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 (Tracey, 2003)
Relationship Factors
Client forms an alliance with therapist
Client receives warmth and positive regard
Client is a partner in therapeutic interaction
Other Common Factors
Client experiences tension reduction
Client is persuaded that change is necessary
Client is provided with information and education
Client receives feedback to gain a more realistic perspective
Client experiences therapeutic techniques and rituals

4. Relationship Factors (groundwork for change)
Therapeutic rapport
Therapeutic alliance
Therapist warmth, respect, empathy, acceptance, and genuineness

5. Other Common Factors Anxiety reduction/arousal Changing expectations
Affective experiencing
Cognitive learning/insight
Focus on what is adaptive

6. Other Common Factors (cont.)
Listening, questioning, advising, interpreting, etc. (see next slide)
Mastery efforts
Facing fears
Practicing
Taking risks
Working through

7. Estimate of % of Time Spent in Various Activities
Process
Counseling
Psychotherapy
Listening 20 60
Questioning 15 10
Evaluating 5
Interpreting 1 3
Supporting
Explaining
Informing
Advising
Ordering 9

8. Do therapist characteristics influence therapy outcomes?

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)
So-called “cultural competence”
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
Social intimacy
Emotional expression
Genuineness
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 [quiz yourself]

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 either verbally or non-verbally.
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 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

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, 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. Data from Christopher R. Larrison, Susan L
Data from Christopher R. Larrison, Susan L. Schoppelrey, and Samantha Hack-Ritzo
Average patient change over time for white patients
Average change over time for minority 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, experience)
How is it done? (Individual vs family vs group, Theoretical orientation)
Whom is it being done to? (Demographic characteristics, Personality)