摘要:

This article reviews literature on negative outcome in psychotherapy for adult, non‐psychotic individuals. Patient, therapist, and therapy variables are examined, and tentative conclusions are drawn from the existing data. Patients who are borderline or obsessive‐compulsive, have severe interpersonal difficulties, are poorly motivated, or who expect psychotherapy to be painless have been found to be at risk for deterioration. On the part of the therapist, lack of empathy, underestimation of the severity of the patient's problems, negative counter transference, poor technique, high concentrations of transference interpretations, and disagreement with the patient about the therapy process all have been associated with negative outcome. Cestalt therapies have produced higher rates of deterioration than other psychotherapy modalities. Issues in research methodology are discussed, including identification of negative responders, outcome measurement, identification of variables related to negative outcome, and the role that ethical dilemmas play in resea

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00022.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

As clinical psychology addresses an increasingly wide spectrum of problems, the discipline's dominant emphasis on psychopathology must be integrated with an equivalent understanding of psychosocial problems. Such a balance is viewed as improving work done in relation to all problems addressed by clinical psychology and the mental health field. In support of these views, this article explores the importance of going beyond psychopathology with respect to (a) classifying behavioral, emotional, and learning problems and (b) conceiving intervention models.

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

There is apparently little difference in the effectiveness of different kinds of psychotherapy. One explanation is that common factors cut across them. The major schools do not much attend to common factors, however, and it may be that outcome equivalence is due as much to common neglect of common factors as to their use. Five common factors are discussed: the therapeutic relationship, expectations, confronting problems, mastery, and attribution of outcome. Linear conceptions of causality seem to contribute to the problem of selective neglect of common factors, and it is suggested that reciprocal interaction may constitute a more viable way of understanding therapeutic processes. Although technical eclecticism and therapy integration have been proposed as potentially integrating the common factors, eclecticism lacks theoretical coherence, and viable integrations have yet to be offered, although statistical methods for testing them (causal modeling) may exist. To suggest what a productive integration could look like, a clinical example is connected metaphorically to a developmental model of attachment. Strategies for further research are also suggested.

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00024.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Like many psychotherapy researchers, I have been fascinated by the role of “specific” and “nonspecific” (or common) factors from the beginning of my career. For a long time K was erroneously believed that nonspecific factors required no skills on the part of the therapist whereas specific factors were equated with specialized training and expertise. Eventually, my fellow researchers at Vanderbilt and I concluded that the two terms are misnomers that have beclouded rather than clarified the basic issues. In the end, I became convinced that therapists’ skills contribute materially to the outcome of therapy and that these skills, rather than being specific techniques, are much more accurately described as the ability to manage the complex human relationship that is the essence of psyc

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00025.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Weinberger's article presents an oversimplified conceptualization of so‐called common factors in psychotherapy. Further differentiation of this concept is needed, considering the different role that may be played by variables subsumed under this rubric in different therapeutic approaches, in interaction with different therapist interventions, and with different types of patients and patient problem

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00026.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Weinberger presents a number of reasoned arguments to explore the nature of common factors in psychotherapy among different theoretical approaches. While it is apparent that common factors are both inconsistently described and often ignored as one looks at various approaches, I contend that there are some unrecognized common elements. The attempt to derive a common list ignores both the different ways that these factors may develop and the variable interaction that may characterize each factor's impact across different theories. Moreover, Weinberger's suggestion that the technical eclectic movement lacks a theoretical base is erroneous. Rather than being a weakness, the absence of a single theory of pathology and change is the strength of technical eclectic approaches.

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00027.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Weinberger's article on common factors (this issue) highlights crucial aspects of the psychotherapy process. Toward the aim of building a theory of psychotherapy change, I further suggest that theoretical eclecticism would fuel our conceptual creativity, by encouraging therapists to openly learn all major theoretical systems and avoid identifying themselves with a predominant one. I also propose that the development of an inte‐grative model of personality represents a necessary building block toward the overall goal of understanding change. Finally, we need to work toward greater clarification of the common factors we have already identified. Throughout my commentary, I provide examples in an attempt to clarify those point

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00028.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This reaction to Weinberger's article (this issue) about common factors in therapy focuses on two issues: (a) to be useful, the common factors need to be defined in more concrete terms, so they can be measured separately from other aspects of therapy process; and (b) rather than just measuring the common factors, we need to study the mechanisms of change, or how the common factors interact with other variables to result in change. Finally, I suggest that we consider the concept of equifinality, that is, that even though different factors have different mechanisms of change, they may all produce the same outcome.

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00029.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

All psychotherapy patients, whatever their specific complaints, suffer from demoralization engendered by pervasive negative meanings that they assign to aspects of themselves and their experiences. Features common to all psychotherapies seek to transform these meanings to positive ones, with concomitant reduction of suffering and disability.

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00030.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

To better identify and understand the role of common factors in psychotherapy, I argue that we should begin with what therapists actually do in psychotherapy, rather than what they say they do. Further, in contrast to Weinberger's position, I argue that there is not yet any convincing evidence regarding the causal role of any common factors in psychotherapy outcome, although research to determine the possible causal role of these and other potential change factors is sorely needed. Finally, I suggest that common factors are not isolated entities that should be taken out of context, but may more fruitfully be considered as complex, multidimensional and interactive processes that are affected by context and change over time. I believe that an important challenge for future work in common factors is the development of theories of the processes of change that include a variety of factors (common and specific) and their interactions.

ISSN:0969-5893    

DOI:10.1111/j.1468-2850.1995.tb00031.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY