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The commonalities of psychotherapy

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

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The commonalities of psychotherapy

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  1. The commonalities of psychotherapy Therapy, therapist, and client variables

  2. If the Dodo lives: why does psychotherapy work? (Wampold, 2001)

  3. 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

  4. Therapy variables • Relationship factors • Learning factors • Action factors

  5. Therapy variables • Relationship factors (groundwork for change) • Therapeutic rapport • Therapeutic alliance • Therapist warmth, respect, empathy, acceptance, and genuineness

  6. Therapy variables (cont.) • Learning factors • Anxiety reduction/arousal • Changing expectations • Affective experiencing • Cognitive learning/insight • Focus on what is adaptive

  7. Therapy variables (cont.) • Action factors • Advice • Behavioral regulation • Mastery efforts (facing fears, practicing, taking risks) • Working through

  8. Estimate of % of Time Spent in Various Activities

  9. 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

  10. 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…

  11. Therapist variables that matter(competence and confidence) • Expertise in specific presenting problems • Acknowledgement of limitations • Commitment to self improvement and staying current • Experience

  12. 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, such as social intimacy, emotional expression, genuineness, and self-care • Has ability to be altruistic (put client’s needs first) • Is ethical

  13. 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

  14. 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

  15. 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

  16. More therapist variables that matter (empathy continued) • 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 “I see myself in your eyes”

  17. More therapist variables that matter (emotional health) • 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 a study of 562 licensed psychologists, more than a third reported emotional exhaustion (often called 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

  18. Client variables • 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

  19. Client variables (continued) • Gender, age, and 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

  20. Prepared by Christopher R. Larrison, Susan L. Schoppelrey, and Samantha Hack-Ritzo and funded by the National Institute of Mental Health. The project was approved by the Institutional Review Board at University of Illinois at Urbana-Champaign Average change over time for minority patients Average patient change over time for white patients

  21. Client-Therapist fit 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 • Who does it?(Demographic characteristics, Personality) • How is it done?(Individual vs family vs group, Theoretical orientation) • Whom is it being done to?(Demographic characteristics, Personality)

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