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Solutions Intensive Day 2. How We Think: Primary Research Agendas/ Theories and Models. Martin Seligman.

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Solutions Intensive Day 2

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Solutions intensive day 2

Solutions IntensiveDay 2


How we think primary research agendas theories and models

How We Think:Primary Research Agendas/Theories and Models


Martin seligman

Martin Seligman

“What we have learned is that pathologizing does not move us closer to the prevention of serious disorders. The major strides in prevention have largely come from building a science focused on systematically promoting the competence of individuals…. Fifty years of working in a medical model on personal weakness and the damaged brain has left mental health professionals ill-equipped to do effective prevention. We need massive research on human strength and virtue. We need practitioners to recognize that much of the best work they do is amplifying the strengths rather than repairing their patient’s weakness.”


Primary agendas in research and practice

Primary Agendas in Researchand Practice

  • Empirically-Supported Treatments (ESTs); Evidence-Based Practices (EBPs)

  • Empirically-Supported Relationships (ESRs)

  • Common Factors (Meta-analysis)

  • Outcome Management


Ebp est

EBP/EST

  • Division 12 of APA – Committee on Science and Practice (formerly TFPP)

  • Viewing models, methods, and techniques as the primary causal agents of change (as proven though RCTs)

  • Increased relevance and dissemination to the professions and public

  • Developing a single list of Empirically Supported Treatments (EST)

  • Comparative Analyses

  • Allegiance effects

  • Efficacy vs. effectiveness settings


Empirically supported relationships esr

Empirically-Supported Relationships (ESR)

  • APA – Division 29 Task Force

  • Formed to identify elements of effective therapy relationships that affect treatment outcomes and determine efficacious methods of customizing therapy to individuals on the basis of their characteristics

  • Includes client and therapist factors and variables that influence relationships and affect change

  • “Efforts to promulgate practice guidelines or evidence-based lists of effective psychotherapy without including the therapy relationship are seriously incomplete and potentially misleading on both clinical and empirical grounds.” (Div. 29 TF)


The therapeutic relationship in context

The Therapeutic Relationship in Context…

Even for those who are convinced that the therapeutic relationship is healing by and of itself, there are strategies that can foster its impact. In other words, since not all kinds of relationships are likely to bring about change, one needs to be aware of interventions (including modes of relating) that should be encouraged or avoided for the relationship to become a corrective experience. (Castonguay & Beutler, 2006, p. 353)

Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 353-369). New York: Oxford University Press.


Meta analysis

Meta-Analysis

Effects on Outcomes

Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.) (1999). The heart

and soul of change: What works in therapy. Washington, D.C.:

American Psychological Association.

Lambert, M. J. (1992). Psychotherapy outcome research: Implications

for integrative and eclectic therapists. In J. C. Norcross & M. R.

Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129).

New York: Basic Books.

Wampold, B. E. (2001). The great psychotherapy debate:

Models, methods, and findings. New Jersey: Lawrence

Erlbaum.


Outcomes management

Outcomes Management

  • Dose-Response Effect

  • All major meta-analytic studies indicate the most significant portion of change occurs earlier in treatment (within the first 5 sessions)

  • The average length of time that clients attend therapy is 6-10 sessions (regardless of the model)

  • Real-Time Feedback Mechanisms

    • Alliance (WAI, HAq-II, SRS, etc.): client ratings of relationship

    • Outcomes (OQ Family, ORS, etc.): individual (well-being), interpersonal, and social role functioning

  • Real-time (outcomes and alliance) feedback can improve outcome between 40-65%

  • “Factor of Fit” and “Practice-Based Evidence”


Intersection and convergence

Intersection and Convergence


Convergence

Convergence?

  • Interpretations of data are most frequently are drawn from thesame studies and the same body of research (Beutler & Castonguay, 2006).

  • Castonguay and Beutler (2006), “We think that psychotherapy research has produced enough knowledge to begin to define the basic principles that govern therapeutic change in a way that is not tied to any specific theory, treatment model, or narrowly defined set of concepts” (p. 5).

    Beutler, L. E., & Castonguay, L. G. (2006). The task force on empirically based principles of therapeutic change. In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 3–10). New York: Oxford University Press.

    Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 353–369). New York: Oxford University Press.


Apa presidential task force on evidence based practice 2006 p 273

APA on EBP“The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”

APA Presidential Task Force on Evidence-Based Practice, 2006, p. 273


Convergence and change

Convergence and Change

  • View the client(s) as a primary factor in change (i.e., identify and build on internal strengths and social support systems)

  • Consider that the strength of the therapeutic relationship and alliance from the client’s perspective is most important

  • Convey empathy

  • Convey positive regard

  • Be congruent and genuine

  • Consider the client-practitioner match


Convergence and change cont

Convergence and Change (cont.)

  • Be sensitive and respectful to the unique cultural and contextual characteristics of each client

  • Create a respectful therapeutic climate in which clients are able to explore and express their personal stories or narratives and associated emotions

  • Include clients in processes (i.e., preferences, service planning, goal setting, tasks, etc.)

  • Select and match methods with clients according to factors such as preferences, level of need, state of readiness, level of distress/impairment, and coping style


Convergence and change cont1

Convergence and Change (cont.)

  • Use educational and developmental processes that increase social skills, coping skills, and self-regulation

  • Incorporate client-practitioner feedback loops (i.e., monitor the strength of the alliance and outcome/the subjective impact of therapy)

  • Attend to alliance ruptures

  • Pay attention to practitioner contributions to change (e.g., expectations, preferences, level of personal awareness, patience, etc.)

  • Employ structure/focus in sessions/meetings/interactions

  • Explore client expectations

  • Create or rehabilitate hope and a future focus

  • Use self-disclosure


Strengths based principles

Strengths-Based Principles

Client Contributions

The Relationship and Alliance

Cultural Competence

Focus on Change

Expectancy and Hope

Factor of Fit


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