Attributed Contribution of Therapist’s Emotional Variables to Psychotherapeutic Effectiveness: A Preliminary Study

BackgroundThe aim of this manuscript is to analyze the degrees of responsibility for healing that psychotherapists attribute to a set of emotional variables of the therapist involved in the therapeutic process. Such variables, framed within the well-known common factors in psychotherapy, have been proven to be essential in making the therapeutic process effective, as has been shown by research in psychotherapy in recent decades.Materials and MethodsBased on an extensive literature review, the responses from a sample of 69 psychotherapists to a tool created ad hoc are analyzed to verify whether their attributions are in line with the results of said review.ResultsThe therapists have doubts about the factors responsible for psychotherapeutic effectiveness, as well as about the value of common variables, including those of an emotional nature, not valuing them above those of a specific type. They also argue against the similar effectiveness of different psychotherapeutic models.ConclusionDiscrepancies have thus been found between the conclusions reached by research on therapeutic processes and the statements made by the therapists studied, which could indicate an insufficient impact of psychotherapeutic research on clinical practice. We also propose courses of action such as establishing training programs for the acquisition and development of emotional skills for therapists that could increase the effectiveness of their interventions.

How do we help people regain control over their lives? An introduction to method of levels therapy

There are many different approaches to psychotherapy. Research indicates comparable effectiveness of various therapies, despite having different theoretical assumptions and using different therapeutic methods. In recent years, many researchers have attempted to understand such results by investigating specific and common factors in psychotherapy. It has been suggested that further developments in the field should aim to investigate factors underlying mental health problems and the principles informing the process of change in psychotherapy. In the current article, we will present perceptual control theory as a scientifically grounded approach that integrates theory and practice. Transdiagnostic principles explain the sources of emotional distress and the process of psychological change in psychotherapy. The main aim of the article is to introduce method of levels therapy, which has been created as a direct application of perceptual control theory principles. Description of the process of therapy is accompanied by clinical examples.

The PACT Model: Improving Outcomes in the Treatment of PTSD

This article introduces a new model for the treatment of posttraumatic stress disorder that has the potential to provide clinicians with information that may facilitate improved outcomes. The PACT model emerged during a systematic literature review intended to suggest ways to enhance the efficacy of evidence-based treatments by critically evaluating the potential mechanisms of therapeutic action at work in a novel treatment approach, MDMA (3,4-Methylenedioxymethamphetamine)-assisted psychotherapy, and applying this understanding to existing treatment protocols. The goal of the review was to synthesize the potential therapeutic mechanisms of action that are involved in this approach, and to better understand how they could inform other protocols without the need to administer MDMA. Four elements of MDMA-assisted psychotherapy that do not require the administration of MDMA and could inform our approach to treating patients with trauma form the basis of the PACT model: (1) Presence; (2) Acceptance; (3) Connection; (4) Transcendence. This article highlights how the PACT model reflects the qualities and values of humanistic–existential therapies, explains how it overlaps with and extends common factors in psychotherapy, and suggests how these four elements may signify important avenues of future research for trauma treatments, focusing on enhancing the patient’s experience of safety and posttraumatic growth.

Common Factors in Psychotherapy

Common factors, or characteristics that are present across psychotherapies, have long been considered important to fostering positive psychotherapy outcomes. The contextual model offers an overarching theoretical framework for how common factors facilitate therapeutic change. Specifically, this model posits that improvements occur through three primary pathways: (a) the real relationship, (b) expectations, and (c) specific ingredients. The most-well-studied common factors, which also are described within the contextual model, include the therapeutic alliance, therapist empathy, positive regard, genuineness, and client expectations. Empirical studies have demonstrated that a strong therapeutic alliance, higher ratings of therapist empathy, positive regard, genuineness, and more favorable outcome expectations are related to improved treatment outcomes. Yet, the long-standing debate continues regarding whether psychotherapy outcomes are most heavily determined by these common factors or by factors specific to the type of therapy used. There have been calls for an integration of the two perspectives and a shift toward evaluating mechanisms as a way to move the field forward. Nonetheless, the common factors are valuable in treatment delivery and should be a focus in delivering psychotherapy.

Psychotherapy, placebos, and informed consent

Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients’ ability to give informed consent to treatment. This ‘deception’ claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments (eg, expectancy effects and therapist effects), rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of psychotherapy have a duty to ‘go open’ to patients about the role of common factors in therapy (even if this risks negatively affecting the efficacy of treatment); to not ‘go open’ is supposed to unjustly restrict patients’ autonomy. This paper makes two related arguments against the ‘go open’ claim. (1) While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners ‘go open’ about therapeutic common factors in psychotherapy, and (2) clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to ‘go open’ should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works.

What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components

Aims Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. Methods We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. Results The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication – focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns – non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures – i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes – i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. Conclusions Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.

The Role of Common Factors in Psychotherapy Outcomes

Psychotherapies may work through techniques that are specific to each therapy or through factors that all therapies have in common. Proponents of the common factors model often point to meta-analyses of comparative outcome studies that show all therapies have comparable effects. However, not all meta-analyses support the common factors model; the included studies often have several methodological problems; and there are alternative explanations for finding comparable outcomes. To date, research on the working mechanisms and mediators of therapies has always been correlational, and in order to establish that a mediator is indeed a causal factor in the recovery process of a patient, studies must show a temporal relationship between the mediator and an outcome, a dose–response association, evidence that no third variable causes changes in the mediator and the outcome, supportive experimental research, and have a strong theoretical framework. Currently, no common or specific factor meets these criteria and can be considered an empirically validated working mechanism. Therefore, it is still unknown whether therapies work through common or specific factors, or both.