Common Factors in Therapy - Counseling and Therapy - Lecture Slides, Slides of Psychotherapy

Download Common Factors in Therapy - Counseling and Therapy - Lecture Slides and more Slides Psychotherapy in PDF only on Docsity!

Working Alliance &

Common Factors in Therapy:

Old and New Challenges.

AIMS for this presentation:

• Review stages of client readiness for change.
• Examine client and therapist characteristics that facilitate positive outcomes.
• Explore common curative factors responsible for quality outcomes in therapy.
• Provide an overview of the working alliance as a powerful dynamic construct.

Motivational Readiness

& Stages of Change:

Pre-contemplation (no intentions)

Contemplation (considering)

Preparation (some commitment)

Action (new behaviours)

Maintenance (working consistently over time)

Termination (self-efficacy, 100% confidence)

(Prochaska, DiClementi, Norcross, 1992 )

Readiness &

Stage of Change: “CUSTOMER”

GREEN LIGHT

• Able to identify goal (agree)
• Views self as part of solution (explore)
• Willing to take steps (encourage)
• A “doer”

Homework : Assign doing tasks.

(BTC, 1993; deShazer; Prochaska & DiClemente)

Client Characteristics related to

Positive Outcomes: (Weiner, 1998)

• Client motivated , and hopes to change, and expects that intervention will help accomplish the change.
• Client is a likable person with good capacity for expressing and reflecting on their experiences.
• Reasonably intact personality.

Therapist Characteristics &

Bond development: (Pope, 1998)

10 most significant attributes

Empathy, Acceptance,

Genuineness, Sensitivity,

Flexibility, Open-mindedness,

Emotional Stability, Confidence,

Interest in people, Fairness.

What Theory Works Best?

Outcome Research: Efficacy!

• Comprehensively proven that therapeutic interventions do have a positive impact
• 25-50 years of research: Failure to establish any one school/theory/model is superior to any other (Smith, Glass, & Miller, 1980)
• “Everyone has won and all must have prizes!”
• Shared core/common features that are curative
• Not IF it works or WHAT works, but HOW it works…

(Lambert, 1992)

Four Common Curative Factors:

• Client Factors (remission, inner strengths, goal directedness, motivation, personal agency, fortuitous events, social support, faith) 40%
• Expectancy/Placebo/Hope (credibility) 15%
• Techniques/Models (questions, feedback, reframing, interpretation, modelling, info) 15%
• Therapeutic Relationship Factors (empathy, warmth, respect, genuineness, acceptance, encouragement of risk-taking) 30%

Common Characteristics of

“Proven” Therapies (O'Donohue et al, 2000)

APA "empirically valid" therapies:

• Involved skill building rather than insight or catharsis;
• Had a specific focus rather than a general one;
• Included regular , ongoing assessment of progress ;
• Relatively brief in duration (20 visits or less).

Understanding the

Working Alliance: (Bordin, 1980)

• Integrates both the relational and technical aspects of therapy
• Strongly associated with outcome across all forms of treatment and intervention

Characteristics:

• Strength of alliance is predictive
• Strength of alliance fluctuates throughout relationship (ruptures and repairs)
• Early Vs. late scores as a marker of success
• Strength of early alliance allows strains and ruptures to be addressed

Phases:

• Phase one occurs in the initial session/s (Bond phase)
• Phase two begins as therapist starts addressing client issues (Work phase)
• Phase two is characterized by one or more strains and ruptures
• Direct therapist focus on ruptures can repair the alliance

Client Behaviours

that Strain the Alliance:

• Overt and indirect expression of negative feelings toward the therapist or the process
• Disagreement about the goals or tasks
• Over-compliance or avoidance manoeuvres
• ‘Self’-enhancing communication that is based in power conflicts (e.g., boasting)
• Non-responsiveness or continued Docsity.com

Clients’ perceptions of

non-alliance minded Therapists :

• critical, hostile
• non-attentive
• non-empathic
• forgetful, suspicious
• belief that the therapist is not clear about their expectations and goals