Specific and Common Factors in Therapy PDF

So what does make therapy effective? Well, it's not the Happy Meal, but we do know that there are certain factors that improve the efficacy of therapy. Well, that is certain factors that help clients to make improvements and change over the course of therapy. I mentioned before that there were speci...

So what does make therapy effective? Well, it's not the Happy Meal, but we do know that there are certain factors that improve the efficacy of therapy. Well, that is certain factors that help clients to make improvements and change over the course of therapy. I mentioned before that there were specific and common factors. We will start by looking at specific factors. Specific factors are really those factors that are unique to the style or approach of therapy that you're doing. So, for example, it may relate to the theoretical model that you're employing. So cognitive behavioral therapy is a theoretical model and would be considered a specific factor, gestalt therapy or acceptance and commitment therapy. These are all theoretical models and would be considered specific factors in therapy. So the type of model that you employ affects treatment outcomes. It can also be within the type of model, though, the specific techniques that you employ. So, for example, I may be practicing within cognitive behavioral therapy, but whether or not I choose to say look at automatic thoughts versus core beliefs or both may influence treatment outcomes. So these are the all of the factors related to the actual type of content that you do in therapy and the way in which you understand the person's difficulties. When we look at a model, what we're talking about here is a set of assumptions about human behavior, what causes behaviour, what changes behaviour, what maintains behaviour and what changes problems. So, for example, when we look at the first one, what caused this behaviout? This could be that the person developed these sorts of tendencies from their parents or from other friends who modeled it to them in adolescence. So there are certain factors that might cause behavior. And depending on the theoretical model that we employ, some factors will be more important than others. What changes behaviour? So perhaps a person was tracking along fine until they were in a road traffic accident and now they experience anxiety and recurring thoughts about that accident. So there's been an event that has changed their behaviour or change their experience of the world. And again, that will differ depending on the model that you employ. What maintains the behavior is the person's had a traffic accident. It started this spiral of anxiety, of anxiety for them, but that anxiety hasn't gone away. It stayed. There were two years on and this anxiety is still going. So what are the factors that keep that problem going? What is it that maintains the difficulties for the person? And finally, what might change the problem? So we've already looked at what might change behavior and bring about a problem, but when a problem exists, what might change it? So in a sense, what might protect a person against the problem getting worse? What factors might help to a problem to resolve of its own accord? These four sets of factors that relate to models are really important, and we're going to discuss them in a lot more detail next week when we look at case conceptualisation. But these would all be considered specific factors relating to the type of model or the type of theory that you employ to understanding your client and developing a treatment plan. So models provide a theoretical framework, a structure and a focus to counseling. So, for example, if we know what's maintaining a problem from a specific theoretical approach that tells us what we need to target in treatment, if we know what changes a problem, that tells us the sorts of factors we need to promote in treatment to get change. So some types of specific factors, some types of models, CBT, which we'll cover separately in terms of cognitive and behavioral in this course, acceptance and commitment therapy, dialectical behavior therapy, narrative therapy, the list goes on. So we have roughly 400 plus different theoretical models for understanding client behaviors. Now, some models are more effective than others for certain types of disorders. So, for example, I gave the example of eating disorders earlier on as being a sort of difficulty that we tend to have not quite as good treatment outcomes with as with anxiety or depression. Now we know with eating disorders, you really should be employing cognitive behavioral therapy, and that's what the national guidelines suggest. So there are certain models that are more effective for different disorders or different problems than others. But there will also be therapist factors at play into this. How comfortable you are with the theoretical approach, what sits best with you and what you're personally best at delivering. So we have a number of different models, and you will likely end up becoming an expert and maybe one or two of these over the course of your career, but probably not in many more than that. Beyond the model that you employ, as I mentioned, there are also the types of techniques that you use. So, for example, in cognitive therapy, you may be employing cognitive restructuring in acceptance and commitment therapy. One particular technique that you may employs cognitive diffusion, but only if you think it's going to benefit the client. Otherwise, you may focus on other techniques still specific to acceptance and commitment therapy. But other than cognitive diffusion, there are many, many, many techniques that you can use to facilitate change in therapy. The key thing being that the techniques focus on the factors that are maintaining the problem. So you want to use these techniques really strategically, but these are still specific factors. So, for example, you wouldn't do cognitive restructuring and acceptance and commitment therapy the same way you wouldn't do cognitive diffusion in traditional cognitive behavior therapy. So these techniques are specific to the models in which they relate. Now, let's take a look at the common factors, so specific factors are all of the things that are unique to the model or the theoretical approach or the techniques that you employ. The common factors are kind of the reverse of that. These are the factors that cut across all of the different theoretical approaches and techniques. These are the things that are really important, regardless of the content that you do in therapy or regardless of the techniques that you do. So, for example, the therapeutic alliance is a really key common factor that promotes change and is important regardless of the actual work that you do in therapy. You need to have a strong therapeutic alliance. So there common factors because they're common across all models. Now, there are various types of common factors, but probably the three main ones are the therapeutic alliance or that's the relationship that you have with the client. And it's usually considered to have three different components, the bond, the effectual or the emotional bond that you and your client have agreement on tasks and therapy and agreement on goals and therapy. So if you don't have a strong bond and if you don't have agreement on the tasks and goals that you want to achieve in therapy, then that's going to be a bit of a problem for achieving change. We also have client factors, so this is, for example, the age of the client, the disorder or the problem that they have, whether or not they've engaged in treatment in the past, their intelligence, their motivation for change. These are all factors that are unique to the client and which will affect therapy outcomes regardless of the technique that you employ and regardless of the model that you employ. So these are factors which influence change, which in a sense are a little bit beyond your control. And then finally, we have expectations for change will go into these and a little bit more detail shortly. But this relates to both the client's expectations of change and your expectations for change. As a therapist, how much hope do you have for this client and how much hope do they have for themselves? So all therapies may not share these factors equally. Some therapies may emphasize some parts more than others, but they all have them to some degree. So finishing up now, what factors do you think may be more important, so now that you have an understanding of what specific factors are and what common factors are? Which of the two do you think influences therapy outcomes the most? So the specific factors relating to the model and the techniques that you use or the common factors that cut across all of those approaches, which influences outcomes more? Have a think about that question and we'll discuss it in more detail in the next section.