Concept: Common factors theory
- World psychiatry : official journal of the World Psychiatric Association (WPA)
- Published almost 5 years ago
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and competence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and © the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology.
Regardless of their historical and theoretical roots, strategies, tactics, and techniques used in everyday psychotherapy across diverse theoretical schools contain common factors and methods from other specific psychotherapeutic modalities that contribute substantially to psychotherapy outcomes. Common factors include alliance, empathy, goal consensus/collaboration, positive regard/affirmation, and congruence/genuineness, among others. All therapies also recognize that factors specific to therapists impact treatment. Starting with these common factors, we add psychotherapeutic methods from many theoretical orientations to create a collection of clinical tools. We then provide concrete suggestions for enacting psychotherapy interventions, which constitute a transtheoretical collection.
Laska, Gurman, and Wampold (2014, pp. 467-481) present their common factors (CF) model as an alternative/complement to existing empirically supported treatments. The CF model is largely based on nonrandomized studies and a post hoc interpretation of a lack of differences between psychotherapies in their outcomes. Our view is that the CF model would be advanced through randomized experiments that test the specific components that Laska et al. (2014) hypothesize as necessary and sufficient for change. With some notable exceptions, we agree with many of the points made by Laska et al. (2014) regarding the relevance of the CF perspective to the delivery of psychotherapy in general, but suggest that prospective studies that control for potential confounds are needed to successfully advance the CF model or any other model of psychotherapy. (PsycINFO Database Record © 2014 APA, all rights reserved).
Laska, Gurman, and Wampold (2014, pp. 467-481) argue for the inclusion of common factors (CF) approaches to psychotherapy to be an alternative to empirically supported therapies when developing an evidence-based practice. Although we applaud their scholarship and the cogency of their arguments, we believe that they fall short of what is needed to define an optimal and effective therapy. Integration rather than amalgamation better captures the complexity of psychotherapy and adds to the explained variance. While CF dimensions certainly should be considered within the research definition of “psychotherapy,” there are also important characteristics of the participants that are not captured in either the patient’s diagnosis or the interventions that the therapist uses that affect outcome. We believe that the authors have inadvertently equated CFs with nonspecific ones and thus excluded a host of moderating variables in psychotherapy that produce specific and differential effects but which are not “nonspecific.” (PsycINFO Database Record © 2014 APA, all rights reserved).
- Psychotherapy research : journal of the Society for Psychotherapy Research
- Published over 5 years ago
Abstract On the occasion of the 25th anniversary of the journal, Psychotherapy Research, three former editors first look back at: (i) the controversial persistence of the Dodo verdict (i.e., the observation that all bona fide therapies seem equally effective); (ii) the connection between process and outcome; (iii) the move toward methodological pluralism; and (iv) the politicization of the field around evidence-based practice and treatment guidelines. We then look forward to the next 25 years, suggesting that it would be promising to focus on three areas: (i) systematic theory-building research; (ii) renewed attention to fine-grained study of therapist techniques; and (iii) politically expedient research on the outcomes of marginalized or emerging therapies.
The facilitation of insight-broadly defined as forming new connections about one’s self, others, and emotions-is viewed as a key process in many forms of psychotherapy. However, relatively little empirical work has addressed what types of therapeutic techniques may facilitate or hinder insight, especially in applied settings. In this practice-research network study, 31 clients and 16 therapists completed questionnaires after 401 sessions of psychotherapy. Multilevel linear modeling was used to explore whether insights are associated with various types of treatments and therapist-reported interventions, while taking into account differences between clients, therapists, and sessions. The results indicate that the types of treatment, as defined by the theoretical orientation of therapists' supervision, were not related to client-rated insight, although this analysis requires more statistical power. However, sessions that included more therapist-reported exploratory interventions than usual for a given client were found to be lower in insight than other sessions for the same client. Similarly, therapists who reported using more exploratory interventions than other therapists had clients who reported experiencing less insight after sessions than other clients. In contrast, therapists who reported using more directive interventions than other therapists, on average, had clients who reported more insight. However, interaction effects revealed that a more complex interpretation of the data was necessary. Specifically, therapists who reported using more directive interventions than their peers, on average, had clients who reported more insight only if the therapists did not also report using high levels of exploratory interventions. Furthermore, directive interventions were associated with insight only when they were used in sessions that also had high levels of common factors. Overall, this study shows that there are both treatment-specific interventions and common factors that are associated with insight, suggesting that understanding differences between types of psychotherapy may require more nuanced analyses within and between treatments. (PsycINFO Database Record © 2013 APA, all rights reserved).