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