Laura C/ Tilburg University/ 2023-2024
Introduction to
Treatment Methods
-mini summary-
This document summarizes the key concepts from the required course materials, focusing on the scientific
papers.
,Laura C/ Tilburg University/ 2023-2024
Lecture 1. Common factors in psychotherapy
Wampold, B. E. (2015). How important are the common factors in
psychotherapy? An update. World Psychiatry, 14(3), 270-277.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/
- psychotherapy seems to work through general factors present
across different approaches, rather than the specific techniques of each
therapy
- traditionally, research compared different therapies to see which was "better.";
however, many therapies show similar results, leading researchers to explore common
factors as the reason for improvement
- common factors- underlying mechanisms that contribute to positive change in
therapy, regardless of the specific techniques used; they are believed to be related to
both the patient and therapist
- contextual model- model proposes three pathways through which psychotherapy
produces benefits:
o real therapeutic relationship: a strong bond between therapist and client is
crucial for progress
o positive expectations: explaining the therapy and disorder helps build client
belief in its effectiveness
o enacting healthy behaviors: therapy encourages clients to take actions that
promote their well-being
the real relationship: this emphasizes the unique bond between therapist and patient built on
genuineness and understanding; unlike most social interactions, therapy allows for open and
honest communication without fear of damaging the relationship
expectations: patients often have unhelpful beliefs about their problems. therapy offers
alternative explanations and strategies, fostering the belief that they can improve; agreement
on therapy goals and activities between therapist and patient is crucial
enacting healthy behaviours: different therapy approaches use specific techniques to create
positive changes in patients; these techniques can involve reframing negative thoughts,
improving relationships, or accepting oneself; all have the purpose to change the behaviour of
the patient towards a healthier and more helpful one
Evidence for various common factors
alliance
empathy
expectations
therapist effects
cultural adaptation of evidence-based treatments
treatment differences
adherence and competence
alliance
- strong alliance between therapist and patient is linked to better outcomes in therapy;
this connection is more likely due to therapist's contribution than the patient's.
- alliance seems to be important across various therapy models.
,Laura C/ Tilburg University/ 2023-2024
empathy
- therapist's ability to understand and share the patient's emotions is crucial; studies
show a positive correlation between therapist empathy and positive outcomes.
- it might be easier for therapists to be empathetic towards motivated patients, but
empathy likely still plays a role in all therapeutic relationships
expectations
- therapist helps patients develop positive expectations about therapy's effectiveness.
- research suggests a weak but positive correlation between expectations and outcomes;
measuring expectations can be difficult because they can change throughout therapy
cultural adaptation
- tailoring therapy explanations and techniques to a patient's cultural background
improves outcomes; this can involve using the patient's language, matching cultural
backgrounds, or incorporating cultural rituals.
therapist effects
- some therapists seem to achieve better results consistently, regardless of specific
treatment methods; therapist characteristics like strong alliance-building skills and
self-doubt might contribute to better outcomes.
- therapist effects are likely more pronounced in real-world settings compared to
controlled studies
Specific effects
- the contextual model contends that all therapies with structure, given by empathic and
caring therapists, and which facilitate the patient’s engagement in behaviours that are
salubrious, will have approximately equal effects
- today, there are claims that some treatments, in general or for specific disorders, are
more effective than others; others, however, claim that there are no differences among
psychotherapies, in terms of their outcomes
o treatment differences: there are disagreements about whether specific therapies are
more effective for certain disorders or if all therapies are equally effective
o dismantling studies: these studies aim to isolate the effects of specific therapy
components by removing them and comparing outcomes; this is considered the
best way to assess specific effects
o adherence and competence: ideally, therapists should follow treatment protocols
(adherence) and deliver them skilfully (competence)
rigid adherence can weaken the therapeutic alliance and increase patient
resistance; flexible adherence seems to be more beneficial
therapist competence in delivering specific techniques isn't strongly linked to
outcomes; therapist qualities like empathy and alliance-building, which aren't
measured in competence ratings, seem to be more important
,Laura C/ Tilburg University/ 2023-2024
Lecture 2. Client-centered psychotherapy and
emotion-focused therapy
Carl Roger’s client-centred therapy
Witty, Marjorie. (2007). Client-Centered Therapy. Chapter 2 (page 35-
48)
https://link.springer.com/content/pdf/10.1007%2F978-0-387-29681-4.pdf
- core beliefs of the client-centered therapy:
o people have an innate drive for self-improvement ("actualizing tendency").
o a supportive environment can foster this growth.
o therapists should trust clients' ability to heal themselves
- the client-centered therapy relies on three core conditions for change:
o congruence (genuineness): therapist is transparent and authentic.
o unconditional positive regard: therapist accepts the client fully, without
judgment.
o empathic understanding: therapist deeply understands the client's perspective
Nondirective approach
- therapists avoid giving advice or setting goals
- the focus is on creating a safe space for clients to explore their own experiences
- therapists use active listening and reflection to help clients gain clarity
Rogers' theory of self
- Rogers proposed that the self has three key components:
o real self (self-worth): this refers to our innermost feelings of worth and value,
formed in early childhood based on experiences and interactions with caregivers.
o perceived self (self-image): this is how we see ourselves in the present moment,
including our strengths, weaknesses, and personality traits.
o ideal self: this represents our aspirations and goals for who we want to become.
it's dynamic and can change over time
congruence vs. incongruence
- incongruence: when there's a significant gap between the real self, perceived self,
and ideal self, it creates psychological tension and distress; this can happen if we deny
our true feelings, or if our self-image is far from our ideal.
,Laura C/ Tilburg University/ 2023-2024
- congruence: when these three aspects of the self are aligned, we experience a sense
of inner peace and well-being; the real self feels accepted by the perceived self, and
both are moving towards the ideal self
- the goal of client-centered therapy is to help clients achieve congruence: this is done
by creating a safe and supportive environment where clients can explore their
experiences and feelings without judgment; through this process, clients can gain a
more accurate understanding of their real self, accept themselves fully, and move
closer to their ideal self
Roger’s theory of change
- Rogers proposed six necessary and sufficient conditions for therapeutic change to
occur; these create a safe and supportive environment:
1) psychological contact: therapist and client connect and build a relationship
2) client incongruence: client experiences distress due to a disconnect between their
ideal self and perceived reality
3) therapist congruence: therapist is genuine and authentic
4) unconditional positive regard: therapist fully accepts the client without judgment
5) therapist empathy: therapist deeply understands the client's perspective
6) communication of empathy and regard: therapist conveys these attitudes to the
client
- when these conditions are met, the client feels understood and accepted; this fosters:
o self-exploration: client explores their experiences in a safe space
o self-acceptance: client begins to accept themself, reducing incongruence
o growth: client moves towards their ideal self and experiences positive change
Means and ends in therapy
- client-centered therapy aims to empower clients to trust their own judgment and
create their own meaning in life; this translates to increased self-confidence,
assertiveness, risk-taking, and empathy for others
- the therapist avoids giving advice, assigning homework, or influencing the client in
any way; this fosters trust in the client's own experience as a guide
! exceptions are made if the client specifically asks for homework or advice
Client-initiated change
- therapists are open to answering client questions and offering additional resources if
requested
- ideally, therapy helps clients become more autonomous and self-directed; setting
goals for clients (which might lead to offering homework and advice) could be
counterproductive (it might create dependency and undermine client confidence)
- still, if the client asks for homework, exercises to do between sessions or other type of
information, a client-centered therapist will provide the necessary knowledge
,Laura C/ Tilburg University/ 2023-2024
Emotion-focused therapy1
Pos, A. & Greenberg, L. (2007). Emotion-focused therapy: The transforming power of affect.
Journal of Contemporary Psychotherapy, 37, 25-31.
Elliott, R., & Greenberg, L.S. (2016). Humanistic-experiential psychotherapy in
practice: Emotion-focused therapy. In A.J. Consoli, L.E. Beutler, & B. Bongar (eds.),
Comprehensive textbook of psychotherapy: Theory and practice (2nd ed.). New York:
Oxford University Press. In press version, page 1-13.
- EFT is a therapy approach based on the importance of emotions in human experience;
emotions are seen as having a natural purpose, guiding us towards meeting our needs
and promoting survival and well-being; negative emotions can become problematic,
but by understanding and processing them, clients can achieve positive change
- EFT helps clients:
o identify and experience their emotions more fully
o explore and understand the meaning behind their emotions
o transform and manage their emotions in a healthy way
this process helps clients access valuable information about themselves and
the world, leading to a more fulfilling life
- EFT draws on several humanistic principles:
o experience is the foundation of thought, feeling, and action
o people have the freedom to shape their own understanding of the world
o humans are complex wholes, made up of different aspects that can have unique
thoughts and feelings
o therapists who are present, empathetic, accepting, and genuine create the best
environment for growth
o supportive environments foster optimal development
Emotion Schemes
- EFT focuses on "emotion schemes" as the core of our emotional experience- these
schemes are automatic patterns that quickly generate emotions without us fully
realizing it; we can't directly access the schemes themselves, but we can understand
them by reflecting on the emotions they produce
- EFT categorizes emotional responses into four types:
1
EFT is sometimes referred to as process-experiential therapy (PE)
, Laura C/ Tilburg University/ 2023-2024
o primary adaptive: immediate, healthy emotional responses that help us take
appropriate action (e.g., feeling fear in a dangerous situation).
o primary maladaptive: immediate, but unhelpful emotional responses learned
from past experiences (e.g., feeling intense shame for feeling fear).
o secondary emotional responses: emotions triggered by our initial emotional
experience (e.g., feeling ashamed of feeling afraid).
o instrumental emotion responses: emotions used to manipulate or control others
(e.g., guilt-tripping someone)
- from the EFT perspective, change occurs by means of:
o awareness
o regulation
o reflection
o transformation of emotion taking place within the context of an empathically
attuned relationship
- in EFT, the therapist is fully present, unconditionally accepting, empathic, and
genuine
- EFT therapists use client behaviours and statements in therapy sessions (markers) to
identify underlying emotional issues.
common markers include:
o confusion or lack of clarity about emotions
o conflicting emotions or self-criticism
o difficulty expressing emotions fully
o unresolved feelings towards others
o vulnerability or shame
- identifying these markers helps therapists:
o understand how emotional processing problems contribute to client difficulties
o set focused treatment goals
o choose appropriate interventions tailored to the specific marker
- EFT interventions aim to:
o help clients access their underlying emotions (primary feelings).
o in severe cases, expose maladaptive emotion schemes to healthier emotions.
o as therapy progresses, therapists make finer distinctions between different types of
emotions (e.g., primary vs. secondary, adaptive vs. maladaptive)
- by addressing emotional processing problems, EFT helps clients experience their
emotions more fully and develop healthier emotional responses
Phases of treatment in emotion-focused therapy:
- phase 1: bonding and awareness
therapist establishes a safe and supportive environment
therapist explains the value of working with emotions in therapy
client learns to approach, value, and regulate their emotions
therapist and client collaboratively identify the client's core pain and underlying issues
- phase 2: evocation and exploration
therapist helps client experience and explore deeper emotions
therapist assesses client's readiness for emotional experiences
