the commonalities of psychotherapy
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The commonalities of psychotherapy
Therapy, therapist, and client variables
If the Dodo lives: why does psychotherapy work? (Wampold, 2001)
Common Factors of Psychotherapy(Examples) (Tracey, 2003)
Relationship Factors Client forms an alliance with therapist Client receives warmth and positive regard Client is a partner in therapeutic interaction
Learning Factors Client is provided with information and education Client’s emotional and interpersonal learning is enhanced Client receives feedback in order to gain a more realistic
perspective Action Factors
Client is persuaded to change Client experiences tension reduction Client experiences therapeutic techniques and rituals
Relationship Factors(groundwork for change)
Therapeutic rapport
Therapeutic alliance
Therapist warmth, respect, empathy, acceptance, and genuineness
Learning Factors
Anxiety reduction/arousal
Changing expectations
Affective experiencing
Cognitive learning/insight
Focus on what is adaptive
Action Factors
Advice
Behavioral regulation
Mastery efforts (facing fears, practicing, taking risks)
Working through
Estimate of % of Time Spent in Various ActivitiesProcess Counseling Psychotherapy
Listening 20 60
Questioning 15 10
Evaluating 5 5
Interpreting 1 3
Supporting 5 10
Explaining 15 5
Informing 20 3
Advising 10 3
Ordering 9 1
Do therapist characteristics influence therapy outcomes?
Why do people become counselors/therapists?
Many reasons are positive Some have a desire to help others less fortunate Some want to help prevent people from having difficulties in the
first place Some want to help people reach their full potential
Some are potentially problematic When the person needs to make a difference but has unrealistic
expectations for helping When the person has a need to care for others, he/she may
undermine the client’s autonomy by doing for the client When the person has a need to solve his or her own problems When the person has a need to be powerful or influential
Therapist variables:What matters and what doesn’t?
Some things don’t matter
Therapist’s demographics are unrelated to outcomes (but important to clients)
Therapist’s modality (theoretical orientation)
Therapist’s specific degree (Ph.D. vs Psy.D. vs MSW)
But some things do…
Therapist variables that matter(competence and confidence)
Expertise in specific presenting problems
Acknowledgement of limitations
Commitment to self improvement and staying current
Experience
More therapist variables that matter (interpersonal dimensions) Sensitive to cultural differences
Respects the client’s worldview, personal experience, spirituality, and culture
Has self-awareness: Knows own biases or prejudices (good or bad) and is able to analyze own feelings
Has ability to model appropriate behaviors Social intimacy Emotional expression Genuineness Self-care
Has ability to be altruistic (put client’s needs first)
Is ethical
More therapist variables that matter (personality)
Few therapist personality traits have been studied, but some have
High levels of dominance in a therapist result in better outcomes when the client and therapist were culturally similar, but low-dominance therapists were more effective with culturally dissimilar client
Tolerance for ambiguity
More therapist variables that matter (empathy)
What empathy is not Sympathy: “I'm sorry you’re sad.” Emotional Contagion: “I feel sad too.” Apathy: “I don't care how you feel.” Telepathy: “I read your sadness
without you expressing it to me in any normal way.”
Just listening
Barter video: Empathy: part 1
More therapist variables that matter (empathy continued)
What empathy is Ability to be present
Barter video: Part 3 Ability to recognize,
perceive and, to some degree, directly experientially feel the emotion of another
Ability to convey understanding without judgment
Ability to remove blocks to connection and action Barter video: Part 2
Similar across different treatment modalities
Modest support for Rogers’s contention that they are necessary and sufficient for therapeutic change
Good support for the idea that it is necessary but NOT sufficient (less successful therapists tend to score lower)
Recently became regarded as teachable learnable “skills”
Evidence for an empathic civilization
More therapist variables that matter (empathy continued)
“I see myself in your eyes”
Freedom from personal problems Survey of 749 APA therapists
44% experienced personal problems in the past 3 years
almost 37% said it decreased the quality of therapy
In study of 562 licensed psychologists, more than a third reported emotional exhaustion or “burnout”
Important to recognize tender areas of one’s life. Clients pick up anger, defensiveness, and anxiety
Therapists need to avoid getting entangled in client’s dynamics
Therapy is for the client not the therapist, so the therapist’s emotional needs must be met elsewhere
More therapist variables that matter (emotional health)
Motivation (lightbulb joke)
Degree of patient’s distress (mixed findings; may be curvilinear)
Intelligence: > IQ = better outcomes
Willingness to see problems as psychological
Optimism about therapy
Client variables
Client variables (continued)
Gender, age, race/ethnicity, and social class Gender of client is not related to outcome, but sexism
sometimes an issue Younger clients have a better prognosis (but avoid
ageism!) Ethnic/racial minorities have similar outcomes in
therapy (maybe! – see next slide), but are less likely to seek it and more likely to drop out of it
No relationship between social class and outcome
Average patient change over time for white patients
Average change over time for minority patients
Data from Christopher R. Larrison, Susan L. Schoppelrey, and Samantha Hack-Ritzo
Client-Therapist fit
Who does it? (Demographic characteristics, personality, experience)
How is it done? (Individual vs family vs group, Theoretical orientation)
Whom is it being done to? (Demographic characteristics, Personality)
Psychotherapy is an Art!!!!!…as well as a science
Theories, techniques and methods of psychotherapy are secondary to the clinician knowing what to do for whom.
The Who-How-Whom Factor
Optional Slides
Commonalities of Healing Practices Across Cultures (Frank & Frank, 1991)
Healer: An individual who is culturally sanctioned as a healer and possesses expertise Ex: psychologist, acupuncturist, shaman
Healing Setting: A context in which the healing art is practiced Ex: office, home, religious location
Ritual: A set of procedures that is necessary for the healing process Ex: talk, physical manipulation of the body,
performance Myth: A rationale for the treatment that is
consistent with the ritual Ex: psychodynamic, physiologic, spiritual explanation
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