Predictors of sustained therapeutic change Some thoughts about conceptualizations.pdf (original) (raw)
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We offer a critical and constructive appraisal of the conclusions provided by the Interdivisional (American Psychological Association [APA] Divisions 12 & 29) Task Force on Evidence-Based Therapy Relationships. We highlight problems in overlapping terminology and definitions, as well as problems in the conduct of its meta-analyses (i.e., duplication of studies between reviews, inappropriate study inclusion , and use of measures of specific constructs for the calculation of effects for multiple relationship elements). On this basis, we express reservation about the conclusions offered by the APA Task Force. This special issue explores whether there are other therapeutic relationship elements that warrant consideration and further study. We were particularly interested in those elements that showed promise based on empirical or theoretical grounds, and in each article, we asked for an account of how the case formulation would guide the methods of adaptation for each individual client, and how the element would contribute to clinically relevant changes. C 2015 Wiley Periodicals, Inc. J. Clin. Psychol.: In Session 71:1–5, 2015.
Frontiers in Psychology, 2010
In Lambert's opinion (2005), "common factors are those dimensions of the treatment setting (therapist, therapy, client) that are not specific to any particular technique. Research on the broader concept of common factors investigates causal mechanisms such as expectation for improvement, therapist confidence, and a therapeutic relationship that is characterized by trust, warmth, understanding, acceptance, kindness, and human wisdom. But also can be expanded to include some mechanisms that are often regarded as unique to a particular form of treatment such as exposure to anxiety-provoking stimuli, encouragement to participate in other risk-taking behavior (facing rather than avoiding situations that make the patient uncomfortable), and encouraging client efforts at mastery such as practicing and rehearsing behaviors. Such a view of common factors recognizes that while specific theories of psychotherapy may emphasize systematic in vivo or in vitro exposure to frightening situations, or social-skills training, nearly all therapies encourage people to review and discuss the things they fear and face rather than avoid such situations. Common factors, no matter how unimportant they may be from the point of view of a particular theory (theoretically inert or trivial) are central to nearly all psychological interventions in practice, if not, theory" (p. 856, 2005).
Clinical Psychology Review, 1997
Sixty-three m-eta-analyses of psychotherapeutic intmentim are reviewed to examine what we have learned from them about the causal nature, magnitude, and generalizability of psychotherapy e&k Despite the large number of meta-anat@es o!emonstrating specfic and nonspec@ causal effects of psychotherapeutic interventions, limitations in outcome studies and in n&a-analytic rtz&ws currents @event usfirn drawing stronggeneralized inferences about the magnitude of effects, conditions that moderate their size, and variables that mediate therapy effects. There is mounting evidence suggesting that biases associated with individual studies do not cancel each other out when studies are combined meta-analytically, leading to in$ated mean effect estimates fM-some interventions, diagnoses, and outwmes, and akflated estimates for others. There is currents little agreement in the reviewed metaanalyses concerning the limits of the apparent robustness of intervention effects, and variables considered as potential moderators of psychotherapy effects are@equently confounded with other study characteristics. Moreovq genera&ability of psychotherafi effects to major target universes (e.g., clinical practice settings, African-American and Latin0 pop!ations) is com@nnised by the predominance of efjicaq studies conducted in controlled research settings on Anglo populations. Future directions fm meta-anat$es of &&otherafi outcome studies are discussed. 0 1997 Etsevier Science Ltd DURING THE LAST 20 years, meta-analysis has become a popular and methodologically sophisticated technique for quantitatively summarizing findings from a large body of empirical research. Major professional journals in the social and health sciences in Australia, Europe, and North-America publish meta-analytic reviews. Textbooks on meta-Correspondence should be addressed to Ceorg E. Matt, instance, for recent comprehensive reviews of the psychotherapy outcome and process literature. Similarly, for a comprehensive examination of meta-analyses of educational, behavioral, and psychological interventions see Lipsey and Wilson (1993).
Evidence-based assessment in a transtheoretical and paradigmatic approach
Current Issues in Personality Psychology, 2017
Evidence-based practice (EBP) is a defined proposal for how to integrate science and clinical practice that treats scientific evidence, particularly the results of empirical research, as a source of clinically useful and highly objective knowledge. We assume that the principles and standards of clinical practice defined in EBP have resulted in the emergence of many trans-theoretical models, but have also significantly influenced the credibility of practice derived from paradigmatic approaches. The aim of the article is to share our reflections on two issues: 1) What clinical problems arise in non-standard situations in the application of evidence-based practice for the best clinical outcomes for a patient with mental health problems? 2) What methods of integrating patient data are used by clinical psychologists in a transtheoretical and paradigmatic approach in differential (assessment), structural-functional and epigenetic (case formulation) diagnosis? In connection with developed standards for diagnosis and the effectiveness of psychotherapy, we consider EBP particularly relevant for the theory and practice of clinical psychology.
PSYCHOLOGIA, 2013
Empirically supported treatments have brought much enthusiasm for establishing a firm empirical basis for clinical practice. However controversies about what constitutes evidence in psychotherapy and what research methodologies qualify as sufficiently rigorous to produce such evidence also abound. Although most psychotherapy researchers are in agreement with the underlying rationale that psychotherapy should be based on rigorous scientific research, many are in disagreement as to what constitutes ideal scientific practice in evidence-based psychotherapy; alternative frameworks of evidence have been proposed. This paper first reviews different models of evidence, namely empirically supported treatments, empirically supported psychotherapy relationships, research informed principles of therapeutic change, and evidence-based practice in psychology, and discusses their relative strengths and limitations. Secondly, it illustrates three research topics and corresponding strategies that both supplement these evidence models and deepen an understanding of process and outcome in psychotherapy. These three areas are: mechanisms of change, systematic case studies, and researcher-practitioner collaboration.
2003
The cognitive structure used by 16 American Board of Professional Psychology-certified psychologists and 5 experienced psychotherapy researchers to delineate common factors of psychotherapy was examined using multidimensional scaling and cluster analysis. The results indicate that 2 dimensions-hot (feeling) versus cool (thinking) processing and therapeutic activity-and 3 clusters-bond, information, and role-are used in conceptualizing common factors. Results are discussed with respect to research and conceptualization of common factors. Psychotherapy is undeniably complex and multifaceted, and to professionals and laypersons alike there seem to be dramatic differences in the way it is practiced. Whether these differences are considered primarily in terms of the different forms of psychotherapy (i.e., the distinct theoretical approaches or treatments) or in terms of the common or nonspecific factors present in all forms of psychotherapy is a source of long-standing debate about the very nature of psychotherapy. One view is that each model of therapy has distinctive effects on clients. This assumption of distinctiveness leads naturally to the inference that some models are more effective than others with particular client types. This treatment distinctiveness belief is exemplified with Paul's (1967) posing the question, "What treatment, by whom, is most effective for this individual with that specific problem and under which set of circumstances?" (p. 111). A competing and perhaps complementary view is that different theoretical approaches are comparably effective (see, e.g., Luborsky et al., 2002). More than 65 years ago, Rosenzweig (1936) contended that "Everybody has won and all must The thoughtful input of the Otsego group is acknowledged.
The New School Psychology Bulletin, 2005
~ Over the past decades, both clinical researchers and practitioners alike have noted the gap between psychotherapy research and practice. Previous research has found that a contributing factor to this gap is that psychotherapy research lacks ecological validity. Therefore, in an effort to distinguish research findings that do have an impact on clinical practice, the present study investigates the following primary question: what particular research findings do psychotherapy researchers, who are also clinical practitioners themselves, find to be useful within their