PSY343 - 7. Common Factors Flashcards
What happens in psychotherapy that helps patients improve their functioning, reduce their symptoms, + enjoy happier + more meaningful lives?
5 umbrella approaches
expectations + beliefs
therapeutic relationship - most robust common predictor of outcome
History of Psychotherapy Integration
Psychotherapy integration movement of conceptual + clinical rapprochement (presumption of harmonous relationship) that includes efforts to:
Integrate diverse therapy models + techniques
History of Psychotherapy Integration
Better understand + improve psychotherapy by considering perspective of different approaches
multiple approaches are effective but in commonalities that can help us understand what makes therapy work
what’s helpful is shared across treatment models
History of Psychotherapy Integration
1930s/40s: Rosenzweig’s (1936) Dodo Bird Verdict: all psychological treatments, regardless of their specific components, produce equivalent outcomes due to common factors shared across treatments
History of Psychotherapy Integration
1950s/60s/70s – Efforts to integrate versions of psychoanalysis + learning theory; attempts towards methodological integration
bring behavioural therapy info into psychoananalysis
History of Psychotherapy Integration
1980s – Psychotherapy integration journals, research groups, textbooks (new handbooks, conferences)
scholars explore possibilities in integrating technically (treatment), theoretically, philosophically (how do i make sense of it)
History of Psychotherapy Integration
1990s – Proliferation of integrative therapies (e.g., EFT, DBT)
2000s-present – Psychotherapy integration widely accepted + increasingly popular approach; common factors emphasized more than specific therapeutic approach
History of Psychotherapy Integration
agreed that not a lot to be gained by comparing approaches unless looking at commonalities
RCTs are still happening
Psychotherapy Integration
Multiple pathways to psychotherapy integration:
• Technical Eclecticism
• Theoretical Integration
• Assimilative Integration
• Common Factors
• 4 approaches not mutually exclusive! common factors approach focus
Technical Eclecticism
Guided primarily by research on what specific methods have worked best with similar problems + patient characteristics
Focuses on predicting for whom interventions will work (more actuarial than theoretical)
Technical Eclecticism
techniques of all models without grounding in own therapists theoretical model
choosing techniques from diff approaches based on disorders
Technical Eclecticism
use procedures drawn from diff therapeutic systems without necessarily subscribing to theories that spawned them
Technical Eclecticism
no necessary connection betw conceptual foundations +
techniques used
toolbox
always a risk that it’s throwing best guess
Theoretical Integration
Two or more therapies are integrated to create a conceptual framework that synthesizes the best elements of the therapies
theoretical models emerging from 2 focused
Theoretical Integration
emphasis on integrating underlying theories of psychotherapy along with techniques from each
EFT: gestalt, client-centred - own new model
DBT: Mindfulness + CBT
Theoretical Integration
Integration aspires to more than a simple combination; it seeks emergent theory more than sum of its parts
personality theory, psychopathology + techniques
mechanisms of change to create new framework
theoretical commonality in approaches
Assimilative Integration
firm grounding in 1 system of psychotherapy, but with willingness to selectively incorporate (assimilate) practices + view from other systems
approach combines the advantages of a single, coherent theoretical system with flexibility of broader range of technical interventions from multiple systems
Assimilative Integration
For example, using a Gestalt two chair intervention within context of an otherwise CBT course of treatment
identify central position
time to time will integrate practices from other approaches
doesn’t change my theoretical model
Common Factors
Commonalities more important in accounting for therapy success than unique factors that differentiate them
CBT: cognitive restructuring
more interested in what is shared among all approaches like relationship
Common Factors
Comparisons of different forms of psychotherapy consistently result in insignificant differences, + contextual + relationship factors often mediate or moderate outcomes
looked at specific techniques impact, smaller variance in outcomes than common factors
Common Factors
little/no substantial difference betw bona fide therapies with regard to client outcomes
important that we talk common factors in bona fide
Common Factors
Bona fide therapies: treatments delivered by trained therapists, based on psychological principles, offered to psychotherapy community as viable treatments + contain specific components
effectiveness of all psychotherapies is due, in part, to factors common to all treatments
Common Factors
Common Factors: elements ubiquitous in all forms of psychotherapy, or at least in several of them
Unique (or specific) Factors: Those elements of a particular psychotherapy that are assumed to be absent in other types of psychotherapy
Common vs. Unique Factors
Faux-unique Variables: elements of therapy typically associated with + more frequently used in particular orientation but that also play a role in effectiveness of other approaches (Castonguay, 2011)
Common vs. Unique Factors
exposure: CBT - but all talk about some approaching of issues
awareness: gestalt - not unique, but key aspect in humanistic
Common vs. Unique Factors
not restricted to particular approach
Insight - central mechanism in psychoanalysis, but used in CBT
proported to be unique but actually common factors
awareness - same process different language
what matters is how you apply common factors
Rosenzweig’s (1936) Common Factors Hypothesis
Different therapeutic approaches relatively equivalent in
• effectiveness across various populations + disorders;
• approaches to treatment propose widely differing
• theories of psychopathology, treatment, and change;
Rosenzweig’s (1936) Common Factors Hypothesis
- Factors common across approaches may be the most parsimonious
- explanation for observed equivalence in efficacy
Rosenzweig’s (1936) Common Factors Hypothesis
therapist with an “effective personality” using any theory of change that implements treatment with some consistency can bring about positive outcome
all share common factors in change process
what we think is working may not be the cause of change
The Common Factors Approach (Frank & Frank, 1993; Wampold, 2001)
Frank (1973): All psychotherapeutic methods are elaborations and variations of age-old procedures of psychological healing that involve 3 elements: healing agent, sufferer, + healing relationship
The Common Factors Approach (Frank & Frank, 1993; Wampold, 2001)
four general Common factors essential characteristics of therapy:
emotionally charged, confiding relationship - context of relationship
The Common Factors Approach (Frank & Frank, 1993; Wampold, 2001)
healing setting: intentionality, therapies, purported to be healing (helps expectations)
rationale or conceptual scheme: identify process of change + understanding of problem + has to be accepted by the client
therapeutic ritual: techniques consistently applied
Transtheoretical Approach (Prochaska & Norcross, 2014)
Processes of Change: activities of therapy that lead to change
create common factors approach to therapy
draws on all major therapy model based on empirical evidence
Transtheoretical Approach (Prochaska & Norcross, 2014)
Consciousness raising, catharsis, self-reevaluation, environment reevaluation, self-liberation, social liberation, counterconditioning, stimulus control, contingency management, helping relationship
Transtheoretical Approach (Prochaska & Norcross, 2014)
Stages of change: client’s readiness for change
Pre-contemplation, contemplation, preparation, action, maintenance, termination
Levels of Change: types of problems that differ in levels of complexity
Transtheoretical Approach (Prochaska & Norcross, 2014)
Symptom/situational problems, maladaptve cognitions, current interpersonal conflicts, family/systems conflicts, intrapersonal conflicts
Transtheoretical Approach (Prochaska & Norcross, 2014)
represent how (process), what (levels), when (stages) depending on change cycles: influences intervention approach
Transtheoretical Approach (Prochaska & Norcross, 2014)
distinct and interrelated stages
CBT: severe problem intervention
can be applied across models
Common Factors that Predict Therapy Outcome
Therapy relationship
Development of a strong therapeutic alliance most robust predictor of outcome (Norcross, 2011)
Common Factors that Predict Therapy Outcome
Expectations for change
High, positive expectation predicts better therapeutic
outcome (Constantino, 2011)
