The commonalities of psychotherapy Therapy, therapist, and client variables

Therapy variables Relationship factors Supportive factors (groundwork for change) Therapist warmth, respect, empathy, acceptance, and genuineness Therapist expertness Therapeutic alliance Anxiety reduction and tension release Learning factors Affective experiencing Changing expectations Cognitive learning/insight Focus on what is adaptive Action factors Advice Behavioral regulation Mastery efforts (facing fears, practicing, taking risks) Working through

Why do people become counselors/therapists? Many reasons are positive Most believe they can really help people Some have a desire to help those that are 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 negative and potentially problematic When a counselor needs to make a difference but has unrealistic expectations for helping When a counselor has a need to care for others, the counselor may undermine the client’s autonomy by doing for the client When the counseling student has a need to solve his or her own problems When the counselor has a need to be powerful or influential

Therapist variables: What matters and what doesn’t Some things don’t matter Therapist demographics unrelated to outcomes (but important to clients) The modality (theoretical orientation) of therapist not important The specific degree (e.g., Ph.D. vs Psy.D. vs MSW) not important Some things do 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 Competence and confidence Expertise in specific presenting problems Acknowledgement of limitations Commitment to self improvement and staying current

Therapist variables: The things that matter (continued) Empathy What exactly is it?  The ability to be sensitive, empathic, and patient  The ability to convey understanding without judgment  The ability to convey to the client that the counselor values the client’s experiences  The ability to convey the belief that the client is capable, trustworthy, respectable, worthy and dependable 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 they are necessary but NOT sufficient, as less successful therapists tend to score lower Recently became regarded as teachable learnable skills

Therapist variables: The things that matter (continued) Freedom from personal problems Survery 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

Therapist interpersonal dimensions that affect outcomes Is sensitive to cultural differences Respects the client’s worldview, personal experience, spirituality, and culture Has self-awareness and knows his or her own biases or prejudices (good or bad) and is able to analyze his or her own feelings Has the ability to model appropriate behaviors Social intimacy Affect Genuineness Self-care Has the ability to be altruistic (put client’s needs first) Is ethical Is experienced Has the ability to use oneself as a vehicle of change

Client variables Motivation (the lightbulb joke) Degree of patient’s distress (mixed findings; may be curvilinear) Intelligence (> IQ = better outcomes) Openness (willingness to see problems as psychological, optimism about therapy) Gender, age, and race/ethnicity, and social class Gender of client is not related to outcome, but is sexism an issue? Younger clients have a better prognosis (but avoid ageism!) Ethnic/racial minorities have similar outcomes in therapy, but are less likely to seek it and more likely to drop out of it No relationship between social class and outcome

Client-Therapist fit Demographic Personality Theoretical orientation