older medical models and neoliberal imperatives. Details of some of the therapies are given along with rationales for the types of therapeutic responses which seem antithetical to current therapeutic models.
... The participants of the present study felt that a contextual perspective further called for an openness to adapt one's approach to the specific needs of each refugee client. The constant adaptation of one's work to clients, such as proposed by integrative psychotherapy, a softening of theoretical positions, and an acknowledgement of what is most needed for each client in her specific situation has been outlined as beneficial in mental healthcare in general (Fisher & Boswell, 2016;Norcross & Wampold, 2018;Wampold & Imel, 2015) and especially with refugee clients Karageorge et al., 2017). ...
To gain insights into psychologists’ experience of working with refugees in Brazil, semi-structured interviews with 14 psychologists were conducted and analysed using thematic analysis. Results showed that participants experienced operating in a novel, precarious and xenophobic context, which led them to move beyond classical psychological work, engage in practical assistance and become very close to clients. Psychologists reported lack of public structures, insufficient competencies and high levels of fatigue. At the same time, they described gaining new perspectives and benefiting from witnessing their clients’ resilience. In terms of facilitators for the work with refugees, participants pointed to the importance of psychologists being flexible, authentic, of showing a high frustration tolerance and of making use of group-based approaches. Participants suggested that, in order to better refugees’ mental health in Brazil, efforts should focus on adopting a more social perspective in psychology, developing anti-discrimination campaigns, building policies for refugee’ inclusion and scaling up investments in mental healthcare in general. Suggestions for future research are made, as well as for psychologists who work with refugees, such as fostering a more collectivity-focused and contextual understanding of mental health.
... Thus, ABM can reduce aggressive behaviors for those with a high level of initial hostile attention bias, or with a low level of initial positive attention bias. Considering the importance of matching the intervention with the participant (Norcross & Wampold, 2018), further studies are needed to identify the impact of individual characteristics on the effectiveness of ABM, which can optimize the intervention benefits. ...
Background and objectives
An attention bias toward hostile stimuli is associated with an increased risk of aggressive behavior. Thus, reducing hostile attention bias may help to reduce aggression in young offenders. We evaluated the remediating effects of Attention Bias Modification (ABM) on hostile attention bias and aggressive behavior in Chinese male young offenders with antisocial tendencies.
Methods
Institutionalized male young offenders (ages 16–18) were recruited and randomly assigned to ABM (n = 28), placebo (n = 28), or waiting list (n = 28). The ABM group received four weeks of training using visual search of emotional faces; the placebo group underwent similar training using visual search of neutral objects. Before and after treatment, aggressive behavior, attention bias toward positive stimuli and hostile stimuli were assessed.
Results
Linear mixed models and hierarchical multiple regression analyses showed that the intervention effect of ABM was moderated by participants’ initial attention bias. Young offenders with a high level of initial hostile attention bias, or with a low level of initial positive attention bias, benefitted most from ABM.
Limitations
The small sample size impedes investigation of the mechanism of the intervention's effects. Further research can determine whether the current results can be extrapolated to the population of female young offenders.
Conclusion
The results of the present study suggest that ABM is helpful for young offenders who show the greatest bias toward hostile stimuli and away from positive stimuli. These findings highlight the importance of matching the intervention and the participant.
Trial registration
osf.io/vj5rk;
... This result stresses the need to take in high consideration the features of the psychotherapist. As the results of the Third Interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness showed [24], each psychotherapeutic treatment presents more possibilities to reach a good outcome if the psychotherapist will be able to tailor his approach and his personality features in relation to personality, culture, and preferences of the patient. For every therapist, handling one's own emotional responses is a crucial aspect to provide effective and balanced treatments. ...
Background
Therapist’s emotional reactions toward patients in clinical facilities are a key concept in the treatment of personality disorders. Considering only clinical settings specialized in treatment of personality pathology the present paper aimed at: (1) assessing any direct relationship between patient symptom severity and therapist emotional response; (2) exploring patients’ functioning configurations that can be associated with specific therapist reactions (3) investigating whether these relationships remains significant when accounting for other setting variables related to patients or therapist.
Methods
The present study included 43 outpatients with personality disorders who underwent a psychotherapy treatment in two Italian facilities dedicated to outpatients with personality disorders and their 19 psychotherapists. The Symptom Checklist-90-Revised (SCL-90R) was used to explore clinical severity condition. Psychotherapists completed the Therapist Response Questionnaire (TRQ) to identify pattern of therapists’ response and the Shedler-Westen Assessment Procedure-200 (SWAP-200) in order to assess personality traits of the patients.
Results
No significant relationship between the clinical severity of the symptoms and the therapist’ responses was found. Even when controlled for clinical severity condition, duration of the treatment, age and educational level of the patient or years of therapist experience, most of SWAP-200 traits appeared to be significant predictors of therapist’ emotional responses.
Conclusions
The present study confirms the value of therapists’ emotional response as a useful tool in understanding psychological processes related to clinical practice highlighting its context-dependent dimension.
... However, precisely for this reason, it seems important to disentangle the two styles in this experimental design. As Norcross and Wampold (2018) highlighted that therapists and counselors are indeed capable of adapting their style to fit patient and client characteristics, the present study can be seen as a supplemental experimental proof-of-concept and may present a small additional piece to the puzzle. With this experimental design, we are able to contribute methodologically to the current research landscape. ...
Background
With a lack of experimental designs that explore which therapeutic style is helpful for which patient, the aim of this study was to test the feasibility of experimentally varying the therapeutic style under realistic conditions and to investigate how this affects alliance ratings by clients and counselors.
Methods
We defined two manualized therapeutic styles (neutral/distant relational style vs. high affiliation relational style) based on the interpersonal circumplex. In a randomized two-group design, 64 healthy university students (70% female, Mage = 23.78, SDage = 2.81) received a single psychological counseling session on interpersonal conflicts by one of four counselors and in one of the two styles. We checked the manipulation success using observer-rated degree of affiliation and ratings of counselors’ interpersonal behavior with the Interpersonal Message Inventory (IMI-R). A series of linear regression models analyzed whether the style predicted working alliance, assessed via the Working Alliance Inventory (WAI).
Results
In accordance with the hypotheses, significant differences in the rated degree of affiliation (p ≤ .001) and IMI-R ratings (p ≤ .001 in friendly, p = .003 in hostile dimension) were found between the two groups. Overall, alliance ratings were high across groups and raters (WAI overall scores ranging from 3.76 to 4.07). The style did not predict clients’ alliance ratings.
Conclusion
The experimental variation of the therapeutic style proved feasible under realistic conditions with high overall alliance ratings. The novel experimental design may provide a basis for further research.
... As described previously, memory reconsolidation is a promising field (see Ecker, 2015Ecker, , 2018. (Norcross & Wampold, 2018). At a task level, therapeutic actions such as memory reconsolidation, exploration of painful events, narrative retelling, imagery rescripting and evocative unfolding tasks may be aligned with the present principle. ...
Intersections between psychotherapy and neurosciences are at its dawn. The quest to understand the neural underpinnings of psychological processes has led several generations of scientists to explore neural correlates between mind, brain, and behaviour. Neuroscience methods and research has given psychology new perspectives and insights about the structure and function of complex neural pathways, that underlie human functioning (cognition, emotion, motivation, and interpersonal behaviour). By translating neuroscientific findings into psychotherapeutic principles of change, it is possible to promote responsiveness towards brain dysfunction that underlies patients' psychological malfunctioning. In psychotherapy, responsiveness is a core aspect of the therapeutic change process, especially to adapt psychological interventions to patients’ motivational stages and preferences, coping styles, neurobehavioral modes, and emotional needs. Within a transtheoretical and translational approach, contemporary neuroscientific findings are revised, discussed, and used to attempt to build-on fourteen theoretical brain-based principles that may be applied to psychotherapy. Translating these empirical findings into practical principles, clinical strategies and tasks is expected to enhance psychotherapy responsiveness grounded on a science-based knowledge of brain functioning.
... These clients are considered difficult to treat (Heijmans et al., 2011;Luca, 2012), a position supported by observably mediocre therapeutic results (Kleinstäuber et al., 2011;van Dessel et al., 2014), leaving a high desire to explore different approaches to engage them in treatment. A flexible usage of personal therapeutic styles, similar to the one demonstrated in the present study, might improve psychotherapy outcomes and client engagement, specifically when client characteristics such as psychotherapy preferences, stage of change, reactance level, coping style, and attachment style are accounted for (Norcross & Wampold, 2018). The overview of different personal therapeutic styles that the therapists in our study used in the treatment of clients with MUPS challenges the assumptions of treatment manuals adherence and of treatment specificity (Wampold & Imel, 2015), and may serve as an inspiration for other practitioners. ...
Treatment specificity and adherence to treatment manuals represent essential components of the medical model in psychotherapy. The model assumes that psychotherapists who work with the same type of clients and who identify with the same theoretical approach work very similarly. This study illustrates the shortcomings of that assumption and explores how therapists’ individuality forms and shapes their unique approaches that resonate with their own personalities, inclinations, and worldviews. Semi-structured interviews with eight Gestalt therapists working with clients who experienced medically unexplained physical symptoms were analysed using the grounded theory method. Considerable differences were found among the therapists within four domains of the personal therapeutic approach, namely Case Conceptualization, Therapeutic Task, Therapist’s Position, and Alternative Strategy. However, regardless of the differences, all the therapists endeavoured, either implicitly or explicitly, to convey to the clients what they considered to be healthy functioning. There is considerable diversity in the way therapists work even when they subscribe to the same psychotherapeutic approach and work with the same type of clients. The exploration of psychotherapists’ usual strategies, as well as the alternative strategies they use when their usual strategies do not work, appears helpful for capturing their personal therapeutic approaches.
... The EEMM links to the past in four important ways. First, our approach builds from and extends approaches focused on enhancing treatment effectiveness by tailoring treatment to the unique individual and their particular situation (Norcross and Wampold, 2018). Researchers have labeled this approaches as treatment adaptation, responsiveness, individualizing, personalizing, and tailoring, and, like the present approach, seek to attune research on processes of change to the details of a specific individual in a specific context. ...
Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly “negative” processes, and supports practitioners in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol.
... There are many types of psychotherapy with varying methods and levels of empirical support. The choice of the most appropriate type of psychotherapy is in part based upon a patient's specific problem or diagnosis and his/her preferences for treatment (5)(6)(7). For this reason, it is especially important that people potentially interested in psychotherapy have access to correct information. ...
Background
The Internet has become the main source of information on health issues, and information now determines the therapeutic preferences of patients. For this reason, it is relevant to analyze online information discussing psychotherapy.
Objective
To investigate tweets posted by 25 major US media outlets between 2009 and 2019 concerning psychotherapy.
Methods
We investigated tweets posted by 25 major US media outlets about psychotherapy between January 2009 and December 2019 as well as the likes generated. In addition, we measured the sentiment analysis of these tweets.
Results
Most of the tweets analyzed focused on Mindfulness (5,498), while a low number were related to Psychoanalysis (376) and even less to Cognitive-Behavioral Therapy (61). Surprisingly, Computer-supported therapy, Psychodynamic therapy, Systemic therapy, Acceptance and commitment therapy, and Dialectical behavior therapy did not generate any tweet. In terms of content, efficacy was the main focus of the posted tweets, receiving Cognitive-Behavioral Therapy and Mindfulness a positive appraisal.
Conclusions
US media outlets focused their interest on Mindfulness which may have contributed to the growing popularity in the past years of this therapeutic modality.
... A growing body of evidence shows therapists should tailor treatments to flexibly meet the needs of each unique client (Norcross & Wampold, 2018). Finally, most research in this area (including studies noted above) use predominantly professional therapist samples. ...
Relatively little research focuses on the impact of therapeutic, relational skills training for untrained helpers. The current study was a randomized control trial which tested a novel, research-informed training protocol that integrated elements of alliance-focused training (AFT) and facilitative interpersonal skills (FIS) in a sample of college undergraduates interested in social helping careers. The AFT/FIS training was compared to a time-matched video demonstration of cognitive therapy (CT video). All participants were assessed on their Facilitative Interpersonal Skills (FIS) and emotional reactions to FIS stimuli pre- and post-training. After controlling for baseline effects, participants in the AFT/FIS training saw a significant increase in post-training FIS, especially in the areas of empathy, alliance bond capacity, and alliance rupture repair responsiveness. AFT/FIS participants also saw increases in positive and affiliative emotional reactions to FIS clips compared to participants in the CT video training. Implications for future empirical investigations and training initiatives are discussed.
... Positioning the client-counsellor relationship in the foreground raises the question of what makes for a therapeutic or growth-fostering relationship that has the potential to support positive outcomes in counselling. There is a recent body of literature on evidenced-based relationships (Norcross & Wampold, 2018) By stepping back and looking at the client-counsellor relationship through the lenses of cultural responsivity and just practice (Collins, 2018c;Audet & Paré, 2018;Paré, 2013), we intend to challenge the embeddedness of counselling practices and processes in the eurocentric worldview. ...
This ebook provides a conceptual and applied practice foundation for building responsive relationships with clients in counselling. It has been designed to disrupt how counsellors often think about the initial phases of the counselling process and the purpose, and use of, counselling microskills and techniques. We also propose reconsideration of how counsellor educators position and teach counselling skills in support of culturally responsive, client-centred, and socially just counselling. It offers a variety of experiential learning activities, commentaries, and videos on different topics, and it guides readers through applied practice skills learning processes. Our goal is to equip you with the competencies (e.g., attitudes, knowledge, skills) that will enable you to optimize the growth-fostering potential of the client–counsellor relationship, to appreciate the interplay of client and counsellor cultural identities and social locations on the contextualized challenges that clients face, to embrace and support their self- and culturally-defined preferred futures, and to nurture collaboration with clients at all points in the counselling process. See: https://responsiverelationships.pressbooks.com/
... Even if one disagrees with the preparadigmatic diagnoses, it is difficult to deny that EBP in psychotherapy has for years traveled a divisive and contentious path. While many contend that RCTs, and the ESTs they beget, have outlived their evidentiary usefulness (e.g., Hayes, 2016;Norcross & Wampold, 2018;Shean, 2015;Tolin et al., 2015), I believe that the proliferation of psychotherapy models and interventions is a related and additional, yet no less troubling, irritant that conspires to keep psychotherapy in a Kuhnian holding pattern. The number of models is estimated at over 500 (Prochaska & Norcross, 2018). ...
... As Clarkin and Levy (2004) indicated, client related personality variables account for a great amount of variance in explaining the change that occurs as a result of counselling and personality variables. In addition, Norcross and Wampold (2018) suggested that adapting the counselling and therapy based on transdiagnostic factors of clients seemed more important than diagnostic factors. Among the client's transdiagnostic factors, exploring the role of the PM as a personality variable with counselling outcome seems crucial. ...
The purpose of current study was to explore psychometric properties of the Turkish version of the Balanced Index of Psychological Mindedness (BIPM). Studies regarding psychological mindedness (PM) are still limited in Turkey; and there are few valid instruments to measure PM. The Turkish version of the BIPM and the 20-Item Toronto Alexithymia Scale (TAS) was administered to 654 voluntary undergraduate students. Confirmatory factor analysis indicated a good fit for the model including two subscales (interest and ability dimensions of PM) with a total of 14 items (x²/df = 3.11, p < .001, RMSEA = 0.060, S-RMR = 0.059, GFI = 0.95, AGFI = .0.93, CFI = 0.94). McDonald’s Omega (ω) for scores on the overall scale was .85, .73 for scores on the Interest Subscale and .76 for scores on the Insight Subscale. Test–retest reliability coefficients were found as .61 for the scores on the BIPM total score, .55 for scores on the Interest subscale and .56 for scores on the Insight subscale (p < .01). As expected, the BIPM total scale score were negatively correlated with TAS total score (r = -.59).
Zusammenfassung:
Hintergrund:
Seit vielen Jahren nehmen Betroffene von Organisierter und Ritueller Gewalt (ORG) psychotherapeutische Angebote der Regelversorgung in Anspruch. Oft gilt die Behandlung durch anhaltende Gewalt -erfahrungen und die Komplexität der Traumafolgestörungen als schwer. Empirisch ist bisher wenig darüber bekannt, welche Therapiemethoden und -interventionen angewandt und von Betroffenen/Psychotherapeut*innen als wirksam erachtet werden. Ungeklärt ist auch, wie spezifisch die Behandlungsansätze und das Wissen von Psychotherapeut*innen hinsichtlich ORG sein sollten und in welcher Form bestehende therapeutische Konzepte angepasst
werden.
Methodik: Im Rahmen eines Forschungsprojekts, das die Unabhängige Kommission zur Aufarbeitung sexuellen Kindesmissbrauchs (UKASK) förderte, wurden Betroffene von ORG und psychosoziale Fachpersonen, die Klient*innen mit ORG Erfahrungen begleitet haben, anonym befragt. Insgesamt haben innerhalb von zwei Online-Befragungen jeweils 158 Betroffene von ihren eigenen Psychotherapien berichtet, und 98 Psychotherapeut*innen/Psycholog*innen machten Angaben zu erfolgten Therapien von Klient*innen mit ORG-Erfahrungen.
Ergebnisse: In der Behandlung der Folgen von ORG haben Psychotherapeut*innen/Psycholog*innen manualisierte,
evidenzbasierte Psychotherapiemethoden wie Dialektisch-Behaviorale Therapie (DBT) und Eye Movement Desensitization
and Reprocessing (EMDR) für weniger wirksam erachtet und seltener
angewandt als andere Interventionsformen. Im Vergleich zu den psychotherapieerfahrenen Betroffenen der Studie schätzten Behandler*innen den Nutzen manualisierter Methoden jedoch
positiver ein. Beide Gruppen bewerteten besonders die Arbeit mit dissoziativen Persönlichkeitsanteilen und traumaspezifischen Stabilisierungsübungen als hilfreich.
The present literature review aims to offer an in-depth examination and critical evaluation of the concept of the therapeutic alliance, as it has been historically unfolded in psychotherapy theory, research and practice. The construct of the alliance holds particular theoretical and practical significance for counselling psychologists, who are expected to demonstrate an understanding of the therapeutic relationship and alliance as conceptualised in different models (HCPC, 2015), as well as the ability to engage in relational practice (BPS, 2015). The critical literature review therefore opens with an examination of the concept of the therapeutic alliance as defined and conceptualised in the major schools of psychotherapy. Core alliance measures are also presented and critically evaluated in relation to their methodological rigour and usefulness in alliance research and practice. The relationship between the therapeutic alliance and outcome is critically reflected upon, whilst giving thorough consideration to therapist, client and interactive factors impacting the development and maintenance of the therapeutic alliance, thus possibly mediating and/ or moderating the relationship between alliance and treatment outcome. Contemporary re-conceptualisations and critiques of alliance theory and research are in turn thoroughly examined and critically discussed. Taking into account the primacy of the therapeutic relationship in Counselling Psychology (BPS, 2005), the literature review concludes with a presentation of the therapeutic implications of alliance theory and research for practitioner psychologists in general and counselling psychologists in particular, irrespective of their therapeutic orientation, in order to enhance their therapeutic skills and efficacy.
With no global standard or system for psychotherapy training, there is substantial variation in psychotherapy curriculum models, accreditation, licensing, and theoretical orientations around the world. Each continent contains a rich and individualized history of the development of psychotherapy that has informed the current status of training models and systems. The emphasis on evidence-based practice in psychology has led to the implementation of training initiatives and strategies with competency-based approaches to optimize the practice of psychotherapy across all professional settings.
The concept of ‘paradoxical outcome’ refers to instances of differences in evaluation of the outcome of psychotherapy when taken from different sources and/or by different modes of evaluation. Paradoxical outcome has become a central issue in psychotherapy practice and research because of its prevalence as well as its implications for the aims and process of therapy. The concept of paradoxical outcome treats discrepancies in the evaluation of psychotherapy as problematic, indicating that the underlying expectation is that the outcome of psychotherapy should be consistent. In this commentary to the special issue, I propose that this assumption that the outcome of psychotherapy is a unified construct that is agreed among interested parties, that underlies the concept of paradoxical outcome, is a fundamental fallacy. Moreover, I argue that it is important to recognize that the outcome of psychotherapy is a complex notion that has different meanings for the various agents implicated in it. This recognition may in turn open the way to exploring the function and goal of psychotherapy for each of the different agents involved in it, and this will highlight its central role as a social and institutional practice that regulates contemporary subjectivities and practices.
Recent advances in the understanding of personality pathology have contributed to an emphasis on the core of personality pathology as deficits in self-functioning and interpersonal functioning at different levels of severity that must be assessed for clinical intervention. In concert with these conceptual and empirical advances, transference-focused psychotherapy (TFP), an empirically supported psychodynamic treatment for borderline personality disorder, has been in constant development with extensive clinical use. This article describes an object relations model for conceptualizing and assessing levels of personality organization, a transdiagnostic approach to personality pathology, and related treatment modifications, thus expanding the utilization of TFP beyond borderline personality disorder to the full range of personality dysfunction. The core of this treatment approach is a sequential interpretive process between patient and therapist. This process takes place within the context of a structured treatment frame tailored to the unique individual with problems in self-functioning and interpersonal functioning in his/her particular environment.
Stigmatisierung ist ein großes Hindernis für jene Menschen, die an seelischen Konflikten und ihren Folgen leiden. Scheinbar bestätigte falsche Vorstellung von seelischen »Erkrankungen« behindern Erreichen und Aufrechterhalten von Lebenszielen und resultieren in erheblicher Deprivation, die die Lebensqualität schwer beeinträchtigen. Schon die Diagnose einer »Geisteskrankheit« ist deshalb auf Gewaltsamkeit zu prüfen, das formale psychiatrische Diagnose-System wird überprüft auf Implikationen für die Notwendigkeit eines neuen Paradigmas.
Objective: The Cooper-Norcross Inventory of Preferences (C-NIP) is a new and promising tool for measuring clients’ preferences regarding psychotherapy. However, the psychometric evaluation of this measure is scarce in general and completely missing for the Czech adaptation of the measure. This study aimed to test the Czech version of the C-NIP factor structure, test its measurement invariance, and establish cut points. Methods: N = 772 adults answered the C-NIP in an online survey. Confirmatory and exploratory factor analyses were used to test the factor structure and assess the C-NIP measurement invariance between men and women and across several levels of psychotherapy experience. Results: The original four-factor model was not supported. Instead, a five-factor model was suggested that fit the data adequately and was strictly invariant with respect to gender and levels of experience with psychotherapy. Conclusions: The Czech C-NIP can be considered a valid and reliable measure of clients’ preferences regarding psychotherapy. The replication of the new factor model is needed.
Introduction
This work builds on a small body of literature that explores core processes in psychotherapy, behavior change, and evidence-based alcohol or other drug (AOD) therapies. Here, this paper discusses two separate but dependent processes. The research team defines goal setting and goal monitoring as collaborative processes where clinicians and clients identify and formulate therapeutic goals; actionable objectives; and revisit, measure, and renegotiate these plans via a standardized procedure over time.
Method
Study methods included a literature review and qualitative content analysis to derive a set of principles and practices of goal setting and monitoring. The research team used source documents (i.e., literature reviews, therapy manuals, and government-issued practice guidelines) and videos (i.e., therapy demonstration videos), and we performed analyses in NVIVO.
Results
The study identified ten principles and 32 practices. The principles suggest that goal setting and monitoring can be characterized as a collaborative, explicit, and standardized approach to engaging in goal-directed therapeutic work. The term goal-directed therapeutic work connotes a shift toward a more accountable frame for care than has been previously emphasized in the literature. The identified practices were organized into five sub-themes related to goal setting (10 practices), goal monitoring (10 practices), as well as practices specific to mechanisms of goal pursuit and behavior change. These practices involved ways to attend to client self-determination (4 practices), motivation (4 practices), and self-efficacy (4 practices).
Conclusions
Goal setting and monitoring are a collaborative means of mapping and tracking a course of mutually accountable treatment. The current work is a novel resource for trainees, clinicians, and clinical supervisors interested in care based on evidence-based principles and practices of AOD and other behavior change therapies.
Transference-focused psychotherapy (TFP) is a principle-driven, transdiagnostic psychodynamic psychotherapy for individuals with personality pathology. Originally developed and empirically validated for patients with the categorical diagnosis of borderline personality disorder (BPD), TFP has since been adapted to meet the clinical needs of the full range of personality disorder presentations from severe personality disorder through sub-syndromal personality pathology. This development of TFP is consistent with recent advances in the understanding of personality pathology with an emphasis on different levels of deficits in self and interpersonal functioning. TFP is theoretically based on objects relations theory and utilizes an assessment of levels of personality organization, which then informs the specific treatment strategies used for each individual patient. The core of this treatment approach is a step-wize interpretive process which takes place within the context of a structured treatment frame.
Zusammenfassung
Das Gespräch hat in jeder Psychotherapie eine zentrale Stellung. „Gesprächstherapie“ ist deshalb irreführend für eine besondere Art der Therapeutik. Im Folgenden wird von Analytiker(in) gesprochen, wenn diese Tradition gemeint ist, ansonsten von Therapeut(en) und Therapeutin. Probleme der Vertraulichkeit bei der Erforschung von Gesprächen können gut und sicher gelöst werden. Die Erforschung der therapeutischen Konversation ist weit vorangetrieben, von psychoanalytischer Seite und anderen weltweit. Da so wichtige Gesprächsmomente wie Schweigen und Erzählen vertieft verstanden werden konnten, wird ein „communicative turn“ vorgeschlagen: nicht länger eine jeweilige Psychotherapietheorie als Ausgangspunkt einer Untersuchung zu wählen, sondern das Gespräch selbst. Dazu werden Forschungsergebnisse mit Bezug zur klinischen Arbeit vorgestellt. Sie sind klinisch gehaltvoll.
Objective:
This study examined the predictive ability of the Rorschach-based Ego Impairment Index (EII-2) on outcome of psychotherapy in different types and durations of therapy.
Method:
A total of 326 outpatients suffering from depressive or anxiety disorders were randomized into receiving solution-focused (n = 97), short-term psychodynamic (n = 101), or long-term psychodynamic psychotherapy (n = 128). Psychotherapy outcome assessments during the 5-year follow-up period covered psychiatric symptoms, social functioning, and work ability.
Results:
Lower EII-2 values, which indicate less problematic ego functioning, were found to predict faster improvement in both short-term therapies as compared to long-term psychotherapy.
Conclusion:
The results provide preliminary support for the utility of EII-2 as a complementary measure to interview-based methods for selecting between short- and long-term therapies.
Background:
Patient suitability has been suggested to predict treatment non-attendance but information on its effect is limited.
Aim:
To study the prediction of the Suitability for Psychotherapy Scale (SPS), on occurrence of treatment non-attendance.
Methods:
Altogether 326 outpatients, with depressive or anxiety disorder, were randomized to short-term psychodynamic psychotherapy (SPP), long-term psychodynamic psychotherapy (LPP), and solution-focused therapy (SFT). SPS was based on seven components from three suitability domains: nature of problems, ego strength, and self-observing capacity. Treatment non-attendance was defined as refusal of engaging therapy and of premature termination. The Cox model and logistic regression were used.
Results:
Treatment non-attendance was significantly more common in LPP patients with poor SPS (RR = 2.76, 95% CI = 1.45-5.26). This was mainly due to poor flexibility of interaction, poor self-concept, and poor reflective ability. Premature termination in SFT showed a similar trend but due to other SPS components: absence of a circumscribed problem, poor modulation of affects, and poor response to trial interpretation. On the contrary, individuals with good values of SPS were more prone to premature termination in SPP.
Limitations:
The prediction of suitability on refusal could only be studied in the LPP group due to few refusals in the short-term therapy groups. The sample consisted of patients who participated in a trial. Thus the findings may not be directly generalized to unselected patients in the public mental health setting.
Conclusions:
Poor suitability, apparently, predicts non-attendance in LPP and SFT, but not in SPP. More studies on large cohorts are needed.
C&BP commemoranding Aaron T. Beck's work. The alliance highlights the qualities of coordination, sincerity, and trust that run through the various (CBT) interventions. Alliance emerges as one of the best-studied process characteristics in psychotherapy, with hundreds of studies on different orientations, treatment conditions, and mental health services. Overall, there is a robust meta-analytic predictive relation between alliance during therapy and therapy outcome (Cohen's d = .58). However, socio-cultural aspects such as the existence of substance use disorder or ethnic minorities partly moderates this relation. In addition, therapist effects are likely. Clinical implications are discussed based on the excellent meta-analytic empirical evidence.
Objective:
The present study tested the efficacy of an unguided internet-based Acceptance and Commitment Therapy (iACT) program for depression, and identified the psychological characteristics of participants who benefitted the most from the program.
Method:
Undergraduate students with mild to severe symptoms of depression were randomized to the iACT group (n = 95) or the waiting-list group (WLC group; n = 87). Depressive symptoms and positive mental health were assessed at baseline (T0 ), at the end of the 6-week program (T1 ), and at a 3-month follow-up (T2 ).
Results:
Compared with the WLC group, the iACT group showed significantly more improvement in depressive symptoms (d = 1.27) and positive mental health (d = 0.59), both at T1 and T2 . Latent Profile Analysis identified three classes of participants: Sensitive-to-Relationship, Low-Reactive-Depression, and Endogenous-Depression group. In general, the treatment was particularly suitable for the Sensitive-to-Relationship class.
Conclusion:
The iACT was effective in treating the depressive symptoms of undergraduates, especially suitable for the clients with high baseline depression, high externality, high resistance, and high sensitivity to relationships.
Conversation analysis (CA) of children-adult—interaction in various contexts has become an established field of research. However, child therapy has received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley, 2006). Psychotherapy process researchers in adult therapy (Stiles et al., 2015) have found that therapists “invent” a new therapy for each patient (Norcross and Wampold, 2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of “unexplainable rage.” The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe “doing contrariness,” as a conversational practice producing epistemic and affiliative disruptions, while “avoiding doing contrariness” and “remedying contrariness” are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding.
Everyone, it seems, is talking and arguing about Evidence-Based Practice (EBP). Those therapies and assessments designated as EBP increasingly determine what is taught, researched, and reimbursed in health care. But exactly what is it, and how do you do it?
The second edition of Clinician's Guide to Evidence-Based Practices is the concise, practitioner-friendly guide to applying EBPs in mental health. Step-by-step it explains how to conduct the entire EBP process-asking the right questions, accessing the best available research, appraising the research, translating that research into practice, integrating that research with clinician expertise and patient characteristics, evaluating the entire enterprise, attending to the ethical considerations, and when done, moving the EBP process forward by teaching and disseminating it.
This book will help you:
· Formulate useful questions that research can address
· Search the research literature efficiently for best practices
· Make sense out of the research morass, sifting wheat from chaff
· Incorporate patient values and diversity into the selection of EBP
· Blend clinician expertise with the research evidence
· Translate empirical research into practice
· Ensure that your clients receive effective, research-supported services
· Infuse the EBP process into your organizational setting and training methods
· Identify and integrate ethics in the context of EBP
Coauthored by a distinguished quartet of clinicians, researchers, and a health care librarian, the Clinician's Guide has become the classic for graduate students and busy professionals mastering EBP.
One explanation for differences in treatment effectiveness for targeted symptoms is that more-effective treatments are more focused on patients’ problems than are less-effective treatments. This conjecture was examined meta-analytically. Comparisons of two treatments of adults with anxiety disorders were included. Effect sizes for targeted symptoms, nontargeted symptoms, and global outcomes (e.g., quality of life and well-being) as well as the relative focus on patients’ problems and researcher allegiance were coded. Metaregressions were conducted to predict effect sizes from (a) variables related to the focus on patients’ problems and (b) researcher allegiance. For symptom measures, the relative focus on patients’ problems predicted the relative effectiveness of the treatments, with the expectations created by explanation appearing more predictive than specific therapeutic actions focused on patients’ problems, although conclusions about relative importance were difficult to determine given collinearity of predictors. Researcher allegiance also predicted the effects of the comparisons. For global outcomes, both the focus on patients’ problems and researcher allegiance seemed to have smaller roles. A focus on patients’ problems appears to be important for the reductions of symptoms. Clinical trials comparing treatments need to balance the focus on patients’ problems and reduce researcher allegiance.
In the United States, the public is heavily lobbied to accept medications as the main answer for dealing with mental maladies like depression. However, examination of the empirical evidence reveals that even when drugs are the primary treatments, findings of benefit are often more dependent on psychosocial, interpersonal factors than commonly believed. This article highlights the reemerging worth of psychotherapeutic relationships in quelling emotional discomfort. It also touches on the roles of business and research bias in overselling the idea of unique merits and specificity of gains derived purely from psychopharmacological solutions.
Objective:
Although the effectiveness of psychotherapy is well documented, little progress has been made in elucidating mechanisms of change. Major impediments to progress are the homogeneity assumptions evident in many psychotherapy studies. Case-specific research strategies avoid treating patients, therapists, and treatments as homogeneous variables and such studies are more successful at elucidating the link between psychotherapy processes and treatment outcome.
Method:
A case-specific, process-outcome study comprised of 39 patients treated by experienced therapists is presented. We did not focus on a supposedly homogeneous diagnostic group of patients (e.g., depressed patients) or particular manualized brands of therapy. Instead, we identified each patient's particular problems and conflicts (plan formulation) and then determined the degree to which therapists effectively addressed the patient's problems-that is, the degree to which therapists' interventions were compatible with (i.e., responsive to) the patient's plan.
Results:
Correlations between ratings of therapist responsiveness (plan compatibility of interventions) and a variety of outcome assessments were significant and substantial (accounting on average for 25% of outcome variance).
Conclusion:
The findings presented here suggest that the extent to which therapists are responsive to their patients' plans is a strong predictor of treatment outcome and of patients feeling positively about their therapy experience.
Professional practice in psychology is anchored in interpersonal or relational skills. These skills are essential to successful interactions with clients and their families, students, and colleagues. Expertise in these skills is desired and expected for the practicing psychologist. An important but little-studied aspect of interpersonal skills is what Stiles and colleagues (Stiles, Honos-Webb, & Surko, 1998; Stiles, 2009, 2013) have called appropriate responsiveness. In treatment relationships, appropriate responsiveness is the therapist's ability to achieve optimal benefit for the client by adjusting responses to the current state of the client and the interaction. This article was designed to clarify this aspect of responsiveness, showing its links to empathy, illustrating how responsiveness has been detected in controlled clinical trials, discussing how educators and supervisors have worked to enhance students' responsiveness, and considering how appropriate responsiveness has been assessed. The article also discusses the development of skills underlying appropriate responsiveness and the role of stable differences in talent in training of professional psychologists. Notwithstanding other pessimistic reports on psychologists' expertise, demonstrable expertise may exist in the effective, responsive use of these skills in treatment settings. Appropriate responsiveness may be a variety of executive functioning, organizing and guiding the use of many specific competencies. As such it may be a metacompetency, with implications for the design of competency schemes. Key to all of these considerations is the distinction between therapeutic techniques and their responsive use, which involves astute judgment as to when and how to utilize these responses to best effect in the treatment situation. (PsycINFO Database Record
Systematic treatment selection (STS; Beutler &. Clarkin, 1990; Beutler, Clarkin, & Bongar, 2000) is an empirically developed procedure for identify-ing the mix of therapist, treatment strategies, and psychotherapeutic inter-ventions that are most likely to produce a favorable response in any given patient. Two basic assumptions underlie this approach: (a) There is no treat-ment method or model that works well on all patients, and (b) most treat-ment methods work well on some patients (e.g., Beutler & Harwood, 2002; Howard, Krause, & Lyons, 1993). The effects of most (if not all) treatments range from very positive to mildly negative, depending on the patient ob-served. STS seeks to identify which patients will respond positively to vari-ous mixes of interventions from different treatment models. Treatments are not mutually exclusive, however. Regardless of whether they are identified (e.g., by similar labels or brands), treatments are distinguished more by the pattern of interventions used than by the exclusivity of the procedures used (e.g., Malik, Beutler, Gallagher-Thompson, Thompson, & Alimohamed, 2003). Moreover, the procedures used are more closely related to the therapist's training and beliefs than to the procedures' scientific validity (Beutler et al., 2000). 29 Contemporary efforts to construct research-informed guidelines do not as a rule address the commonalities among treatments; practitioners prefer instead to think of each treatment model as a discrete and identifiable entity that can be applied to all patients with the same diagnosis. However, the presence of a shared diagnosis occludes the presence of important differences among patients. Thus, the appropriateness of any given treatment model de-pends both on the pattern of interventions used and the fit of these interven-tions to both the diagnostic and nondiagnostic characteristics of the patient. In contrast to the broad approach of fitting a treatment model to a patient's diagnosis, STS seeks to identify the specific pattern of patient traits and states (dimensions) that best fit with a corresponding pattern of demand characteristics that constitute the amalgamation of a treatment strategy and a therapist's particular relationship style. Rather than identifying the treat-ment received by a patient purely in terms of the theoretical model that guides it (e.g., cognitive therapy, psychoanalytic therapy, interpersonal therapy) or the techniques that it contains (e.g., interpretation, thought records, evidence analysis), all of which may reveal more about a particular therapist's beliefs than about in-therapy behavior, STS is constructed around principles of behavior change—guiding theorems of change and relationship that cut across treatment models and theories and that can be applied by individual therapists from different perspectives (Beutler et al, 2000). In the strictest sense, STS is not an "integrative therapy"; it does not attempt to combine theoretical concepts or to derive a unified theoretical approach of any type. To the degree that it falls within the domain of current descriptors, it is a "technical eclectic" approach, but even that label is impre-cise because STS does not specify any particular set of techniques but rather allows the therapist to use procedures from any particular approach that are consistent with the application of cross-cutting principles of change and in-fluence (e.g., therapeutic change is most likely when the therapeutic proce-dures do not evoke patient resistance). The principles and applications of STS have been defined and devel-oped through a four-step process (Beutler et al., 2000). The first step was a series of literature reviews designed to identify predictors and moderators of therapeutic change. The second step was to collapse and combine these pre-dictors and moderators into a smaller set of clusters, each of which identified a particular fit or match between patient qualities and treatment strategies that reliably relate to change and improvement. The third step was to de-velop means for measuring the patient qualities and treatment strategies that emerged from the prior steps. The fourth step tested a series of hypotheses that had been extracted from the reviews of literature, all of which bore on the question of what factors accounted for optimal therapeutic change. A detailed review of these steps is contained in Beutler et al. (2000). The application of the original STS dimensions for the task of planning treatment is illustrated in the next section, as applied to the case of Frank, a 30 BEUTLER ETAL.
It has been argued that psychotherapy is a profession without any expertise (Shanteau, 1992). We examine the validity of this claim, reviewing the literature on expertise, clinical decision making, and psychotherapeutic outcome assessment, and find it a reasonable assessment. There is no demonstration of accuracy and skill that is associated with experience as a therapist. We posit that this absence of an expertise-experience relation is attributable to therapists' lack of access to quality outcome information regarding their interventions and an overreliance on fallible information-processing strategies even when such outcome information is available. The research on providing outcome feedback is reviewed, and although it does relate to client improvement, it has not been shown to be associated with any gains in therapist skill or expertise. We propose a model of outcome information usage and specific a priori hypothesis testing as a means of developing expertise. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Controversy about the effectiveness of psychotherapy has a long history. In 1952, British experimental psychologist, Hans Eysenck, casued a furor when he proclaimed that the application of psychotherapy was no more beneficial than the abscence of treatment. In his report, Eysenck (1952( summarized the results of 24 reports of psychoanalytic and eclectic psychotherapies with more than 7,000 neurotic clients reated in naturalistic settings compared with two control groups. Eysenck found that the more intensive the therapy, the worse the results. In fact, Eysenck's date suggested that clients in psychoanalytic treatments had significantly worse cure rates tha nclients who received no treatment.
Human interaction, including psychotherapy, is systematically responsive; therapists' and clients' behavior is influenced by emerging context, including perceptions of each other's characteristics and behavior. Feedback and mutual influence occur on a wide range of time scales, including treatment assignment, strategy, and tactics, -and even within the delivery of interventions. Consequently, research that assumes linear relations among psychotherapeutic variables may not be trustworthy. The concept of responsiveness helps show how client characteristics, therapist characteristics, and process components may be important in psychotherapy despite a lack of linear relations to outcomes. Research strategies that incorporate responsiveness include the use of evaluative measures, systems approaches, and qualitative and narrative approaches.
Objective:
Concerns about the maturing science of cultural adaptation of evidence-based interventions (EBIs) have encompassed deficient standardization of theoretical frameworks and inefficiencies adapting multiple EBIs for multiple ethnic groups. Others argue that original EBIs applied with fidelity address universal processes applicable across ethnicity without adaptation. Study goals were to (1) establish a unifying data-driven framework for culturally adapting mental health EBIs for ethnic minorities, and (2) provide information for the fidelity debate by examining the extent to which fidelity to core EBI components is achieved in the cultural adaptation process.
Method:
A systematic review of primary research was conducted utilizing an inductive approach via thematic synthesis to code 20 years of cultural EBI adaptation studies for mental health problems in ethnic minorities. Studies were coded for adapted EBI components and extent of EBI modification.
Results:
Results yielded the Cultural Treatment Adaptation Framework (CTAF), an overarching data-driven framework providing common concepts and language for adapted treatment components that unifies cultural adaption science. Findings also demonstrated patterns of adapted components. All adapted EBIs (100%) yielded changes in peripheral (engagement and treatment delivery) components. In contrast, only 11.11% of culturally adapted EBIs yielded core therapeutic component modifications. Instead, 60.0% required core additions that address sociocultural, cultural skill, and psychoeducation needs.
Conclusion:
Fidelity to core components is largely preserved in cultural adaptation, but core component addendums, delivery, and contextualization are substantially changed. The CTAF and its patterns represent a key step in advancement of a maturing cultural adaptation science. (PsycINFO Database Record
The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientific understanding of how humans heal in a social context and explains findings from a vast array of psychotherapies studies. This model provides a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005
The concept of complementary therapeutic relationship (CTR) is introduced. According to this prescriptive concept, therapists are supposed to offer each patient an individually custom tailored relationship that suits his or her most important goals. These goals are determined in Plan Analysis 1, case conceptualizations (Caspar, 1995, 1996, 1997a). The question is raised whether therapies in which therapists spontaneously develop a complementary relationship with their patients yield better results, as the concept suggests. Therapies with 22 depressed inpatients from a project dedicated to the study of interpersonal psychotherapy underwent additional analysis: The complementarity of therapist behavior was rated using Plan Analyses, and complementarity values were correlated with effect sizes in Symptom Checklist-90, Beck Depression Inventory, Hamilton Rating Scale, and Global Assessment of Functioning scores. The hypothesis that complementarity is correlated to outcome was partly confirmed, interestingly for success rated by the patients but not for success rated by others. A comparison of complementarity with the position in the interpersonal circle, as assessed with the Inventory of Interpersonal Problems scale, revealed that therapists were mainly complementary when it was most easy, with the patient in the friendly part of the interpersonal circle. These findings are interpreted, and conclusions for further research as well as for psychotherapeutic practice are derived.
In response to recent discussion of the importance of identifying theoretically derived patient characteristics to be included in the study of patient-therapy (PT) and patient-outcome (PO) interactions in psychotherapy research, this paper presents a model of two broad configurations of personality style and psychopathology that appear to be related to aspects of therapeutic process and outcome. Anaclitic psychopathologies are disorders primarily preoccupied with issues of interpersonal relatedness such as trust, caring, intimacy and sexuality, and which use primarily avoidant defenses (e.g., denial and repression) to cope with psychological conflict and stress. In contrast, introjective psychopathologies are disorders primarily concerned with establishing and maintaining a viable sense of self, ranging from a basic sense of separateness, to concerns about autonomy and control, to issues of self-worth, and that use primarily counteractive defenses (e.g., projection, doing and undoing, intellectualization, reaction formation, and overcompensation). This differentiation, made with acceptable reliability from clinical case reports, related significantly to: (a) different types of outcome in long-term intensive treatment of seriously disturbed young adults, and (b) different response to two forms of therapy—psychoanalysis and psychotherapy. These findings are consistent with recent results from the NIMH Treatment of Depression Collaborative Research Project, which indicate that depressed patients with higher levels of social functioning do better in brief interpersonal therapy, while depressed patients with higher cognitive functioning do better in brief cognitive-behavioral therapy. The results of these three studies indicate the importance of including differentiations among patients in psychotherapy research and the potential value of the anaclitic-introjective distinction in studies of psychotherapy process and outcome.
Empirical evidence shows that treatment failure is a significant problem and one that practitioners routinely overlook. A substantial minority of patients either fail to gain a benefit from the treatments offered to them, or they outright worsen by the time they leave treatment. Intervening in a timely fashion with such individuals cannot occur if practitioners are unaware of which cases are likely to have this outcome.
Prevention of treatment failure describes procedures and techniques that can be used by clinical practitioners and administrators to identify patients who are at risk for treatment failure. The book summarizes evidence that convincingly shows that a shift in routine care is needed, and that such a shift can be accomplished easily through integrating specific methods of monitoring patient treatment response on a frequent basis in routine care. Treatment response is placed in the context of historical views of healthy functioning and operationalized through the use of brief self-report scales. Providing alert-signals to therapists, along with problem-solving tools, is suggested as an evidence-based practice that substantially reduces patient deterioration and increases the chances of the return to normal functioning. The book also provides illustrations on how accumulated data resulting from monitoring patient treatment response can be used to improve systems of care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Relationships of choice are no less important than techniques of choice for effective psychotherapy. A flexible repertoire of relationship styles, plus a wide range of pertinent techniques seem to enhance treatment outcomes. Decisions regarding different relationship stances include when and how to be directive, supportive, respective, cold, warm, tepid, formal, or informal. If the therapist's style differs markedly from the patient's expectations, positive results are unlikely. Two clinical vignettes illustrate different therapeutic styles chosen by the therapist. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Comments on the articles by J. C. Norcross, A. A. Lazarus, R. T. Dolan et al, and L. E. Beutler and A. J. Consoli (see PA, Vols 18399, 18382, 18405, and 18374, respectively) and argues that therapeutic techniques and therapeutic relationships are not and cannot be mutually exclusive: they are inherently interrelated and interdependent. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In order to formulate research hypotheses, designs and procedures, researchers must rely on their prior conceptions of the phenomenon they study. The paradigmatic status of a science depends in part on researchers sharing a common basic image of the central phenomenon. However, psychotherapy researchers have been guided in formulating studies not by one but by four basic images, which represent psychotherapy alternatively (a) as mental health treatment, (b) as personal education, (c) as a reform or correctional process, and (d) as moral or spiritual redemption. The dominant image of therapy as treatment inclines researchers to define process in terms of technique, therapists as professionals trained in the application of techniques, patients as embodiments of psychiatrically diagnosable disorders, and outcome as the end result of a treatment episode. Other formulations of process, therapist, patient and outcome variables are suggested by less explicitly acknowledged images of therapy, engendering confusion among researchers. To repair this situation, the nature and origin of the four basic images of psychotherapy are discussed, their integration into a general research-based model is proposed, and the implications of this “generic” model for the design of future research are explored.
The variance in outcomes for psychotherapy patients is not partitionable into components that are independent contributions of treatments, therapists, and patients. If these inputs did not influence one another over the course of psychotherapy, they could be independent and so have additive main-effects or interaction-effects on outcomes. But that is impossible because they do influence one another and therapists are responsible for actively managing the psychotherapy process by repeatedly adjusting these inputs toward optimally influencing one another. The consequent interdependence of these inputs within the therapy process needs to be reflected in the design and analysis of psychotherapy outcome studies, as it presently is not, if we are to learn who is adequate for treating whom, how, and why so.
This article introduces the issue of the Journal of Clinical Psychology: In Session devoted to evidence-based means of adapting psychotherapy to the patient's (transdiagnostic) characteristics. Practitioners have long realized that treatment should be tailored to the individuality of the patient and the singularity of his or her context, but only recently has sufficient empirical research emerged to reliably guide practice. This article reviews the work of an interdivisional task force and its dual aims of identifying elements of effective therapy relationships (what works in general) and identifying effective methods of adapting treatment to the individual patient (what works in particular). The task force judged four patient characteristics (reactance/resistance, preferences, culture, religion/spirituality) to be demonstrably effective in adapting psychotherapy and another two (stages of change, coping style) as probably effective. Two more patient facets (expectations, attachment style) were related to psychotherapy outcome but possessed insufficient research as a means of adaptation. This special issue provides research-supported methods of individualizing psychotherapy to the person, in addition to his or her diagnosis.
REVIEWS THE CURRENT STATUS OF PSYCHOTHERAPEUTIC RESEARCH, CONCLUDING THAT THE GREATEST NEED IS FOR OUTCOME STUDIES. THE MAJOR VARIABLES AND DOMAINS INVOLVED IN PSYCHOTHERAPY ARE DELINEATED TO SHOW WHERE ERRORS HAVE OCCURRED IN PAST INVESTIGATIONS, AND TO SERVE AS A BASIS FOR DETERMINING THE DEGREE OF CONTROL NECESSARY TO ANSWER THE VARIED QUESTIONS CONCERNING THE PRACTICE OF PSYCHOTHERAPY. STRATEGIC CHOICES FOR ACCUMULATING KNOWLEDGE ARE SUGGESTED IN TERMS OF THE SELECTION OF VARIABLES, CRITERIA, AND ADEQUATE RESEARCH DESIGNS FOR A GIVEN LEVEL OF EMPIRICAL KNOWLEDGE. CONTRARY TO MANY CURRENT VIEWS, THE PRESENT METHODOLOGY OF SCIENTIFIC PSYCHOLOGY IS FELT TO BE ADEQUATE FOR EVALUATING PSYCHOTHERAPY; HOWEVER, THE VALUE OF DIFFERENT RESEARCH APPROACHES FROM CASE STUDIES TO FACTORIAL DESIGNS MUST BE RECOGNIZED AND USED STRATEGICALLY. (2 P. REF.)
History of psychotherapy: Continuity and change
- L. E. Beutler
Clinical handbook of psychological disorders
- J. C. Norcross
- L. E. Beutler
Bergin and Garfield’s Handbook of psychotherapy and behavior change
- S. A. Baldwin
- Z. E. Imel
Persuasion and healing: A comparative study of psychotherapy
- J D Frank
- J B Frank
Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore: Johns
Hopkins University Press.
Handbook of psychotherapy and behavior change
- J. F. Clarkin
- K. N. Levy
The benefits of psychotherapy
- M L Smith
- G V Glass
- T I Miller
- W B Stiles
- L Honos-Webb
- M Surko
Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore: Johns Hopkins University Press.
Stiles, W. B., Honos-Webb, L., & Surko, M. (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice,
5, 439-458.
The rebirth of psychosocial importance in a drug-filled world
- Greenberg
- Norcross
University of Kansas (representing APA Division 17)
- James W Lichtenberg
James W. Lichtenberg, Ph.D., University of Kansas (representing APA Division 17)
American Psychological Association Task Force on Evidence-Based Practice
American Psychological Association Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology.
American Psychologist, 61, 271-285.
How and why are some therapists better than others? Understanding therapist effects
- L Castonguay
- Hill
Castonguay, L., & Hill, C. E. (Eds.). (2017). How and why are some therapists better than others? Understanding therapist effects.
Washington, DC: APA Press.
Evidence-based relationships and responsiveness for depression and substance abuse
- J C Norcross
- L E Beutler
Norcross, J. C., & Beutler, L. E. (2014). Evidence-based relationships and responsiveness for depression and substance
abuse. In Barlow, D. H. (Ed.), Clinical handbook of psychological disorders (5th ed). New York: Guilford.