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69 Cards in this Set
- Front
- Back
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Common factors framework based on temporal sequence in therapy |
Lambert & Ogles, 2004 Support factors Learning factors Action factors |
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Surprise finding of NIMH TDCRP |
Both medication/ IPT sig. better than placebo for severely depressed, CBT not better than placebo for severely depressed |
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Goldfriend's argument about common factors (1980) |
At strategy level of abstraction, therapies had particular commonalities |
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3 names for Empirically Supported Treatments |
EVTs (APA, 1995) ESTs (Kendall, 1998) Evidence Based Practice (Institute of Medicine, 2001) |
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Do clients maintain gains? |
Feske & Chambless, 1995 Usually one year, according to meta analysis |
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4 general areas of outcome conceptualized by OQ-45 |
Lambert Symptoms of psychopathology Interpersonal difficulties Social role functioning Well-being |
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Okiishi at al., 2006 approach to understanding outcomes |
Outcomes vary as a function of treatment provider. We should study what effective therapists do |
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Pattern of alliance related to positive outcome? |
High, low, high; v shape (Gelso & Samstag, 2008) |
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Dodo bird conjecture |
Rozenzweig, 1936 "Everybody has won, and all must have prizes" Argued against specificity and for the non-central aspects common in most therapy |
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Dodo bird revisited |
Duncan, 2002 |
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Dissatisfaction with individual theoretical approaches spawned 3 movements |
Arkowitz, 1992 Theoretical integration Technical eclecticism Common factors |
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Better predictor of outcome: allegiance or type of therapy? |
Allegiance Berman, Miller & Massman, 1985 |
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The great psychotherapy debate |
Wampold, 2001 |
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Therapy is ineffective and no better than spontaneous remission |
Eysenck, 1952 |
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First meta analysis of psychotherapy |
Smith & Glass, 1977 375 studies comparing treatment condition to a control condition and found that 75% of those treated were better off than non-treated, effect size .68 |
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Problems with comparison studies |
Allegiance effects Same therapists delivering both conditions of treatment Potential for type 1 and type 2 error No difference between txs could be result of insufficient power Lambert & Ogles, 2004 Wampold, 2000 |
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Therapies should be considered equally effective until evidence has been found that a treatment is not as good |
Wampold, et al., 1997 Large meta analysis of studies from six major counseling research journals from 1970 to 1995 supported common factors approach |
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Efficacy vs effectiveness? |
Efficacy - RCTs, emphasis on internal validity through limiting types of patients, types of treatment through manuals, specific training, random assignment (Chambless et al., 1998; Lambert & Ogles, 2004) Effectiveness - 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) |
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EST took off after what |
1996 division 12 task force on promotion and dissemination of psychological procedures - criteria based (Lambert & Ogles, 2004; Orlinsky et al., 2004; Wampold & Bahti, 2004) |
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APA recognizes that effects due to what are more important than what |
Common factors (absolute efficacy) vs specific treatments (relative efficacy) APA, 2012 |
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2 implications of common factors |
Most valid and structured psychotherapies are roughly equal in effectiveness Patient and therapist characteristics, which are not usually captured by a patient's diagnosis or by the therapists use of a specific psychotherapy, affect the results Castonguay & Beutler, 2006 Livesley, 2007 Norcross, 2011 |
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General or average effects of Psychotherapy are significant and large |
Chorpita et al., 2011 Smith, Glass, & Miller, 1980 Wampold, 2001 |
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EST proponents argue that adherence to a manual is crucial and related to outcomes but allegiance is not |
Heimberg, 1998 Kazdin, 1998 |
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Manuals have improved client outcomes since 1960s? |
No Lambert, 1998 |
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How long are EST studies |
Short, 6-16 sessions Westen et al., 2004 |
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Multicultural critique of ESTs |
May be incompatible with multicultural sensitivity (Atkinson et al., 2001) Culture might influence outcomes (Quntana & Atkinson, 2002) |
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4 therapeutic factors Labert, 1992 |
Extratherapeutic factors Common factors Expectancy or placebo Techniques |
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If not ESTs then what? |
Wampold, 2001 Need for rationale, ritual consistent with rationale Specific ingredients are used but not as dogma Coherent thought in choosing interventions that will be effective Treatments compatible with clients worldview (values and attitudes) Trained in many theories and techniques (only those based on psychological principles) Clients choose the best therapist, not the best therapy |
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Recommendations re: common factors vs est debate |
Wampold, 2001 Limit clinical trials Focus on elements of therapy that explain general effects or unexplained variance Relax emphasis on treatment manuals Focus on effectiveness rather than efficacy |
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Pressure for adherence to medical model comes from |
Managed care system, APA div 17 task force (APA 1995) |
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4 broad categories of common factors Grencavage & Norcross, 1990 |
Therapist qualities Change processes Treatment structure Relationship |
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Fervor for ESTs is thought to have begun with Paul, 1967 article. Why? |
Questioned which treatments work best under what conditions, what time, what setting, which type if client, what type if disorder, etc. |
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What is relative efficacy? |
How well a treatment works in comparison to an existing treatment |
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Brooks-Harris argue for 8 routes to integration, what are the primary 3 argued by most? |
Theoretical integration: combines 2+ theories into a more complex tx. Synthesis involves reconciling underlying assumptions Technical eclecticism: using a combo of techniques that work well together, without a well defined theoretical synthesis. May have one foundational theory and integrate other techniques. Common factors: based on a core of healing elements shared across theories and techniques |
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Common factors healing elements shared across techniques and theories |
corrective emotional experience, warmth, empathy, unconditional positive regard, hope, trust, persuasion, challenging misconceptions, changing schemas, restoring morale, providing new experiences, giving accurate feedback |
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What is absolute efficacy? |
How well a treatment works vs a no treatment control group |
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.82 effect size for therapy |
Shapiro & Shapiro, 1982 |
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What evidence did Shapiro & Shapiro, 1982 provide to support the medical model? |
Cognitive and multimodal behavioral therapies showed relative efficacy over other methods |
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Absolute efficacy effect size of .75-.85 |
Wampold, 2001 |
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Assumptions of the medical model |
Specific factors exist and are the agent of change for specific disorders Common factors are uninteresting Adherence to a manual is related to outcomes while allegiance is not Psychopathology is highly malleable Comorbidity is not an issue Psychiatric disorders can be treated independently of personality factors Experimental methods provide the gold standard for finding useful treatment packages |
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Therapy relationship accounts for why clients improve or don't as much as any particular treatment method citation |
Norcross, 2011 |
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Monitoring the therapeutic relationship is important and can lead to what practical benefits |
Lambert, 2010 Increased opportunities to remain alliance ruptures Improve the relationship Modify technical strategies Avoid premature termination |
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Therapeutic alliance is built on what 3 things in the early stages of treatment |
Bordin, 1994 Emotional bond Agreement on goals Consensus on tasks |
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Clients evaluation of quality of therapeutic alliance is the best predictor of outcome citation |
Horvath et al., 2011 |
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Empathy is a moderate predictor of outcome citation |
Elliot, Bogart, Watson & Greenberg, 2011 |
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Collaboration is... |
Tryon & Winograd, 2011 Goal consensus Moderate predictor of outcome |
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Positive regard has a moderate relation with outcome citation |
Farber & Doolin, 2011 |
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Positive regard may be especially effective for what type of client |
Farber & Doolin, 2011 Racial/ethnic minority groups |
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Congruence is a small/moderate predictor of outcome citation |
Golden, Klein, Wang, & Austin, 2011 |
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What benefit does client feedback offer |
Lambert & Shimokawa, 2011 Small/moderate influence on outcome, especially good for clients at risk for negative outcomes early in therapy |
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How are rupture repair episodes related to outcome |
Safran, Muran, & Eubanks-Carter, 2011 Small to moderate |
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Effect of countertransference on outcome? |
Hayes, Gelso & Hummel, 2011 Negative and small, r= -.16 |
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What stage of change fares poorly? |
Norcross, Krebs, & Prochaska, 2011 Precontemplation |
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Percentage if client improvement can be attributed to therapeutic alliance |
Lambert, 1992 30% |
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Who is the primary change agent in therapy |
Tallman & Bohart, 1999 The client |
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3 factors of client success |
Glenvacage & Norcross, 1990 Positive expectations for therapy Distressed Actively seeking help |
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3 necessary therapist qualities |
Rogers, 1951 Accurate empathy Warmth Genuineness |
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Paradoxical theory of change |
Rosner, 1987 Change occurs when you allow yourself to be who you are, not who you would like to be |
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% distribution for specific vs general effects |
Wampold, 2001 Specific - 8% Common factors - 70% 22% unexplained variance |
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Wampold, 1997, meta analysis showed what comparative efficacies |
Therapy v no treatment = .82 Therapy vs placebo = .48 Placebo vs no treatment = .42 Difference between bona fide treatments = .00 <ES <.21 |
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Absolute efficacy of therapy ingredients |
Wampold, 2001 Specific ingredients = 1% Working alliance = 5% Therapist effects = 6% Allegiance = <10% |
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How many common factors are there? |
Rozenweig, 1936: 4 Garfield, 1995: 13 Grencavage & Norcross, 1990: 4 Lambert & Ogles: 3 |
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APA (2006) definition of EBP |
Not EST, integration of best available research for this client (culture, characteristics, prefernce) under the circumstances |
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Contextual model says these 3 aspects of treatment interact |
Imel & Wampold, 2008 Emotionally charged, confiding relationship Acceptable explanation of distress Treatment consistent with explanation |
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How do expectations fit into efficacy research? |
Thomas, 1987 Expectation created by provider was critical to symptom reduction |
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3 critiques of common factors |
Sexton et al., 2004 They're necessary but not sufficient, dismiss need for techniques Vauge and not scientific Crits-Cristoph et al., 2006 Can be reduced to a warm relationship |
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7 strategies for conducting outcome research |
Tx package strategy Dismantling strategy Constructive strategy Parametric strategy (30 vs 50 min) Common factors control group Comparative outcome strategy Moderation design (which type of clients) |
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How can therapy be altered for resistant clients |
Resistant clients do better with unstructured therapy, non resistant to better with structure |
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Range of variance accounted for by common factors in outcomes |
30% - 70% Barley, 2002 - Wampold, 2001 |
