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

Therapy variables Relationship factors Learning factors Action factors

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

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

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

Estimate of % of Time Spent in Various Activities ProcessCounselingPsychotherapy Listening2060 Questioning1510 Evaluating55 Interpreting13 Supporting510 Explaining155 Informing203 Advising103 Ordering91

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, such as social intimacy, emotional expression, genuineness, and 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 1Empathy: part 1

More therapist variables that matter (empathy continued) What empathy is Ability to be present Barter video: Part 3Part 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 2Part 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 civilizationempathic 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 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

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