DIMENSIONS OF THERAPEUTIC SKILLS AND TECHNIQUES: EMPIRICAL IDENTIFICATION, THERAPIST CORRELATES, AND PREDICTIVE UTILITY (original) (raw)
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THE THERAPIST'S THERAPIST: A REPLICATION AND EXTENSION 20 YEARS LATER
How do mental health professionals choose their own psychotherapists? This study replicates and extends a 1987 national survey of psychotherapists regarding the selection criteria and sociodemographic characteristics of their personal therapists; 608 psychologists, counselors, and social workers participated. Therapists' therapists tended to be middle aged and White (94%) but equally female and male. Their most frequent theoretical orientations were integrative, eclectic, cognitive, and psychodynamic (but rarely behavioral or systemic). Psychology was their most prevalent profession, followed by social work, counseling, and psychiatry. Topping the list of therapist selection criteria were competence, warmth, experience, openness, and reputation. The prototypical positive features of personal treatment that therapists repeated with their own patients all concerned cultivation of the therapeutic relationship. The 2007 results are tentatively compared with those obtained in 1987, thus chronicling the evolution of therapists' therapists over the years.
Frontiers in Psychology, 2021
Background: The aim of this manuscript is to analyze the degrees of responsibility for healing that psychotherapists attribute to a set of emotional variables of the therapist involved in the therapeutic process. Such variables, framed within the well-known common factors in psychotherapy, have been proven to be essential in making the therapeutic process effective, as has been shown by research in psychotherapy in recent decades. Materials and Methods: Based on an extensive literature review, the responses from a sample of 69 psychotherapists to a tool created ad hoc are analyzed to verify whether their attributions are in line with the results of said review. Results: The therapists have doubts about the factors responsible for psychotherapeutic effectiveness, as well as about the value of common variables, including those of an emotional nature, not valuing them above those of a specific type. They also argue against the similar effectiveness of different psychotherapeutic models. Conclusion: Discrepancies have thus been found between the conclusions reached by research on therapeutic processes and the statements made by the therapists studied, which could indicate an insufficient impact of psychotherapeutic research on clinical practice. We also propose courses of action such as establishing training programs for the acquisition and development of emotional skills for therapists that could increase the effectiveness of their interventions.
A representative sample of American psychologists engaged in psychotherapy were surveyed concerning their characteristics, activities, affiliations, theories, and selected attitudes. 410 members ofAPA Division 29 (Psychotherapy) returned a mailed questionnaire, providing a current and comprehensive assessment of the profession. Survey results are described in detail and compared to the findings of a similar survey of American clinical psychologists (Division 12 members). Among the most salient findings were that: 1) over 80% of therapists have had personal therapy and highly value these experiences as preparation for providing therapy; 2) individual therapy is the most popular therapeutic modality, but over one-half of the sample engage in marital and family therapy; 3) while therapists spend relatively small percentages of their time doing research, they do as a group publish and present papers; 4) private practice is the modal affiliation of the sample and may be the most equitable employment setting; and 5) psychodynamic orientations have experienced renewed preference with eclecticism declining, suggesting a need for more integrative models of therapy.
Clinical Psychology Review, 2010
Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multicomponent trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, selfdirected trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed.
Relational interventions in psychotherapy: development of a therapy process rating scale
BMC Psychiatry, 2016
Background: In psychodynamic psychotherapy, one of the therapists' techniques is to intervene on and encourage exploration of the patients' relationships with other people. The impact of these interventions and the response from the patient are probably dependent on certain characteristics of the context in which the interventions are given and the interventions themselves. To identify and analyze in-session effects of therapists' techniques, process scales are used. The aim of the present study was to develop a simple, not resource consuming rating tool for in-session process to be used when therapists' interventions focus on the patients' relationships outside therapy. Methods: The present study describes the development and use of a therapy process rating scale, the Relational Work Scale (RWS). The scale was constructed to identify, categorize and explore therapist interventions that focus on the patient's relationships to family, friends, and colleges Relational Interventions and explore the impact on the in-session process. RWS was developed with sub scales rating timing, content, and valence of the relational interventions, as well as response from the patient. For the inter-rater reliability analyzes, transcribed segments (10 min) from 20 different patients were scored with RWS by two independent raters. Two clinical vignettes of relational work are included in the paper as examples of how to rate transcripts from therapy sessions with RWS. Results: The inter-rater agreement on the RWS items was good to excellent. Conclusion: Relational Work Scale might be a potentially useful tool to identify relational interventions as well as explore the interaction of timing, category, and valence of relational work in psychotherapies. The therapist's interventions on the patient's relationships with people outside therapy and the following patient-therapist interaction might be explored.
Psychotherapy Relationships That Work II
This article introduces the special issue of Psychotherapy devoted to evidence-based therapy relationship elements and traces the work of the interdivisional task force that supported it. The dual aims of the task force are to identify elements of effective therapy relationships (what works in general) and to identify effective methods of adapting or tailoring treatment to the individual patient (what works in particular). The authors review the structure of the subsequent articles in the issue and the multiple meta-analyses examining the association of a particular relationship element to psychotherapy outcome. The centrality of the therapy relationship, its interdependence with treatment methods, and potential limitations of the task force work are all highlighted. The immediate purpose of the journal issue is to summarize the best available research and clinical practices on numerous elements of the therapy relationship, but the underlying purpose is to repair some of the damage incurred by the culture wars in psychotherapy and to promote rapprochement between the science and practice communities.
Journal of Counseling Psychology, 2019
Objective: Clients' emotional experience and self-understanding are two clients' processes thought to play a key role in many therapeutic approaches, especially psychodynamic psychotherapy. Previous studies exploring client processes and the interventions assumed to promote them have found that both processes and interventions are related to a reduction in symptoms. However, the complex associations between the use of specific interventions, clients' processes and symptomatic outcomes have rarely been investigated. Using data collected on a session-by-session basis, we explored (a) the temporal associations between clients' processes (emotional experience and self-understanding) and treatment outcomes (clients' level of functioning); (b) the associations between therapists' affect-focused and psychodynamic interventions and clients' processes; and (c) the direct and indirect associations among therapists' interventions, clients' processes, and clients' functioning. Method: Clients (N =115) undergoing psychodynamic psychotherapy reported their general functioning presession using the Outcome Rating Scale (ORS), and their emotional experience and selfunderstanding post-session using the Emotional Experience Self-Report (EE-SR) and Self-Understanding Scale (SUS), respectively. Therapists reported their use of interventions postsession using the Multitheoretical List of Interventions (MULTI). Results: Longitudinal multilevel models indicated that higher emotional experience and self-understanding scores predicted subsequent change in functioning. Moderate (vs. high or low) use of affect-focused interventions predicted an increase in clients' emotional experience. Greater use of psychodynamic interventions predicted an increase in clients' self-understanding, which also mediated improvement in functioning. Conclusion: These findings highlight the importance of adjusting therapists' use of interventions to promote clients' therapeutic processes and outcomes.
Journal of Contemporary Psychotherapy, 2019
Previous results have demonstrated that psychotherapists working in a practice setting have a relatively low treatment adherence, regardless of the therapy school to which they were affiliated. The objective of this study was to investigate whether the therapist's attitudes in therapeutic matters are a better predictor of interventions employed than the therapeutic method in which the therapist was trained. The relationships between various types of psychotherapeutic intervention and both predictors were tested by means of Markov Chain Monte Carlo simulations. A total of 162 therapy sessions conducted by 18 therapists affiliated to 6 different therapeutic methods were analyzed. The interventions were classified according to the criteria of essentiality and commonality. The analysis showed that 40% of the examined intervention types were significantly associated with at least one of the nine attitude scales considered, whereas only 14% exhibited a significant association with the completed type of therapy training. The latter predictor was only associated with interventions of the kind essential/not common, whereas the attitude scales were related with both essential and common interventions. The rather weak association between the type of completed training and preferred therapeutic intervention types means that many essential intervention techniques acquired during training assume a subordinate role in a practice setting. Choice of therapeutic action is conditioned to a greater extent by nuances in individual attitudes, which may change throughout a professional career. The reciprocal influence of a psychotherapist's attitude and his or her professional development is discussed.