Articles Introduction to Treatment Methods
Lecture 1:
How important are the common factors in psychotherapy?
Common factors: alliance, empathy, expectations, cultural adaptation and therapist differences
- Specificity (including different treatment differences), specific ingredients, adherence and
competence
Conclusion: common factors are important for producing the benefits of psychotherapy
The contextual model: 3 pathways through which psychotherapy produces benefits
1. The real relationship: the personal relationship between therapist and patient marked
by the extent to which each is genuine with the other and perceives/experiences the
other in ways that benefit the other
- The interaction is confidential
- Disclosure of difficult material does not disrupt the social bond
2. The creation of expectations through explanation of disorder and the treatment
involved:
- Participating in psychotherapy appears to be a form of remoralization
- According to the contextual model, patients come to therapy with an explanation for their
distress, formed from their own psychological beliefs -> folk psychology
- patients believe that the explanation provided and the concomitant treatment actions will
be remedial for their problems -> patient and therapist will need to be in agreement
about the goals of therapy as well as the tasks (alliance)
- Alliance: the degree to which the therapy dyad is engaged in collaborative, purposive
work
3. Specific ingredients (the enactment of health promoting actions)
- Each cogent treatment contains certain well-specified therapeutic actions
- Greytexpectations and a strong alliance is necessary for it
- Therapies with the most potent specific ingredients – will be more effective than others
Before them, an initial therapeutic relationship must be established (deeper bonds of trust and
attachment are required and developed)
- A combination of bottom-up and top-down processing
- The initial interaction between patient and therapist is critical, because more patients
prematurely terminate therapy after the first session than at any other point
Treatments with the most potent specific ingredients will be more effective than others
Evidence:
Alliance: the bond, the agreement about the goals of therapy, and the agreement about the
tasks of therapy
- Correlation between alliance and outcome about 0.27
- Criticism: symptoms, patient’s contribution to the alliance, halo effect
Empathy: therapist expressed empathy is a primary common factor, critical to pathway 1, warm,
caring, empathic interaction within a healing setting is important
Expectations: relationship between rated expectations and outcome
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,Cultural adaptations: evidence-based treatments that are culturally adapted will be more
effective for members of the cultural group for which the adapted treatment is designed
- Adapting evidence-based treatments more effective than unadapted evidence-based
treatments
Therapist effects: the contextual model predicts that there will be differences among therapists
within a treatment
- Modest therapist effects
- Effective therapists are able to form stronger alliances across a range of patients, have a
greater level of facilitative interpersonal skills, express more professional self-doubt, and
engage in more time outside of the actual therapy practicing various therapy skills
Specific effects from dismantling studies: a specific ingredient is removed from a treatment to
determine how much more effective the treatment is in total
- Minimal differences between the total treatment and the treatment without one or more
critical ingredients
- Adding an ingredient to an existing treatment increased the effect for targeted variables
by a small amount
Adherence and competence: for cases where the therapist followed the protocol and did so
skillfully, there should be better outcomes, but this is not the case
- Rigid adherence to a protocol can attenuate the alliance and increase resistance to the
treatment
Common factors must be considered therapeutic and attention must be given to them
Criticisms of the common factors: they are an atheoretical collection of commonalities
Lecture 2:
Client-centered therapy
Client-centered therapy: Rogers’ way of working with persons experiencing all types of personal
disturbances or problems in living
Rogers’ theory of therapy: people posses resources of self-knowledge and self-healing, and
that personality change and development are possible if a definable climate of facilitative
conditions is present
Some persons and environments foster growth and development in human beings, and some
undermine and inhibit growth
Actualizing tendency: the organism’s motivation to realize and enhance inherent potentials
(potato example)
Congruence: a state of wholeness and integration within the therapist, theorized to emerge
from the therapist’s self-acceptance and positive self-regard, and from the evolving capacity for
self-awareness free from inner censorship
Unconditional positive regard: a condition that exists upon a continuum, we are sometimes
conditional in our regard for the client, but strive to realize greater and greater acceptance in the
relationship
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,Empathic understanding of the client’s frame of reference: entering the private, perceptual world
of the other and becoming thoroughly at home in it, temporarily living their life, moving about in it
delicately without making judgments, sensing meanings of which they are scarcely aware, but
not trying to uncover feelings of which the person is totally unaware, since this would be too
threatening
Nondirective attitude: no other goals than to empathize and understand (not active listening)
- Results in a profound respect for the client and for the client’s own choices and
self-direction
Only acceptable goals in client-centered therapy relate to the therapist’s ability to realize the
therapeutic attitudes of congruence, unconditional positive regard, and empathic understanding
of the internal frame of reference of the client
“When the situation is most difficult, that’s when a client-centered approach is most needed and
what is needed there is a deepening of the therapeutic attitudes and not trying something more
technique-oriented”
Rogers’ theory of change: necessary and sufficient conditions for psychotherapeutic
personality change
- 30% of the variance in outcome can be attributed to “common factors” which includes
the relationship, with 40% relating to client factors such as social learning, 15% relating
to specific techniques, and 15% reflecting expectancy or hope for the success of therapy
(aka alliance)
Clients in client-centered therapy sometimes set personal goals and make progress toward
fulfilling those goals without any direction by the therapist
- Aims: strengthening the personal authority of the client as a knower and reliable creator
of personal meanings, beliefs, ideas, and whose own inner experiencing can be trusted
as a guide for living
Clients in client-centered therapy become more self-assertive, more confident in their own
frames of reference, more capable of risk-taking, more open to experiencing, more empathic
toward others
Homework:
Non-directive if request from the client for homework from the therapist
Categories not addressed by homework:
- Sexual abuse
- Learning disorders
- Delusions and hallucinations
Client-centered therapists place trust in the client as the person who decides whether or not the
kind of change produced by psychotherapy is worth the inevitable injuries to self involved in
even the most sensitive and carefully nondirective relations
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, Emotion-focused therapy: The transforming power of affect
Aka experiential therapy
Views emotions as centrally important in the experience of self, in both adaptive and
maladaptive functioning, and in therapeutic change
- Following and guiding the client’s experiential process, and emphasizes the importance
of both relationship and intervention skills
- Emotion as the fundamental datum of human experience
EFT humanistic-phenomenological principals:
1. Experiencing is the basis of thought, feeling and action
2. Human beings are fundamentally free to choose how to construct their worlds
3. People function holistically while at the same time are made up of many parts, or
self-organizations, each of which may be associated with quite distinctive thoughts,
feelings and self-experiences
4. People function best and are best helped by a therapist who is psychologically present
and who establishes an interpersonal environment that is empathic, unconditionally
accepting, and authentic
5. People grow and develop to the best of their abilities in supportive environments
Emotion schemes are seen as the main source of experience
Emotion schemes can be organized into four distinct classes of emotional response
1. Primary adaptive emotion responses: immediate emotional responses to a situation
that help an individual take appropriate action (anger helps set boundaries)
2. Primary maladaptive emotion responses: also immediate, but involve over-learned
responses from previous, often traumatic, experiences, once useful
3. Secondary emotional responses: emotional reactions to primary emotional
experiences (feeling afraid and then feeling shame about being afraid)
4. Instrumental emotion responses: emotional responses that are used to influence and
control others, may not be deliberate or conscious
Each class of emotional response is worked with in a different fashion
Principles of emotional change:
- Awareness: most fundamental
- Regulation
- Reflection
- Transformation: client accesses a new emotional state in the session that un-does the
maladaptive emotion, maladaptive emotion schemes must be activated in the therapy
session before they can be changed by accessing other more adaptive emotions
- Relational environment: therapist is fully present, unconditionally accepting, empathic,
and genuine, therapist tries to make psychological contact with and convey a genuine
understanding of the client’s internal experience
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