Effective Psychotherapy (Miller & Moyer, 2021) Flashcards
An invitation
One assertion is that more effective therapist( those whose clients tend to get better) share more certain interpersonal characteristics, regardless of their particular theoretical orientation or treatment approach (Anderson et al., 2009)
Mind and heart: therapeutic attitudes
Consider that therapeutic skills involved both an internal experiential component and an external expressive component
Mind and heart: therapeutic attitudes
Perhaps most fundamental in helping relationships is a commitment to compassion… this is not just feeling for (sympathy) but a desire and intention to alleviate suffering and facilitate others wellness and growth (Armstrong, 2010)
Mind and heart: therapeutic attitudes
A second therapeutic attitude, underlying therapeutic skills is a sense of counseling and psychotherapy as a partnership… in order to help people change their behavior or lifestyle, you need their expertise and partnership
Therapist effects
Therapist effects have been a subject of psychological research since the 1940s, and the results have been reassuringly consistent overtime
Therapist effects
In treatment outcome research, such other factors include attributes of the client being treated (age, gender, problems, severity, personality) of the treatment itself (length, structure, manual, guided, supervision, and quality assurance)
Therapist effects
Studies of this kind, typically fine little or no outcome difference based on the specific treatments being compared, but a significant difference attributable to the therapist who provide the treatments
Differences between therapists
Differences and therapist effectiveness can be detected as early as the first session predicting clients treatment out (Erekson et al., 2029)
Differences between therapists
Rather than simply being an effective, some therapist may actually be harming their clients.. in fact, therapist and therapies can cause harm
Differences within therapists
Therapist do differ in overall effectiveness (i.e. can be rank ordered in their helpfulness when compared with each other) and also very in their skills and effectiveness, depending on the client, they are treating
Differences within therapists
Even the best therapist are not effective with every client, and even the worst may be helpful with a few
Client – therapist match
There will be other biases that therapist Harbor, and working with various clients, and demographic client variables, such as age, ethnicity, and gender, do not tell the whole story
Client-therapist match
Some therapist know it is easier to form a collaboration with some clients, and with others, for reasons that are not always clear
Therapeutic skills
Eight therapeutic skills of more effective therapist:
Accurate empathy
Acceptance
Positive regard
Genuineness
Focus
Hope and expectation
Evoking
Offering information and advice 
Accurate empathy 
Empathy is a skill more than just a trait or inexperience.. the skill of accurate empathy does not require feeling the same thing. Another person is feeling at the same time she or he is experiencing it.
The how of communicating accurate empathy
A helping relationship involves understanding and appreciating another’s experience, being able to perceive reality from his or her perspective, as if you were that person
The communication aspect of accurate empathy
Consider silence, and how that can benefit the process, misunderstanding, mishearing and people don’t always say exactly what they mean 
Empathetic, listening
It is a way of listening that helps you avoid roadblocks and step inside another person’s world (please see page 25 for the 12 roadblocks to listening, Gordon, 1970
What to reflect
The active reflection focuses on particular facets of what someone says, selectively, emphasizing, or strengthening them.. no one reflects; to do so would be bizarre
What to reflect?
Some authors have suggested that what is reflected, and indeed, how much empathy is expressed, should be align with the needs of the client
Do clients cause therapist empathy?
One rival explanation is that better – prognosis clients (e.g. those who are more ‘motivated’) inspire counselors to be more empathetic and that’s why therapist empathy predicts better outcomes
Acceptance 
Nonjudgmental acceptance has long been regarded as an important, therapeutic skill and counseling
Acceptance
The counselors manner is unconditional… acceptance is “the ability to listen without preconception, prejudgment, or condemnation” (Strupp, 1960)
The attitude of acceptance
Non-judgmental acceptance is a key element in the practice of mindfulness
The attitude of acceptance
Implicit in this therapeutic attitude is a belief that human beings have inherent worth in deserve respect without needing to earn it
The how of communicating acceptance
Clients can be particularly sensitive to perceived, blame or disapproval
Positive regard
Clients do not need to prove or earn a counselor respect. PR is a precondition extended to all without regard for apparent merit, rooted in an intentional view of humankind as inherently.. “ positive, forward moving, constructive, realistic, and trustworthy”-Rogers, 1962)
Positive regard
There appears to be a number of different terms used to refer to the same or similar concepts with relation to positive regard- such as warmth, acceptance, respect and support
Affirmation
Affirmation is a way to convey positive regard. It involves both noticing and commenting on a persons strengths, positive actions, and attributes
Positive regard
Positive regard is also communicated in many ways besides direct verbal affirmations.. clients may value what you do even more than what you say about them (Suzuki & Farber, 2016).. for example the client may value a therapist being a good listener
Genuineness
Therapist genuineness is greater when they spend less effort, concealing themselves, and instead, responding ways that are uniquely and authentically their own
Genuineness
Genuineness means the therapist as a person shines through, rather than being hidden behind a façade (Lietaer, 2001a).
Negative emotions towards clients
A common reason for clinicians to choose interpersonal distance over genuineness, is the avoidance of intense negative emotion that can arise with some clients from time to time
Focus
With each new client and initial step for focusing is to clarify the goals of your work together
Having a clear focus is by no means universal and practice .. one element of focus in the therapeutic relationships is a felt responsibility to have clear direction for your services
The how of focusing
The focusing process, then, is one of finding direction for treatment among these various, and sometimes conflicting potential goals
Hope
A hopeful attitude is optimism: anticipating and expecting positive change. Optimism is a choice, a benefit of the doubt… you decide to see a glass is half full, rather than half empty
Evocation
Evocation calls forth and supports what clients already have, their own strength, and wisdom
The ability to evoke, a clients own resources is a particular skill of therapist that stands in contrast to the technical skills of teaching and advising
The attitude of evocation
A starting point in the attitude of evocation is recognizing that there is something important to evoke from clients
The attitude of evocation
Some forms of psychotherapy have heavily emphasize, giving client something that they lack, be insight, knowledge, skills, motivation, or rational, thinking.
Evocation:” you have what you need, and together, we are going to find it“
Offering information and advice
 client relationships range from directing to following
Offering information and advice
At one extreme is a directing style that involves telling people what they should do by dispensing, information, solutions, instructions, or advice. .. there are times when this is an appropriate and even expected role
Offering information and advice
At the opposite extreme is a compassionate companion, who listens empathically, conveys acceptance, and affirmation, and assiduously avoids, providing answers or advice.. sometimes this is what clients prefer
Asking permission
One useful step is the ask permission before offering information or advice
Asking permission
Asking permission honors self -direction
Training
We defined training as the conveying of skills that are needed to improve treatment in someway
Supervising
 supervision is a formal relationship between two providers, one of whom has authority over the other
Coaching
Coaching on the other hand is a collaborative relationship. It typically requires directly observing a learners performance and providing feedback and suggestions for skill improvement.
Experiential learning
Engaging trainees in experiential practices is particularly important for developing interpersonal therapeutic skills
