Chapter 14Intervention: Identifying Key Elements of Change

INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE

PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO

Topics

2

What Works for Whom, and When?Process and Process-Outcome Research

Common Factors in PsychotherapyThe Therapeutic AlliancePsychotherapy EquivalenceEmpirically Supported Therapy Relationships

Process research and process-outcome research:

Understanding what specifically causes effective outcomes within psychotherapy

Note that not all therapy is effective for all people

Effective therapy does not always indicate how it was effective

Research can look at any time frame: seconds, minutes, days, weeks, etc.

What Works for Whom, and When?

Example – Viewpoint Box 14.1 Looking closely at client outcome, Tang &

DeRubeis (1999) noted that many patients make sudden gains around sessions 4-6

Important to consider: Client factors (aspects about each specific client) Therapist factors (aspects about the specific

therapist) Treatment factors (aspects about the treatment

given)

Process and Process-Outcome Research

Client Factors that Influence Treatment: Sociodemographic Characteristics

Client Factors:Psychological Functioning

Client Factors:Personality Characteristics

Therapist Factors – Findings Limited findings on effect of ethnicity of therapist

on outcome Age, gender unrelated to outcome Therapists trained in mental health have better

outcomes than general health practitioners Inconclusive differences on sub-mental health

fields (clinical psych, social work, marriage and family counsellors, etc.)

Process and Process-Outcome Research

Therapist Factors that Influence Treatment:Sociodemographic Characteristics

Therapist Factors that Influence Treatment: Professional Background

Therapist Factors that Influence Treatment: Personality Characteristics

Examining Treatment Factors

Treatment Factors – Findings Note that when all patients are grouped together

there are not differences in directiveness, insight, or symptom reduction

Between-session assignments do not increase the effectiveness of therapy, but for treatments that require them (e.g., CBT) whether a client does the homework is predictive of success

Treatment Factors

Several ways to define common factors

Jerome Frank’s (1973) model of role of a healer in society

Weinberger (1995) factors noted: Therapeutic relationship Client expectations Confronting problems in therapy Client’s sense of mastery Client’s attribution for outcome

Common Factors in Psychotherapy

Lambert and Ogles’ three factors (support, learning and action)

Support Factors Reducing isolation Providing reassurance Therapeutic alliance Therapist expertise Therapist respect, empathy Acceptance, warmth Catharsis

Common Factors in Psychotherapy

Lambert and Ogles’ three factors (support, learning, and action)

Learning Factors Advice Cognitive learning Emotional experiencing Insight Feedback Exploration of assumptions Beliefs, expectations

Common Factors in Psychotherapy

Lambert and Ogles’ three factors (support, learning, and action)

Action Factors Practice Modeling Reality testing Facing fears Working through issues Development of mastery Behavioral regulation

Common Factors in Psychotherapy

Integrative treatment models have developed from this research

One factor has been most consistently linked to positive outcome: therapeutic alliance – the quality and strength of the therapist-client relationship

Common Factors in Psychotherapy

Positively related to treatment outcome for adults and adolescents

Can be assessed by client, therapist or an independent rater

Importance of understanding correlation does not equal causation

The Therapeutic Alliance

Dodo Bird Effect: term used when psychotherapy orientations are systematically compared there are no clear differences

Some differences exist in some studies (particularly meta-analyses when certain studies are grouped), or when looking at client or therapist differences

Psychotherapy Equivalence

Important concepts: Alliance and cohesion: importance of a good

working relationship Empathy: the ability to understand another

person’s experience Goal consensus and collaboration: importance

of patient and therapist agreeing upon treatment goals

Reactance/resistance and impairment: changing the directiveness and frequency based on the client

Empirically Supported Therapy Relationships

Some important concepts Client variables that might decrease benefits:

impairment, Axis II, unfavourable expectations

Helpful relational conditions: the formation of a therapeutic alliance

Helpful therapist behaviours: empathy, collaboration, authenticity, skillful

Intervention targets: interpersonal issues, problematic cognitions, maladaptive emotions & behaviours

Empirically Based Principles of Change

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