Researchon updating computer systems in hospitals
(Further elaboration and critiques of this "unrealistic model"—as embodied in much of the empirically supported treatment movement—are found throughout this volume, with a pointed and detailed evaluation provided by Wampold in chap. As medicine progresses, more effective treatments are developed, and the less effective treatments are discarded; gastric ulcers are now tteated with antibiotics rather than acid-neutralizing antacids because it was discovered that ulcers are caused by bacteria living in the gut. Easier said than done; therapists can demonstrate theit ptivilege of clients through careful listening, attending to feedback (see chap. Beutler (Eds.), Principles of therapeutic change that work (pp. Specifically, we believe that clinical seivice settings should be responsible fot using an MFS to collect, process, and analyze data collected concurrent with treatment.
—Charles Dickens, A Tale of Two Cities Dickens, starting his celebrated novel, used the rhetorical device called anaphora: the repetition of a word or words at the beginning of two or more successive clauses or sentences. Indeed, as the next section discusses, the research evidence has shown convincingly that the particular tteatment is relatively unimportant and the combination of thetapist, the client, and their work together is critical to the success of psychotherapy. In other words, clients are the common factor across varying forms of psychotherapy. On the other hand, many master's programs do emphasize interpersonal skills in admissions decisions, yet are forced to accept the vast majority of applicants for economic survival. To enhance client engagement in setvices, Duncan, Spatks, Millet, Bohanske, and Claud (2006) emphasized the impoitance of giving youths and theii categivets a voice about both the outcome and fit of provided services in their Partners for Change Outcome Management System (PCOMS). A tecent investigation of Parent Management Training, the Oregon Model (PMTO) futthet illustrates. Journal 0/Consulting and Clinical Psychology, 71, 973-979.
WAMPOLD It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity. As presented here, however, the status of superiority of treatment method, above all else, may well indeed be a consequence of history rather than of science. Their effort, involvement, intelligence, and creativity enable them to accommodate and metabolize different therapeutic approaches and achieve positive outcomes. Fitst, we must select students for graduate training who are both academically qualified and inteipeisonally skilled. On the one hand, Ph D and MD/DOs programs are very competitive in admissions, but favor entrance examination scores, undergraduate grades, and research experiences over interpersonal skills. Categivets or other adults typically initiate or maintain mental health services for youth (Yeh & Weisz, 2001). When therapists were drawn from the same pool, the supetiotity of EBT was nonsignificant. Establishing specificity in psychotherapy: A meta-analysis of stmctural equivalence of placebo controls.
A Tale of Two Cities, as the opening foreshadows is in part a story of dualities, set in a revolution at a defining moment in history. In 1936, Saul Rosenzweig, having observed that advocates of the vatious psychotherapies all claimed great success, suggested that there were commonalities among various treatments and that these commonalities were responsible for the benefits of psychotherapy. Clearly, clients come to thetapy because they have not been successful resolving problems with the resources available to them. We need to find a middle way, a way that commits us to selectingrigorouslyprepared and intetpersonally adept people. Journal of Consulting and Clinical Psychology, 68, 1027-1032. Both scales consist of only fout items and are completed by the client and caiegivet on a session-by-session basis. Distinguishing caregiver strain from psychological distress: Modeling the relationships among child, family, and caregiver variables. 6, this volume, foi the problems with such teviews), Ogden and Hagan (2008) reported that PMTO was effective in reducing parent-reported child externalizing problems, improving teacher-reported social competence, and enhancing parental discipline ovei TAU. with children exhibiting setious behavioral problems and moreover that an EBT program can be transported successfully to a new participant group" (p. The initial analysis that compared PMTO with TAU included 16 outcome measuies. On 1 of the 4 measures repotting a significant effect foi PMTO (the Child Behavioi Check List Total), the difference between the means at the end of tteat382 SPARKS AND DUNCAN ment of PMTO veisus TAU was 1.92 points.
In so doing, he created a cadence that not only makes the passage more memorable—some might say immortal—in the annals of literature but also intensifies the emotions he intends to evoke in his readers. Second Strand: Common Factors Models The strand that is obscured by the medical model of psychotherapy is the one that emphasizes the humanistic interaction of therapist and client. Such a view is not meant to minimize the importance of therapists. For this reason, some students with questionable preparation and mental health are admitted. B., Crits-Christoph, P., Gladis, L, & Siqueland, L. Alliance predicts patients' outcomes beyond in-treatment change in symptoms. How clients perceive therapist empathy: A content analysis of received empathy. PCOMS utilizes the Child Outcome Rating Scale (Duncan, Millet, & Sparks, 2003) for children 6 to 12 yeais of age (the fitst self-report outcome measuie foi children undet 13 yeats) and the Outcome Rating Scale (Millet & Duncan, 2000) fot youths 13 yeats and oldei. Aftei an unctitical account of reviews claiming PMTO efficacy (see chap.
Thirty years ago, Orlinsky and Howard (1978) tendered that "the difficulties encountered in [the] earliest stage of science arise not from the absence of a model for research, but from the multiplicity of basic models dividing the allegiances of researchers" (p. When the foregoing observation was made, schoolism—that is, immersion in and loyalty to a therapeutic orientation (be it psychoanalytic, behavioral, cognitive, etc.)—was the rule of the day. It is not surprising that debates were rampant and discourse was of the puerile "mine's better" sort. " is a resounding "Yes." Psychotherapeutic treatments have been subjected to tigotous clinical trials, and the benefits are demonstrably large. RESEARCH EVIDENCE FOR THE COMMON FACTORS MODELS 77 Lambert, M. Therapists facilitate client involvement by providing an atmosphere in which clients can be open, participate, test ideas, and make mistakes. Supervisors can assist clinicians in targeting areas for growth, as well as agency-wide tiaining needs, by reflecting on patterns of strengths and weaknesses across multiple clients on the basis of case chaiactetistics and tieatment piocess data. Most youth outcome measures were developed pt imarily as pte-post ot pet iodic outcome measures.
Those entering the field at that time tended to "work within one or another of these competing orientations, according to personal preference and the historical accidents of their training and work environs" (Orlinsky &. In this period, Strupp (1978) suggested that a newcomer'sfirstimpression of modem psychotherapy was bound to be bewilderment. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions (pp. Washington, DC: American Psychological Association. The effectiveness of psychotherapy exceeds that of many accepted medical practices. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. Bachelor, Laverdiere, Gamache, and Bordeleau (2007) found that the major- 96 BOHART AND TALLMAN ity of clients (76%) could be classified as either active or mutual collaborators, placing the primaty emphasis in treatment on their own efforts or on joint involvement with the therapist. Narrative medicine: Honoring the stories of illness. The online learning modules on common factots include not only infoimation but specific tools that can be used in supeivision and clinical sessions. CFIT: A system to provide a continuous quality improvement infrastructure through organizational responsiveness, measurement, training, and feedback. Such instmments provide an excellent way to measure program effectiveness but are not feasible to administer frequently and, therefore, do not provide teal-time feedback foi immediate treatment modification befoie clients drop out of suffet a negative outcome; in short, they are not clinical tools as much as they ate ovetsight tools.
Yet, it is true that in this period of our history, it is the "best of times" and the "worst of times." This is neither a cliche nor a literary technique. PSYCHOTHERAPY EVIDENCE FOR SPECIFIC INGREDIENTS The research evidence fails to support the conjecture that the focus on treatment is related to outcome and instead suggests that the common factots, as Rosenzweig (1936) presciently predicted, are critical to successful psychotherapy. Gassman and Grawe (2006) concluded that successful therapists "created an environment in which the patient felt he was petceived as a well functioning person. Research on the effectiveness of the psychotheiapy relationship is constrained by theiapist responsiveness—the ebb andflowof clinical interaction, as you put it. Howevet, parents who received feedback perceived mote positive outcomes than caregivets who did not receive feedback. In addition to these undeiwhelming results, the PMTO therapists teceived 18 months of training and ongoing suppott and supetvision duting the study, wheteas the TAU theiapists leceived no additional ttaining, suppott, ot supervision.
Over the past decade, advances in knowledge and social changes congenial to the practice of psychotherapy are contrasted to instability, monetary anxieties, and a crisis of confidence. Briefly, the research evidence related to several critical questions is reviewed in this section. Healing practices, which have existed since the origins of the human species and which are indigenous to every culture, past and present, have only recently been subjected to scientific scrutiny to determine whether or not they are effective. As soon as this was established, productive work on the patient's problems was more likely" (p. Strength-based approaches are increasingly becoming a part of many psychotherapies. Responsiveness tefeis to behavioi that is affected by emetging context and occuts on many levels—including choice of an overall treatment, case formulation, strategic use ofthe self and method—and then adjusting those to meet the emetging, evolving needs ofthe client in any given moment (Stiles, Honos-Webb, & Suiko, 1998). A significant limitation of this study is the small sample size, which reduces the possibility of finding the most powerful effects of feedback, namely fot clients who are eithei not improving oi deteiiotating. Finally, the dose of treatment favored PMTO (work with parents; 40 vs. The meager results, no findings on 12 of 16 measutes, and no effects favoring PMTO for children 8 years of age and over, combined with the confounds ofthe differential training and support of the two thetapist gioups and unequal doses of tieatment, cast significant doubt on this study's conclusions.
It is proposed that practice-based evidence brings accountability to the practice of psychotherapy and improves the quality of services. Of course, the practical application of such an interpretation is limited, but there are several ways to convert this index into something more useful (see Wampold, 2001b). Therapist effects in outpatient psychotherapy: A three-level growth curve approach. Recognizing that this sense exists and then helping clients access and unpack the implicit meanings involved can help them mobilize positive motivation for change. Attention to and acceptance of the feedback depend laigely on the perceived credibility ofthe feedback source, the value of the infonnation contained within, and the fotm ofthe feedback. The human capacity to thrive in the face of potential trauma. Are you saying that at the practice level, outcome measures have to be brief? Long measures are laigely impiactical in the teal wotld, especially in wotk with families. Journal of Consulting and Clinical Psychobgy, 77, 693-704Anker, M., Owen, J., Duncan, B., & Sparks, J. Split alliances, gender, and partner influences in couple therapy: A randomized sample in a naturalistic setting.