Common Psychotherapeutic Factors PDF

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Common Psychotherapeutic Factors...

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COMMON PSYCHOTHERAPEUTIC FACTORS In its beginnings, psychotherapy was presented as a unique procedure, both in its theoretical and technical aspects. As psychology as a scientific discipline grew, the models began to diversify, generating a field of proposals on many occasions confronting each other. (Fernández Álvarez, 2008). The time of rivalry between the different psychological currents has been overcome thanks to the research work in psychotherapy, since its findings suggest that the different models are equally effective; as the Dodo bird from Alice in Wonderland dictates: Everyone has won and everyone should have a prize. (1975, Luborsky, Singer & Luborsky, 1975 cited in Tallman & Bohart, 1999) It is these findings that have led many authors to postulate the existence of processes common to the different models of psychotherapy, processes that are, ultimately, responsible for the improvement achieved; These are the so-called common factors. The present investigation arises with the purpose of deepening in the aforementioned concept, exploring in turn the degree of approach that advanced students and psychology teachers have about the subject. On the other hand, an attempt is made to know aspects related to the psychotherapy carried out by the subjects of the sample, describing the variables that determined the choice of their psychotherapist, comparing between students and teachers the weight of the theoretical orientation in said choice and evaluating the degree overall satisfaction with the treatment. An investigation of these qualities could be a valuable contribution since it makes it possible to reflect on the most essential aspects of psychotherapy, those that exceed the theoretical differences, as well as allow us to reconsider about the epistemological aspects that have led to the diversification of psychology and their respective currents. The thesis work developed below is made up of two parts, a section corresponding to the Theoretical Framework and another to the Methodological Framework.

In the Theoretical Framework the following chapters are developed: first chapter entitled "Common Factors", the purpose is to define said concept as well as to develop each of these factors (extra-therapeutic factors, therapeutic relationship, expectations and placebo and specific techniques) taking for it Scott Miller et al. proposal. In the second chapter, entitled “Contextualization of the Common Factors Approach” the intention is to display a historical journey from the appearance of this approach to its study today. In addition, an attempt is made to briefly define the integrative movement, in order to understand the context that currently enables the study of common factors. Ultimately, it seeks to define the differences between this approach and the other lines of approach of the integrative movement: technical eclecticism and theoretical integration. In the third chapter, "Psychotherapy Systems", we seek to understand some basic epistemological questions about the existence of various paradigms within psychology. Next, an attempt is made to carry out a comparative analysis on the theoretical look and therapeutic approach of five models of psychotherapy: the psychoanalyst model, the existential, the cognitive-behavioral, the systemic and finally the Gestalt. The Methodological Framework is developed in chapter four where the main objectives of the present study and the research questions are defined. In addition, the methodology, the research design, the measurement instruments used and the characteristics of the sample are detailed. Finally, in chapter five, the presentation and analysis of the research results is carried out. Finally, the conclusions reached in the framework of the research carried out are presented.

THEORETICAL FRAMEWORK

Chapter I: Common factors

I.1 Introduction In the first chapter of this Thesis an attempt is made to define the concept of common factors, including the contributions of the various authors with whom we have worked throughout it. It also seeks to develop each of these common factors, taking as a guide the proposal of Scott Miller and collaborators: extra-therapeutic factors, therapeutic relationship, expectations and placebo, and specific techniques, integrating this current proposal with the pioneering approach of Jerome Frank.

I.2 Definition of the concept About the multiplicity of psychotherapy currents existing in the psychological discipline, Jerome Frank (1977, 232) believes that "The fact that they all flourish simultaneously is proof that they all have something to offer." With this, the author realizes that all known forms of psychotherapy have proven to be equally effective and that this uniformity of results shows that there are core issues shared by the different theories. Although the theoretical assumptions and psychotherapeutic interventions of each school are apparently dissimilar and even opposite, as stated by Frank (1977, 350) "Examining them more closely, however, certain aspects of the psychotherapeutic scene strongly suggest that the characteristics shared by the various psychotherapies far exceed their differences." Taking this into account, it can be affirmed that there are curative elements in psychotherapy independent of the theoretical orientation that constitute a bridge between the different schools; This is what the concept of common factors is about. When trying to address a definition of "common factors", some authors formulate that "A simple explanation is to characterize them as those that are not in the manual." Castro Solano (2001, 66). With this, the author refers that these

Factors are not detailed in treatment manuals, because they are not specific to any particular school of psychotherapy. Prochaska and Norcross complete this idea by postulating that there is a central nucleus underlying psychotherapy that goes beyond theoretical differences. Michael J. Lambert (1992, cited in Prochaska and Norcross, 2009, ch. 1) indicates that "this nucleus is composed of common factors or non-specific variables, common to all forms of psychotherapy and not specific to a particular therapy" . According to various authors, the so-called common factors are responsible for therapeutic success. Traditionally, these factors have also been known as nonspecific. However, various authors such as Snyder, Michael & Cheavens (1999) avoid such a name because on some occasions it has been misinterpreted as vague or unknown factors. It is necessary to note that, on the contrary, nonspecific means that the factors are not specific to any particular theoretical orientation and are shared by all psychotherapy approaches. Uribe Rastrepo (2008, 25) argues that when the term nonspecific factors is used, we are actually talking about very specific elements: the relationship and expectations among other factors that strongly impact the therapeutic situation. Therefore, according to this author, “it is preferable to speak of common factors and not nonspecific factors, In 1992 Michael J. Lambert, after a review of different outcome studies, proposed four factors that contribute to change in psychotherapy: extra-therapeutic factors, common factors, expectations and techniques. Miller, Duncan and Hubble, as a result of the first project of the ISTC (Institute for the Study of Therapeutic Change) broaden the definition of what were traditionally considered as common factors (the second of the four elements exposed by Lambert). Whereas before it was considered that they referred to the variables that mediate the therapeutic relationship (such as empathy and respect) and that are present in all schools of psychotherapy, The proposal of these authors suggests that these four elements in their totality should be considered common factors and that the second element corresponds to the relationship between the patient and the therapist. In short, of

According to the aforementioned authors, the common factors are: the extra-therapeutic ones, the therapeutic relationship, the expectations and the specific techniques. This proposal is taken as a guide in this Thesis and is the one that is detailed below. In order to simplify the development of the theme, the common factors are set out separately but it should be clarified that in the dynamics of the therapeutic situation they are elements that interact, enhancing their effects; Some authors call this property a synergistic relationship between the common factors. (Uribe Rastrepo, 2008)

I.3 Extra-therapeutic factors According to Michael Lambert's analysis of outcome studies, extra-therapeutic factors are the largest contributors to change (40%). It deals with aspects of the client and his environment, such as strengths, resources, social support and fortuitous events in his life, which facilitate recovery regardless of formal participation in therapy, and which, it is assumed, outweigh everything what the therapist can do. (Duncan, Miller & Hubble, 1998) Extra-therapeutic factors are operational elements in the life of the client before he begins psychological treatment, this includes random interactions between his internal strengths and external events, such as a new job or a crisis resolved in a favorable way. (Duncan & Miller, 2001) A clear demonstration of the influence and importance of extra-therapeutic factors are the pre-treatment change (that is, from when the decision to start psychotherapy is made until the moment when it is attended) and the change between sessions, which they suppose times and spaces independent of the influence of psychotherapy. The resources or sources of support that people have are varied, for example family, a friend, the church and even a book. Many people resort only to them without considering the possibility of psychological treatment. Frank (1977) believes that when people are troubled, they generally seek help eagerly and respond favorably to those who provide it. It is also very

They are likely to turn first to places outside of psychotherapy, reaching it only if the first sources have failed. At the time, Frank perceived these types of factors as a difficulty for the research task. In this regard, he states: The psychotherapeutic session represents only a tiny fraction of the patient's encounters with others; later, the results attributed to psychotherapy could be due to concurrent life events, including having resorted to the help of others, in addition to the therapist. (p.371) Currently, far from representing a difficulty, extra-therapeutic factors are an element to be taken into account and even to be incorporated into psychotherapy. According to this, Duncan, Miller and Hubble (1998) suggest that therapists should listen carefully to any change that may have occurred in the life of the subject, regardless of the treatment, integrate it and accommodate to that change. They should also help clients see any changes as a consequence of their own efforts and therefore something they can repeat in the future. As mentioned earlier, people have support outside of the psychotherapeutic relationship and have a natural tendency to seek help when they need it. Bearing this in mind, the therapist should facilitate this natural tendency, encouraging clients to explore and use resources in their daily lives. The fact of assessing the resources or skills does not mean that the therapist ignores the suffering of the consultant, which is what leads him to go to a therapist in the first instance, on the contrary, he will keep the full story in mind, both the complaint with its negative aspects such as the strengths and general positive characteristics of the consultant. This is another way of integrating extra-therapeutic factors into treatment, since the therapist does not focus solely on the needs and failures of the subject, but will keep in mind what they already have in their life that can be used to achieve therapeutic goals. In this sense, the techniques and the therapist himself are resources that the consultant will use in the process to achieve the desired changes.

In sum, taking into account the Lambert percentage distribution, the importance of what happens outside the sessions can be noted, a fact that is often forgotten or little valued by therapists, for which Duncan, Miller and Hubble (1998, 3) they have cleverly titled the extra-therapeutic factors as "The Silent Heroes of Psychotherapy." Prochaska (1992 cited in Mirapeix and Rivera, 2010) completes this idea by expressing the following: (…) The time that the patient attends the session corresponds to approximately one percent of his waking activity throughout the week; To pretend that this minimal percentage of time devoted to psychotherapy is what produces the change is too omnipotence on the part of the therapist. (p.19)

I.4 Therapeutic relationship This factor, according to the aforementioned Lambert research, is the second contributor to the change (30%). The therapeutic relationship, as an active element of psychotherapy is something that no model of psychotherapy questions. However, as Prochaska and Norcross (1994) point out, the desirable type of relationship and its relative importance are issues of theoretical disagreements. At one end of the continuum, therapies such as behavioral, see the relationship between client and therapist as little relevant. In the middle of the continuum, cognitive therapies that understand this relationship as a necessary precondition for advancing treatment could be located. At the other end of the continuum, Carl Rogers Client-Centered Therapy sees the therapeutic relationship as the essential process that produces change. For its part, As can be seen, the role that this factor plays in psychotherapy has different interpretations between the different models, as well as different conceptualizations. In fact, the terms client or patient that are used to describe the therapeutic relationship have different theoretical implications, this is a point of controversy because each term reflects a particular way of understanding the subject.

An interesting article entitled “Unspecific Variables in Psychotherapy” by Santibáñez Fernández et al. (2008) reviews the literature on the nonspecific variables that intervene in the therapeutic process, specifically the consultant, the therapist and the relationship. This article will serve as a guide for the description that follows. I.4.1 Consultant variables According to the aforementioned article, the variables of the consultant that intervene in the therapeutic process are (Winkler & cols., 1989 cited in Santibáñez Fernández et al., 2008): 1. Demographic variables: gender, age and socio-economic level The investigations found no significant relationship between gender and the outcome of psychotherapy. In any case, in specific cases such as women victims of rape, it is necessary to consider the gender of the therapist. On the other hand, it has been found that the more years of education and better socio-economic level of the consultant, the longer will be their permanence in treatment. 2. Clinical diagnosis: a. Personality characteristics and style of operation : Personality aspects such as intelligence, ability to produce associations, flexibility, variety of interests, depth of feelings, energy level, degree of ego integration, ego strength, amount of stress, and verbal productivity have been found to be relate to the success of therapy. On the other hand, clients with internal locus of control would benefit more from directive therapies, since they tend to attribute the therapeutic results to their own efforts. On the contrary, consultants with external locus of control tend to do better with directive treatments in which external determinants of behavior are the focus of analysis. In addition to those mentioned, another element that is considered in relation to the mode of operation is the defensive style.

b. Type of disturbance: Consultants with mild affective or behavioral disturbances seem to have a more marked improvement than consultants with more serious disturbances such as schizophrenia, paranoia or borderline personality. c. Symptom complexity: According to Beutler, consultants who have circumscribed or monosymptomatic symptoms respond better to behavioral treatments. Consultants who present with multiple symptoms, on the other hand, could benefit more with insight therapies. 3. Belief and expectations: Beliefs and expectations, not only about the treatment but also about the figure of the therapist, can influence the duration of therapy and a possible dropout. The highest number of dropouts occur between the first and the fifth session, which has led many to think that when patients assume that the treatment will exceed their expectations for duration, they drop out. Therefore, it is important to clarify doubts and beliefs from the beginning. 4. Personal disposition:Consultants with a negative disposition towards treatment and who are intransigent to the therapist's efforts to establish the therapeutic alliance, would obtain poor results. On the contrary, the positive disposition would favor successful results. The motivation, expectations and needs of the consultant are fundamental variables in the commitment to treatment. Taking into account that psychotherapy is ideally a voluntary process, it has been observed that when people are forced into treatment, they hardly benefit from it, or else abandon it. It is necessary to complement the aforementioned with the contribution of Jerome Frank regarding the figure of the consultant. The author (1977) maintains that the range of dysphoric emotions that afflict patients who consult a therapist is wide and varied, but all of them are framed in what he calls demoralization, a condition that all forms of psychotherapy seek to alleviate. Biological, psychological and social components of personal functioning always intervene in it, to a greater or lesser degree. Whatever the main focus of psychotherapy must affect all three components to achieve positive results. The

Demoralized people are incapable of facing certain problems that threaten them, so they feel isolated, powerless and hopeless. While some people in these moods attack those who try to help them, the majority of the demoralized seek help eagerly and respond favorably to those who provide it. It could then be said that demoralization increases suggestibility. The place of the client in the therapeutic relationship is recognized by most psychotherapy approaches, however it seems that the contribution of the therapist has been more revered. From the position of "professionalcentrism", it is the therapist with his techniques who causes the therapeutic changes. Authors such as Tallman and Bohart (1999) oppose such a position and express it in the following way: The reason different approaches to psychotherapy work equally well is that each gives clients the opportunity to work through them and solve their problems. Even if different techniques had different specific effects, clients would take those effects, individualize them for their specific purposes, and use them. (p.6) This idea reveals that although the interaction between therapist and consultant is crucial in the treatment and the consultant's perceptions of the therapeutic relationship greatly influence the process, the consultant's contribution is more powerful than that of the therapist, which is congruent with Lambert's findings: the consultant's pre-existing conditions (extra-therapeutic factors) are the ones that ultimately have the greatest weight in the results. In short, the consultant is the primary agent of change. I.4.2 Therapist variables According to various authors (Winkler & cols., 1989 cited in Santibáñez Fernández et al., 2008) the variables of the therapist that intervene in the therapeutic process are: 1. Attitude: The basic attitude of the therapist that is a facilitator of change is respect for the client, as well as acceptance, understanding,

warmth and motivation to help. On the contrary, poor listening skills, lack of understanding and the disposition of a cold and distant relationship on the part of the therapist ...