Ch 14: Intervention: Identifying Key Elements of Change

Question 1

What is process research?

Answer 1

• examines patterns using therapist and/or client data that are evident within and across therapy sessions
• eg. does client-therapist alliance predict client attendance?

Question 2

What is process-outcome research?

Answer 2

• examines the relation between variables related to the process of providing psychotherapy and the outcome of therapy
• ie. variables that relate to outcome are mechanisms of change
• eg does client-therapist alliance predict symptom reduction

Question 3

How are psychotherapy process and process-outcome similar and different?

Answer 3

• number of strategies for studying what transpires in therapy (process) and how it relates to client change (process-outcome) has grown
• both ask how an intervention works, whereas treatment-outcome research asks which intervention is more efficacious

Question 4

What are common factors?

Answer 4

• therapeutic elements that occur in all or most treatment, believe to be critical for successful client outcomes

Question 5

What are some client variables?

Answer 5

• personality characteristics
• current life circumstances
• life experiences
• family-of-origin characteristics
• ethnicity and cultural factors
• beliefs about psychological struggles
• treatment expectations

Question 6

What are some general facts of client variables?

Answer 6

• studies have tended to be non-systematic and hard to detect patterns
• pre-existing variables may have the greatest impact on client decisions about seeking and engaging in treatment
• client-therapist relationship is likely to have a greater influence on the course and outcome of treatment

Question 7

How do therapist variables contribute to variability?

Answer 7

• significant variability in therapist effectiveness

- therapists account for 3% of variability of outcome in efficacy trials and 7% of effectiveness trials

Question 8

How does therapist effectiveness effect clients?

Answer 8

• clients report feeling more understood

- most noticeable among clients with high levels of problem severity

Question 9

What is known about therapist strengths and weaknesses?

Answer 9

• therapists have strengths and weaknesses in their competencies to address client struggles
• need for systematic feedback on client progress to improve skills and expertise in providing therapy

Question 10

What are common factors in psychotherapy?

Answer 10

• effectiveness of any treatment is due to common factors

Question 11

What is Weinberger’s common factor framework?

Answer 11

• therapeutic relationship
• client expectations
• confrontation of problems in therapy
• client’s development of a sense of mastery
• client’s attributions for treatment outcome

Question 12

What is Lambert and Ogles common factor frameworks?

Answer 12

• categories of support factors
• learning factors
• action factors under which other common factors are grouped

Question 13

What are integrative treatment models?

Answer 13

• adopt theories and techniques from major treatment approaches to optimize the mix and influence of common factors
• majority of integrative therapists still draw upon one primary approach

Question 14

What is the therapeutic alliance?

Answer 14

• quality and strength of the collaborative relationship between a client and therapist
• most common common factor
• received the most research attention and support as outcome predictor

Question 15

What are some components of the therapeutic alliance?

Answer 15

• positive affective bonds
• consensus about and commitment to therapy goals
• shared sense of partnership in the therapeutic process

Question 16

What are some general facts about alliance?

Answer 16

• alliance measured in early sessions is consistent predictor of engagement and outcome
• alliance achieved in telehealth services is comparable to face-to-face alliance and has a small but positive association with therapy outcome

Question 17

What psychotherapy is best when there are multiple options?

Answer 17

• first uses interventions with the greatest research support for a given presentation and population
• if unsuccessful, turn to treatments with less empircal support

Question 18

Which psychotherapy is most effective?

Answer 18

• strongest support for behavioural and CBT therapies

Question 19

What are evidence-based psychotherapy relationships?

Answer 19

• aspects of the therapeutic relationship found by research to be associated with positive outcomes

Question 20

How does the APA define evidence-based psychotherapy relationships?

Answer 20

• categorized treatment elements as demonstrably effective, probably effective and promising but insufficient research to judge
• issued practice, training, research and policy recommendations based on findings

Question 21

What are the demonstrably effective evidence-based psychotherapy relationships?

Answer 21

• alliance
• cohesion (groups)
• empathy
• collecting client feedback
• adapting treatment to: reactance, preferences, culture

Question 22

What are probably effective evidence-based psychotherapy relationships?

Answer 22

• goal consensus
• collaboration
• positive regard
• adapting to: stage of change, coping style