EST v Common Factors

Question 1

What is the dodo bird conjecture?

Answer 1

Rozenzweig (1936): Dodo bird conjecture of äóìEverybody has won, and all must have prizesäó äóñ argued against specificity and for the non-central aspects common in most therapies-Dodo bird revisited (Duncan, 2002)

Question 2

What is Goldfriend’s (1980) argument about common factors?

Answer 2

at strategy level of abstraction, therapies had particular commonalities

Question 3

Dissatisfaction with individual theoretical approaches spawned three movements?

Answer 3

1 theoretical integration, 2 technical eclecticism, 3 common factors (Arkowitz, 1992)

Question 4

allegiance better predictor of outcome than what?

Answer 4

type of therapy (Berman, Miller, & Massman, 1985)–these guys also believe that comparative designs (comparing 2 or more groups to each other without control groups) is more internally valid than using control groups.

Question 5

What do Frank & Frank (1991) consider to be common elements to all therapies?

Answer 5

1. emotionally charged2. confiding relationship3. healing setting4. rationale or conceptual scheme for problem and treatment5. procedure based on rationale that requires active participation

Question 6

The Great psychotherapy debate (citation)

Answer 6

Wampold, 2001

Question 7

This study claimed that therapy was ineffective and was no better than spontaneous remission

Answer 7

Eysenck, 1952

Question 8

What was the first meta-analysis of psychotherapy, and what did it find?

Answer 8

Smith & Glass (1977) published the first meta-analysis looking at 375 studies comparing a treatment condition to a control condition and found that 75% of those treated were better off than non-treated with an average effect size of .68

Question 9

What are some problems with comparison studies?

Answer 9

Comparison studies problematic due to allegiance effects, same therapists delivering both conditions of treatment, potential for Type I and Type II error, etc. (Lambert & Ogles, 2004; Wampold, 2000)

Question 10

What did Wampold find in 1997?

Answer 10

Wampold et al. (1997) large meta-analysis of studies from six major counseling research journals from 1970 to 1995 supported common factors approach. -therapies should be considered equally effective until evidence has been found that a treatment is not as good.

Question 11

What is efficacy vs. effectiveness?

Answer 11

Efficacy uses randomized clinical trials, emphasizing internal validity through limiting the types of patients, the types of treatment delivery through manuals, specific training, random assignment (Chambless et al., 1998; Lambert & Ogles, 2004)Effectiveness studies are in real populations, and can be used to address practical questions such as when, how, and with whom to use a specific treatment (Rush, 2009).

Question 12

EST has REALLY taken off after what event?

Answer 12

-a 1995 task force on promotion and dissemination of psychological procedures (Lambert & Ogles, 2004; Orlinsky et al., 2004; Wampold & Bahti, 2004)-1995 Task Force on Promotion and Dissemination of Psychological Procedures (Division 12) äóñ criteria based

Question 13

APA recognizes that effects due to common factors (absolute efficacy) are more important than effects due to what?

Answer 13

specific treatments (relative efficacy; APA, 2012)

Question 14

2 important implications of common factors

Answer 14

(1) most valid and structured psychotherapies are roughly equivalent in effectiveness (2) patient and therapist characteristics, which are not usually captured by a patient’s diagnosis or by the therapist’s use of a specific psychotherapy, affect the results (Castonguay & Beutler, 2006; Livesley, 2007; Norcross, 2011);

Question 15

The general or average effects of psychotherapy are widely accepted to be significant and _____?

Answer 15

LARGE (Chorpita et al., 2011; Smith, Glass, & Miller, 1980; Wampold, 2001).

Question 16

EST proponents argue that adherence to a manual is crucial and related to outcomes but _____ is not.

Answer 16

allegiance (Heimberg, 1998; Kazdin, 1998)

Question 17

Manuals have been around since the 1960s, have they improved client’s outcomes?

Answer 17

No (Lambert, 1998)

Question 18

How long are ESTs?

Answer 18

EST studies are short, 6-16 sessions (Westen et al., 2004)

Question 19

What is the multicultural critique of ESTs?

Answer 19

May be incompatible with multicultural sensitivity (Atkinson, et al., 2001). Indeed, culture might influence outcomes (Quntana & Atkinson, 2002)

Question 20

What was Labert’s (1992) big contribution to the common factors literature?

Answer 20

identified 4 therapeutic factors1. extratherapeutic factors2. common factors3. expectancy or placebo4. techniques

Question 21

Norcross presented a seminal paper in 2001 that were conclusions of division 29 task force. What were some highlights?

Answer 21

NAME?

Question 22

If not ESTs then what?

Answer 22

Wampold (2001) recommends:1. need rationale for treatment and a ritual consistent with rationale2.Specific ingredients are used, but not to be as dogma3.coherent thought in choosing interventions that will be effective; randomly choosing just as ineffective as a strict adherence to manual4.treatments that are compatible with the clientäó»s worldview; values and attitudes most important5.trained in as many theories and techniques, but only those based on psychological principles6. clients choose the best therapist, not the best therapy

Question 23

What are some recommendations, given the common factors/EST debate?

Answer 23

Wampold (2001) recommends 1.limiting clinical trials, 2.focusing on elements of therapy that explain general effects or unexplained variance,3.relax emphasis on treatment manuals4.focus on effectiveness rather than efficacy

Question 24

adherence to medical model was brought on by pressure from what?

Answer 24

managed care system and eventually Div. 17 task force (APA, 1995)

Question 25

4 broad categories of common factors according to Grencavage and Norcross?

Answer 25

1. therapist qualities2. change processes3. treatment structure4. relationship(Grencavage & Norcross, 1990)

Question 26

Fervor for ESTs is thought to have begun with Paul’s (1967) article. Why?

Answer 26

He questioned which treatments work best under what conditions, what time, what setting, which type fo client, which type of disorder, etc.

Question 27

What is relative efficacy?

Answer 27

How well a treatment works compared to an existing treatment

Question 28

Although Brooks-Harris argue for 8 routes to integration, what are the primary 3 argued by most?

Answer 28

1. Theoretical integration: combines 2+ theories into a more complex tx. Synthesis involves reconciling underlying assumptions. 2. Technical Eclecticism: Using a collection of techniques that work well together, without a well-defined theoretical synthesis. May have one foundational theory and integrate other techniques.3. Common factors: Based on a core of healing elements shared across theories and techniques (Corrective emotional experience, warmth, empathy, unconditional positive regard, hope, trust, persuasion, challenging misperceptions, changing schemas, restoring morale, providing new experiences, and giving accurate feedback)

Question 29

What is absolute efficacy?

Answer 29

How well a treatment works compared to a no-treatment control group

Question 30

Common factors framework based on temporal sequence in therapy? (3 factors)

Answer 30

support factors, learning factors, action factors(Lambert & Ogles, 2004)

Question 31

Shapiro and Shapiro also found a large effect size for therapy, what was it?

Answer 31

d = .82 (Shapiro & Shapiro, 1982)

Question 32

What evidence did Shapiro & Shapiro (1982) provide to support the medical model?

Answer 32

Cognitive and multimodal behavior therapies showed relative efficacy over other methods

Question 33

In 2001 Wampold reported a therapy effect size of .75-.85 (with concensus at .8). This referred to ____ efficacy.

Answer 33

Absolute efficacy (how well therapy works compared to a control group, those who don’t receive therapy)

Question 34

What are some assumptions of the medical model, which undergirds ESTs?

Answer 34

i.Specific factors exist and are the agent of change for specific disordersii.Common factors are uninteresting (may be present but not important)iii.Adherence to a manual is related to outcomes while allegiance is notiv.Psychopathology is highly malleable;EST studies are short, 6-16 sessions (Westen et al., 2004)v.Comorbidity is not an issuevi.Psychiatric disorders can be treated independently of personality factorsvii.Experimental methods provide the gold standard for finding useful treatment packages

Question 35

The therapy relationship accounts for why clients improve (or don’t) as much as _______

Answer 35

any particular treatment method (Norcross, 2011)

Question 36

Monitoring the therapeutic relationship is important, and can lead to what practical benefits?

Answer 36

(Lambert, 2010)-increased opportunities to repair alliance ruptures, –improve the relationship, -modify technical strategies, and -avoid premature termination

Question 37

Therapeutic alliance in early stages of treatment is build on what 3 things?

Answer 37

(Bordin, 1994)1. emotional bond2. agreement on goals3. consensus on tasks

Question 38

client’s evaluation of quality of therapeutic alliance is best predictor of _________.

Answer 38

outcome (Horvath et al., 2011)

Question 39

emapthy is a _____________ predictor of outcome

Answer 39

moderate, r = .30 (Elliot, Bohart, Watson, & Greenberg, 2011)

Question 40

goal consensus, which is a moderate predictor of outcome in a recent meta-analysis, is referred to as _____________

Answer 40

collaboration (Tryon & Winograd, 2011)

Question 41

positive regard has a ______________ relationship with outcome

Answer 41

moderate (Farber & Doolin, 2011)

Question 42

positive regard may be especially effective for what kinds of clients?

Answer 42

racial/ethnic minority groups (Farber & Doolin, 2011)

Question 43

congruence is a ____________predictor of outcome

Answer 43

small/medium, r = .24, (Kolden, Klein, Wang, & Austin, 2011)

Question 44

What benefits does client feedback offer?

Answer 44

(Lambert & Shimokawa, 2011)-small to moderate positive influence on outcome-especially good for clients at risk for negative outcomes early in therapy

Question 45

How are rupture-repair episodes related to outcome?

Answer 45

small to moderate, r = .24 (Safran, Muran, & Eubanks-Carter, 2011)

Question 46

What is the effect of countertransference on outcome?

Answer 46

negative and small, r = -.16 (Hayes, Gelso, & Hummel, 2011)

Question 47

stages of change is important, what stages fares poorly

Answer 47

precontemplation (Norcross, Krebs, & Prochaska, 2011)

Question 48

Any differences between spiritual and secular therapies?

Answer 48

not on psych distress, but on spiritual outcomes, not surprisingly spiritual therapies are better (Worthington et al., 2011)

Question 49

What is a citation for the fact that gains made in therapy are maintained over time?

Answer 49

Nicholas & Berman, 1993

Question 50

What percentage of a client’s improvement can be attributed to the therapeutic alliance?

Answer 50

30% (Lambert, 1992)

Question 51

Who/what is the primary change agent in therapy?

Answer 51

The client (Tallman & Bohart, 1999)

Question 52

What are 3 factors of client success?

Answer 52

Glenvacage & Norcross (1990). positive expectations for therapy2. distressed3. actively seeking help

Question 53

What are 3 necessary therapist qualities (Rogers, 1951)

Answer 53

1.accurate empathy2. nonpossessive warmth3. genuineness

Question 54

What is the “paradoxical” theory of change?

Answer 54

Change occurs when you allow yourself to be who you are, not who you would like to be (Rosner, 1987)

Question 55

What is Wampold’s (2001) % distribution for specific v. general effects?

Answer 55

Specific effects = 8%; Common factors = 70%; 22% unexplained variance

Question 56

Wampold et al (1997) meta-analysis showed what comparative efficacy for psychotherapy, placebo, no treatment, and between treatments?

Answer 56

psychotherapy v. no treatment = .82; psychotherapy v. placebo = .48; placebo v. no treatment = .42; difference between bona-fide treatments = .00<.21

Question 57

Wampold (2001) showed what for the absolute efficacy of various psychotherapy ingredients?

Answer 57

Specific ingredients = 1%; Working Alliance = 5%; Therapist Effects = 6%; Allegience = <10%

Question 58

How many common factors are there?

Answer 58

Depends on who you ask: Rozenweig (1936): 4; Garfield (1995) = 13; Frank & Frank (1991)=6; Grencavage and Norcross (1990)= 4 (w/ 89 total facets); Lambert & Ogles (2004)=3 (based on temporal order); Tracey et al. (2003) = 2 process factors (feeling v. thinking); 3 ‘clusters’ (bond, information, role)

Question 59

What is the APA’s 2(2006) definition of Empirically Based Practice (EBP)?

Answer 59

NOT EST, but integration of best available research for THIS client (characteristics, culture, and preferences) under these circumstances

Question 60

What was “project MATCH” (1993)?

Answer 60

Largest controlled study on alcohol abuse (; Compared CBT, 12-step, Motivational Interviewing; found no differences in outcomes (even at 10yrs later); client’s rating of alliance biggest predictor

Question 61

What did the Treatment for Depression Collaborative Research Project (TDCRP; NIMH, 1989) show?

Answer 61

Looked at CBT, IPT, Drug, Placebo for treatment of depression, equal outcomes across conditions (though antidepressant was slightly more effective than IPT/CBT)