What are the Core Tasks of Psychotherapy? A Presentation for the 2013 Evolution of Psychotherapy...

Expertise and Psychotherapy:Expertise and Psychotherapy:Core Tasks

Scott D. Miller, Ph.D.International Center for Clinical Excellence

The Evolution of Psychotherapy:The Evolution of Psychotherapy:

•Since the 1960’s:

•Number of treatment

approaches grown from 60 to

400+;

So, what’s happened?

400+;

•10,000+ “how to” books

published on psychotherapy;

•145 manualized treatments for

51 of the 297 possible diagnostic

groups in DSM.

Duncan, B., Miller, S., Wampold, B., & Hubble, M. (eds.) (2009). The Heart and Soul of Change: Delivering What Works.

Washington, D.C.: APA

Miller, S.D., Hubble, M.A., Chow, D.L., & Seidel, J.A. (2013). The outcome of psychotherapy: yesterday, today, and

tomorrow. Psychotherapy, 50, 88-97.

Wampold, B.L. (2001). The great psychotherapy debate. Mahwah, NJ: LEAPress.

•In most studies of treatment conducted over the

last 40 years, the average treated person is better

off than 80% of the untreated sample.

•No difference in outcome between treatment

The Evolution of Psychotherapy:The Evolution of Psychotherapy:Progress

•No difference in outcome between treatment

approaches;

•Taken together, comparative, component

(dismantling), mediating variable, & aptitude-by-

treatment studies all show that specific ingredients

are NOT needed to achieve a good outcome.

Duncan, B., Miller, S., Wampold, B., & Hubble, M. (eds.) (2009). The Heart and Soul of Change: Delivering

What Works. Washington, D.C.: APA Press.


“Decades of psychotherapy

research have failed to find

a scintilla of evidence that

Progress ?

a scintilla of evidence that

any specific ingredient is

necessary for therapeutic

change.”

Ahn, H., & Wampold, B. (2001). Where oh where are the specific ingredients: A meta-analysis of

component studies in counseling and psychotherapy. Journal of Counseling Psychology, 48(3), 251-257.

Duncan, B., Miller, S.D., Wampold, B., & Hubble, M. (2009). The Heart and Soul of Change: Delivering

What Works in Therapy. APA: Washington, D.C.

Wampold, B. (2001). The Great Psychotherapy Debate. Mahwah, N.J.: LEA, 204.


Factor # Studies # Patients Effect Size d % of variability in

outcomes

Common Factors

Alliancea 190 2630 .57 .075

Empathya 59 3599 .63 .090

Goal Consensus/collaborationa 15 1302 .72 .115

Positive Regard/Affirmationa 18 1067 .56 .073

Congruence/Genuinessa 16 863 .49 .057

Specific Ingredients

Differences between treatmentsb 295 >5900 <.20 <.010

Adherence to protocolc 28 1334 .04 <.001

Rated competence in delivering

particular treatment

18 633 .14 .005

aNorcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy,

48(1), 4-8. doi: 10.1037/a0022180bWampold, B. E. (2001b). The great psychotherapy debate: Model, methods, and findings.

Mahwah, NJ: Lawrence Erlbaum Associates.cWebb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S.

(2011). Two aspects of the therapeutic alliance: Differential relations with depressive symptom

change. Journal of Consulting and Clinical Psychology, 79(3), 279-283. doi: 10.1037/a0023252


Factor # Studies # Patients Effect Size d % of variability in

outcomes

Common Factors

Alliancea 190 2630 .57 .075

Empathya 59 3599 .63 .090

Goal Consensus/collaborationa 15 1302 .72 .115

What Does Make a Difference ?

Positive Regard/Affirmationa 18 1067 .56 .073

Congruence/Genuinessa 16 863 .49 .057

Specific Ingredients

Differences between treatmentsb 295 >5900 <.20 <.010

Adherence to protocolc 28 1334 .04 <.001

Rated competence in delivering

particular treatment

18 633 .14 .005

aNorcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy,

48(1), 4-8. doi: 10.1037/a0022180bWampold, B. E. (2001b). The great psychotherapy debate: Model, methods, and findings.

Mahwah, NJ: Lawrence Erlbaum Associates.cWebb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S.

(2011). Two aspects of the therapeutic alliance: Differential relations with depressive symptom

change. Journal of Consulting and Clinical Psychology, 79(3), 279-283. doi: 10.1037/a0023252

•Baldwin et al. (2007):

•Study of 331 consumers, 81

clinicians.


Baldwin, S., Wampold, B., & Imel, Z. (2007). Untangling the Alliance-

Outcome Correlation. Journal of Consulting and Clinical Psychology, 75(6),

842-852.

clinicians.

•Therapist variability in the

alliance predicted outcome.

•Consumer variability in the

alliance unrelated to

outcome.

•Despite the evidence:•Training continues to emphasize

model and technique;

•Therapists firmly believe that the

expertness of their techniques leads


expertness of their techniques leads

to successful outcomes;

•The field as a whole is continuing

to embrace the medical model.

•Emphasis on so-called, “empirically

supported treatments” or “evidence

based practice.”

•Embracing the notion of diagnostic

groups, treatment specificity.

Eugster, S.L. & Wampold, B. (1996). Systematic effects of participants role on

the evaluation of the psychotherapy session. Journal of Consulting and Clinical

Psychology, 64, 1020-1028.

The Evolution of Psychotherapy:The Evolution of Psychotherapy:What are the “Core Tasks” of Therapy?


•What is the core task

A New Question and Focus

“…the most important

determinant of

Miller, S.D., Hubble, M.A., Chow, D.L., & Seidel, J.A. (2013). The outcome of psychotherapy: yesterday, today, and

tomorrow. Psychotherapy, 50, 88-97.

•What is the core task

of psychotherapists?

Engagement

determinant of

outcome…[this] can

be considered fact

established by 40-

plus years of research on psychotherapy.”

Orlinsky et al. (2005). Process and outcome in psychotherapy. In M.J. Lambert (ed). The Handbook of Psychotherapy

and Behavior Change (5th ed.). New York: Wiley.

Understand,

Affirm,

Be Congruent, Genuine, &

Engagement

Be Congruent, Genuine, &

Collaborative,

Seek Consensus

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