PSY343 - 7. Common Factors

Question 1

What happens in psychotherapy that helps patients improve their functioning, reduce their symptoms, + enjoy happier + more meaningful lives?

Answer 1

5 umbrella approaches
expectations + beliefs
therapeutic relationship - most robust common predictor of outcome

Question 2

History of Psychotherapy Integration

Answer 2

Psychotherapy integration movement of conceptual + clinical rapprochement (presumption of harmonous relationship) that includes efforts to:
Integrate diverse therapy models + techniques

Question 3

History of Psychotherapy Integration

Answer 3

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

Question 4

History of Psychotherapy Integration

Answer 4

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

Question 5

History of Psychotherapy Integration

Answer 5

1950s/60s/70s – Efforts to integrate versions of psychoanalysis + learning theory; attempts towards methodological integration
bring behavioural therapy info into psychoananalysis

Question 6

History of Psychotherapy Integration

Answer 6

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)

Question 7

History of Psychotherapy Integration

Answer 7

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

Question 8

History of Psychotherapy Integration

Answer 8

agreed that not a lot to be gained by comparing approaches unless looking at commonalities
RCTs are still happening

Question 9

Psychotherapy Integration

Answer 9

Multiple pathways to psychotherapy integration:
• Technical Eclecticism
• Theoretical Integration
• Assimilative Integration
• Common Factors
• 4 approaches not mutually exclusive! common factors approach focus

Question 10

Technical Eclecticism

Answer 10

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)

Question 11

Technical Eclecticism

Answer 11

techniques of all models without grounding in own therapists theoretical model
choosing techniques from diff approaches based on disorders

Question 12

Technical Eclecticism

Answer 12

use procedures drawn from diff therapeutic systems without necessarily subscribing to theories that spawned them

Question 13

Technical Eclecticism

Answer 13

no necessary connection betw conceptual foundations +
techniques used
toolbox
always a risk that it’s throwing best guess

Question 14

Theoretical Integration

Answer 14

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

Question 15

Theoretical Integration

Answer 15

emphasis on integrating underlying theories of psychotherapy along with techniques from each
EFT: gestalt, client-centred - own new model
DBT: Mindfulness + CBT

Question 16

Theoretical Integration

Answer 16

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

Question 17

Assimilative Integration

Answer 17

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

Question 18

Assimilative Integration

Answer 18

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

Question 19

Common Factors

Answer 19

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

Question 20

Common Factors

Answer 20

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

Question 21

Common Factors

Answer 21

little/no substantial difference betw bona fide therapies with regard to client outcomes
important that we talk common factors in bona fide

Question 22

Common Factors

Answer 22

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

Question 23

Common Factors

Answer 23

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

Question 24

Common vs. Unique Factors

Answer 24

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)

Question 25

Common vs. Unique Factors

Answer 25

exposure: CBT - but all talk about some approaching of issues
awareness: gestalt - not unique, but key aspect in humanistic

Question 26

Common vs. Unique Factors

Answer 26

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

Question 27

Rosenzweig’s (1936) Common Factors Hypothesis

Answer 27

Different therapeutic approaches relatively equivalent in
• effectiveness across various populations + disorders;
• approaches to treatment propose widely differing
• theories of psychopathology, treatment, and change;

Question 28

Rosenzweig’s (1936) Common Factors Hypothesis

Answer 28

• Factors common across approaches may be the most parsimonious
• explanation for observed equivalence in efficacy

Question 29

Rosenzweig’s (1936) Common Factors Hypothesis

Answer 29

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

Question 30

The Common Factors Approach (Frank & Frank, 1993; Wampold, 2001)

Answer 30

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

Question 31

The Common Factors Approach (Frank & Frank, 1993; Wampold, 2001)

Answer 31

four general Common factors essential characteristics of therapy:
emotionally charged, confiding relationship - context of relationship

Question 32

The Common Factors Approach (Frank & Frank, 1993; Wampold, 2001)

Answer 32

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

Question 33

Transtheoretical Approach (Prochaska & Norcross, 2014)

Answer 33

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

Question 34

Transtheoretical Approach (Prochaska & Norcross, 2014)

Answer 34

Consciousness raising, catharsis, self-reevaluation, environment reevaluation, self-liberation, social liberation, counterconditioning, stimulus control, contingency management, helping relationship

Question 35

Transtheoretical Approach (Prochaska & Norcross, 2014)

Answer 35

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

Question 36

Transtheoretical Approach (Prochaska & Norcross, 2014)

Answer 36

Symptom/situational problems, maladaptve cognitions, current interpersonal conflicts, family/systems conflicts, intrapersonal conflicts

Question 37

Transtheoretical Approach (Prochaska & Norcross, 2014)

Answer 37

represent how (process), what (levels), when (stages)
depending on change cycles: influences intervention approach

Question 38

Transtheoretical Approach (Prochaska & Norcross, 2014)

Answer 38

distinct and interrelated stages
CBT: severe problem intervention
can be applied across models

Question 39

Common Factors that Predict Therapy Outcome

Answer 39

Therapy relationship

Development of a strong therapeutic alliance most robust predictor of outcome (Norcross, 2011)

Question 40

Common Factors that Predict Therapy Outcome

Answer 40

Expectations for change
High, positive expectation predicts better therapeutic
outcome (Constantino, 2011)