Flashcards in Process and Outcome Deck (54):
What is the dodo bird conjecture?
Rozenzweig (1936): Dodo bird conjecture of “Everybody has won, and all must have prizes”
– argued against specificity and for the non-central aspects common in most therapies
-Dodo bird revisited (Duncan, 2002)
What is Goldfriend's (1980) argument about common factors?
at strategy level of abstraction, therapies had particular commonalities
Dissatisfaction with individual theoretical approaches spawned three movements?
1 theoretical integration,
2 technical eclecticism,
3 common factors (Arkowitz, 1992)
allegiance better predictor of outcome than what?
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.
What do Frank & Frank (1991) consider to be common elements to all therapies?
1. emotionally charged
2. confiding relationship
3. healing setting
4. rationale or conceptual scheme for problem and treatment
5. procedure based on rationale that requires active participation
The Great psychotherapy debate (citation)
This study claimed that therapy was ineffective and was no better than spontaneous remission
What was the first meta-analysis of psychotherapy, and what did it find?
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
What are some problems with comparison studies?
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)
What did Wampold find in 1997?
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.
What is efficacy vs. effectiveness?
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).
EST has REALLY taken off after what event?
-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) – criteria based on FDA
-managed care companies give pressure to establish comparable efficacy to drug treatments
-NIMH control by psychiatrists; medicalization, required standardization, internal validity versus external validity
APA recognizes that effects due to common factors (absolute efficacy) are more important than effects due to what?
specific treatments (relative efficacy; APA, 2012)
2 important implications of common factors
(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);
The general or average effects of psychotherapy are widely accepted to be significant and _____?
LARGE (Chorpita et al., 2011; Smith, Glass, & Miller, 1980; Wampold, 2001).
EST proponents argue that adherence to a manual is crucial and related to outcomes but _____ is not.
allegiance (Heimberg, 1998; Kazdin, 1998)
Manuals have been around since the 1960s, have they improved client's outcomes?
No (Lambert, 1998)
How long are ESTs?
EST studies are short, 6-16 sessions (Westen et al., 2004)
What is the multicultural critique of ESTs?
May be incompatible with multicultural sensitivity (Atkinson, et al., 2001). Indeed, culture might influence outcomes (Quntana & Atkinson, 2002)
What was Labert's (1992) big contribution to the common factors literature?
identified 4 therapeutic factors
1. extratherapeutic factors
2. common factors
3. expectancy or placebo
Norcross presented a seminal paper in 2001 that were conclusions of division 29 task force. What were some highlights?
-ESTs that omit therapeutic relationship are lying
-Adapting and tailoring treatment to patient needs is crucial
+Therapeutic alliance +Cohesion in group therapy
+Empathy +Goal consensus and collaboration
=Promising and Probably Effective
+Positive regard +Congruence/genuineness
+Feedback +Repair of alliance ruptures
+Self-disclosure +Manage countertransference
+Quality of relational interpretation
If not ESTs then what?
Wampold (2001) recommends:
1. need rationale for treatment and a ritual consistent with rationale
2.Specific ingredients are used, but not to be as dogma
3.coherent thought in choosing interventions that will be effective; randomly choosing just as ineffective as a strict adherence to manual
4.treatments that are compatible with the client’s worldview; values and attitudes most important
5.trained in as many theories and techniques, but only those based on psychological principles
6. clients choose the best therapist, not the best therapy
What are some recommendations, given the common factors/EST debate?
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 manuals
4.focus on effectiveness rather than efficacy
adherence to medical model was brought on by pressure from what?
managed care system and eventually Div. 17 task force (APA, 1995)
4 broad categories of common factors according to Grencavage and Norcross?
1. therapist qualities
2. change processes
3. treatment structure
(Grencavage & Norcross, 1990)
Fervor for ESTs is thought to have begun with Paul's (1967) article. Why?
He questioned which treatments work best under what conditions, what time, what setting, which type fo client, which type of disorder, etc.
What is relative efficacy?
How well a treatment works compared to an existing treatment
Although Brooks-Harris argue for 8 routes to integration, what are the primary 3 argued by most?
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)
What is absolute efficacy?
How well a treatment works compared to a no-treatment control group
Common factors framework based on temporal sequence in therapy? (3 factors)
support factors, learning factors, action factors
(Lambert & Ogles, 2004)
Shapiro and Shapiro also found a large effect size for therapy, what was it?
d = .82 (Shapiro & Shapiro, 1982)
In 2001 Wampold reported a therapy effect size of .75-.85. This referred to ____ efficacy.
Absolute efficacy (how well therapy works compared to a control group, those who don't receive therapy)
What are some assumptions of the medical model, which undergirds ESTs?
i.Specific factors exist and are the agent of change for specific disorders
ii.Common factors are uninteresting (may be present but not important)
iii.Adherence to a manual is related to outcomes while allegiance is not
iv.Psychopathology is highly malleable;EST studies are short, 6-16 sessions (Westen et al., 2004)
v.Comorbidity is not an issue
vi.Psychiatric disorders can be treated independently of personality factors
vii.Experimental methods provide the gold standard for finding useful treatment packages
The therapy relationship accounts for why clients improve (or don't) as much as _______
any particular treatment method (Norcross, 2011)
Monitoring the therapeutic relationship is important, and can lead to what practical benefits?
-increased opportunities to repair alliance ruptures, --improve the relationship,
-modify technical strategies, and
-avoid premature termination
Therapeutic alliance in early stages of treatment is build on what 3 things?
1. emotional bond
2. agreement on goals
3. consensus on tasks
client's evaluation of quality of therapeutic alliance is best predictor of _________.
outcome (Horvath et al., 2011)
emapthy is a _____________ predictor of outcome
moderate, r = .30 (Elliot, Bohart, Watson, & Greenberg, 2011)
goal consensus, which is a moderate predictor of outcome in a recent meta-analysis, is referred to as _____________
collaboration (Tryon & Winograd, 2011)
positive regard has a ______________ relationship with outcome
moderate (Farber & Doolin, 2011)
positive regard may be especially effective for what kinds of clients?
racial/ethnic minority groups (Farber & Doolin, 2011)
congruence is a ____________predictor of outcome
small/medium, r = .24, (Kolden, Klein, Wang, & Austin, 2011)
What benefits does client feedback offer?
(Lambert & Shimokawa, 2011)
-small to moderate positive influence on outcome
-especially good for clients at risk for negative outcomes early in therapy
How are rupture-repair episodes related to outcome?
small to moderate, r = .24 (Safran, Muran, & Eubanks-Carter, 2011)
What is the effect of countertransference on outcome?
negative and small, r = -.16 (Hayes, Gelso, & Hummel, 2011)
stages of change is important, what stages fares poorly
precontemplation (Norcross, Krebs, & Prochaska, 2011)
Any differences between spiritual and secular therapies?
not on psych distress, but on spiritual outcomes, not surprisingly spiritual therapies are better (Worthington et al., 2011)
What is a citation for the fact that gains made in therapy are maintained over time?
Nicholas & Berman, 1993
What percentage of a client's improvement can be attributed to the therapeutic alliance?
30% (Lambert, 1992)
Who/what is the primary change agent in therapy?
The client (Tallman & Bohart, 1999)
What are 3 factors of client success?
Glenvacage & Norcross, 1990
1. positive expectations for therapy
3. actively seeking help
What are 3 necessary therapist qualities (Rogers, 1951)
2. nonpossessive warmth
What is the "paradoxical" theory of change?
Change occurs when you allow yourself to be who you are, not who you would like to be (Rosner, 1987)