Trust, empathy and mutual understanding are essential to achieve effective therapy results. How patients perceive and believe in the treatment process determines their engagement and therapy outcomes.
Therapists must adapt and combine techniques and strategies to meet the unique needs of each patient. The contextual model of psychotherapy is a conceptual framework that emphasizes the importance of various factors in the effectiveness of psychotherapy. This model was primarily developed by Bruce E. Wampold and detailed in his book "The Great Psychotherapy Debate" (2001). At the heart of the contextual model is the belief that the effectiveness of psychotherapy emerges from a combination of intertwined elements, rather than a single method (Wampold & Imel, 2015). The model highlights three vital pathways through which therapy impacts patients: the therapeutic relationship, the creation of expectations, the execution of specific therapeutic strategies
Psychotherapy has undergone considerable evolution, enriched by various theories, and this model has played a vital role in identifying the importance of common factors in psychotherapy and in providing a refined understanding of therapeutic effectiveness. (Wampold, 2015). This model has been studied and explored successfully by research such as that of DR Vitry (2021) at SYPRENE in Paris, France. I want to not only define the fundamental principles of the contextual model, but also closely examine the impact of these common factors on psychotherapy outcomes.
Impact and practice
The emphasis on common factors aims to transform the practice of psychotherapy, drawing attention to the intricacies of the therapeutic process, emphasizing the importance of the therapeutic relationship, cultural sensitivity and the need to adopt approaches flexible and patient-centered. This understanding is crucial not only for the effective practice of psychotherapy, but also for the continued advancement and relevance of the field. This evolution should allow us to go beyond specific techniques and take into account, with more sensitivity and attention, elements such as the therapeutic relationship, the patient's expectations (Nardone and Portelli, 2007; Robson, 2023) and the cultural background. Knowing the central role of the therapeutic relationship in achieving positive outcomes requires us to prioritize building trust, empathy, and understanding. This relationship forms the backbone of therapy, providing a secure basis for exploring and treating psychological issues. A strong therapeutic alliance is correlated with improved patient engagement, reduced dropout rates, and more effective treatment outcomes (Wampold, 2001).
Enhancing self-reflection and therapist development
Awareness of therapist effects, that is, the impact of their personality, skills and behaviors on therapy, should encourage continued professional development and personal reflection in this area. . Clinicians are encouraged to assess and refine their skills regularly, ensuring their approach remains effective and meets the needs of each patient, similar to deliberate practice (Miller et al., 2020). Deliberate practice is a highly structured and focused approach to skill development, characterized by specific goals, continuous feedback, and a significant level of effort and focus. It was popularized by psychologist K. Anders Ericsson, who studied how people become experts in their field.
Key Elements of Deliberate Practice
Specific, Well-Defined Goals: Deliberate practice involves working to achieve specific goals designed to improve particular aspects of performance. These goals are not simply about engaging in an activity, but about improving specific elements of the skill.
Concentration and effort: Training requires a high level of concentration and is often mentally demanding. The practitioner must concentrate fully on the task, often going beyond their comfort zone.
Structured Approach: Unlike casual practice, deliberate practice is methodical and often involves a structured practice regimen. This structure is usually designed by a teacher or coach who knows how to develop skills effectively.
Immediate feedback: Regular and immediate feedback is essential in deliberate practice. This feedback, whether from a coach, teacher, or self-assessment, helps the individual understand their progress and areas for improvement.
Repetition and refinement: This involves repeated performance of the skill, with adjustments based on feedback. This cycle of execution, feedback, and refinement is essential to mastering the skill.
Specific skill development: Instead of general improvement, deliberate practice targets very specific areas of development, often breaking complex skills into smaller, more manageable pieces.
Getting out of your comfort zone: this generally involves exercising to the limit of your abilities. The challenge is high enough to test the individual's skills, but not so high as to be unattainable.
Long-term commitment: Mastery through deliberate practice is a long-term process. It requires sustained effort over a long period, often involving many hours of practice (Vitry, 2020).
Importance in the field of psychotherapy
Recognition of the importance of common factors promotes a more adaptive and integrative approach to therapy. Clinicians are better equipped to combine different methodologies and techniques, tailoring their approach to best meet the individual needs of their patients, alongside deliberate practice. The emphasis on common factors in psychotherapy is not simply a change in therapeutic approach; it represents a fundamental shift in understanding what makes therapy effective and what we should focus on.
The paradigm shift of this approach challenges the notion of universal superiority of certain treatment models or techniques, emphasizing instead the importance of the qualities of the therapist, the therapeutic alliance and the treatment context.
This approach aligns with growing research that highlights the need for culturally competent support in therapy.
Reflects a shift toward more evidence-based practices, where decisions are based on the most current research and tailored to individual patient needs.
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The role of expectations
Expectations exert a considerable influence on human behavior and play an important role in psychotherapy and medicine (Kirsch, 2012). The expectancy effect can be used to influence patients' perceptions of their treatment and problems (Frank, 1973). Nurturing optimistic expectations and realistic, meaningful expectations for change, through clinical dialogue (Gibson, 2022) and coherent articulation of the problem/disorder and the proposed treatment, enhances the effectiveness of therapy. Although the importance and centrality of specific techniques that can leverage these common factors must be emphasized, their success is facilitated by creating positive expectations and encouraging beneficial behaviors (Wampold, 2001). This challenges the traditional belief in the supremacy of specific techniques as the primary catalysts for change, and instead proposes a more holistic approach to therapy (Nardone and Portelli, 2007). Empathy or the feeling of empathy is emerging as an essential component of psychotherapy, with studies showing that there is a strong association between empathy and positive treatment outcomes (Elliott et al., 2011). The therapist's capacity for empathy deeply strengthens the therapeutic alliance and drives the overall success of therapy, but true empathy is felt most deeply when we strike a chord with patients in our clinical dialogue and also when the effects of therapy and the desired changes are felt in patients' real lives, only then can patients think that we truly understand their plight (Gibson, 2022; Nardone and Balbi, 2008).
Cultural adaptation and therapist effect
Therapists' skills and personal qualities (therapist effects) have a substantial impact on therapy outcomes (Baldwin, Wampold, & Imel, 2007) and are trans-contextual, challenging the belief that therapies specific are essential for certain disorders. It is thus proposed that the effectiveness of psychotherapy is largely attributed to common factors rather than specific treatment methods (Wampold & Imel, 2015). It is also important to clarify that common factors can be significantly strengthened by effective therapeutic interactions that rely on relationship and communication (Gibson, 2022; Nardone, 2009; Vitry et al., 2021).
Where to train in the systemic and strategic approach?
LACT offers several live certified web training courses with 50 international trainers.
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References
- Baldwin, SA, Wampold, BE and Imel, ZE (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842-852.
- Benish, S.G., Quintana, S. and Wampold, B.E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58(3), 279-289.
- Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260.
- Elliott, R., Bohart, AC, Watson, JC, & Greenberg, LS (2011). Empathy. Psychotherapy, 48(1), 43-49.
- Frank, J.D. (1973). Persuasion and healing: A comparative study of psychotherapy (2nd ed.). Baltimore: Johns Hopkins University Press.
- Gibson, P. (2023). Persuasion Principle. Strategic persuasion. Strategic science
- Grégoire Vitry, Claude de Scorraille, Claudette Portelli, Michael F. Hoyt, Redundant Attempted Solutions: Operative Diagnoses and Strategic Interventions to Disrupt More of the Same, Journal of Systemic Therapies, 10.1521/jsyt.2021.40.4.12, 40, 4, (12 -29), (2021).
- Nardone, G. and Balbi, E. (2008). The logic of therapeutic change. Karnac Books.
- Nardone, G. and Portelli, C. (2005b). Knowing Through Changing. The evolution of brief strategic therapy. Crown House.
- Nardone, G., & Salvini, A. (2007). Strategic dialogue. KarnacPublishing.
- Robson, D. (2023). The Expectation Effect. Cannongate. UNITED KINGDOM.
- Wampold, B.E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates.
- Wampold, B.E. (2015). How important are common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277.
- Wampold, BE and Imel, ZE (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). New York, NY: Routledge.
