Therapists' perceptions of the psychotherapeutic process: development of a psychotherapy process inventory

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

Background

The 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 Methods

Based 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.

Results

The 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.

Conclusion

Discrepancies 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.

The conceptualization and measurement of therapeutic alliance: an empirical review

Therapeutic alliance constitutes a major variable in explaining the outcome of treatment. However, meta-analytic, narrative, and theoretical reviews have all begun to comment on significant deficiencies in both conceptualization and measurement of alliance. While the evidence on the overall impact of alliance on treatment outcomes is impressive, we know much less about its components, modelling and discrete measurement. We review the conceptual and methodological underpinning of current alliance concepts and measures with the aim of identifying the current status of the methods and clarifying the conceptual and measurement tasks ahead. The review makes clear the diversity of concepts and measures available to address treatment alliance; however there is no one current measure of alliance that meets all the predefined criteria in either adult or child populations. We discuss the most successful measures to date, and recommend future developments in the field of alliance, including conceptual and experimental approaches, developmental issues, and analytic techniques.

Relationship of client participation to psychotherapy

Dimensions of client participation in psychotherapy were assessed to investigate whether participation is unidimensional or multidimensional, stable over therapy, and/or related to measures of psychotherapy outcome. Participation dimensions included compliance with scheduling (lateness, rescheduling, no-show) and with homework assignments (completion of a daily diary and relaxation home-practice), reported acceptance of the credibility of therapy rationale, satisfaction with global and specific aspects of therapy, expectation of personal improvement in anxiety symptomatology, self-rated engagement in therapy activities, and reported judgments about therapist characteristics and relationship qualities. Outcome measures included assessor ratings, daily client self-report of anxiety severity, and questionnaire measures. Subjects were 30 clients participating in a 12-session generalized anxiety disorder comparative treatment study in which they receive progressive relaxation training plus either cognitive therapy or nondirective therapy. Across clients in both treatment groups, behavioral compliance measures were poorly intercorrelated and unrelated to the other participation measures. Canonical correlation of participation variables with change on pre-post outcome measures showed a significant relationship between some participation variables representing satisfaction with specific aspects of therapy and the therapeutic relationship and improvement in daily level of subjective anxiety.