The Relationship Effect. John C. Norcross, PhD University of Scranton. Thought Experiments. What accounts for the success of treatment for the addictions? What accounts for the success of your personal therapy?. Your Probable Answer. Many things account for success
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John C. Norcross, PhDUniversity of Scranton
What accounts for the success of treatment for the addictions?
What accounts for the success of your personal therapy?
ΨEBPs have profound implications for practice, training, research, and policy
Ψ No one is arguing for the converse (non-evidence based practices)
ΨWhat is privileged as “evidence-based” will determine, in large part, what treatment is conducted, what is taught, what is funded
ΨEBPs are noble in intent, but ripe for misuse and abuse
Do treatments cure disorders,
or do relationships heal people?
would find the answer obvious, and empirically validated. As a general trend across studies, the largest chunk of outcome variance not attributable to preexisting patient characteristics involves individual therapist differences and the emergent therapeutic relationship between patient and therapist, regardless of technique or school of therapy. This is the main thrust of three decades of empirical research.
1. identify elements of effective therapy relationships (what works in general)
2. identify effective methods to customize therapy to the individual patient (what works for particular patients)
♦ Cohesion in Group Therapy
♦ Goal Consensus & Collaboration
NIDA Collaborative Cocaine Treatment Study:
Early Miller (1980s) studies on problem drinking:
Recent Moyers, Miller, & Hendrickson study:
Karno & Longabaugh (2002, 2005)
Make the creation and cultivation of a therapy relationship a primary aim.
Adapt the therapy relationship to specific patient characteristics in the ways shown to enhance outcome.
Routinely monitor patients’ responses to the therapy relationship and ongoing tx.
Concurrent use of ESRs and ESTs tailored to the patient is likely to generate the best outcomes.
Training programs are encouraged to provide explicit and competency-based training in the effective elements of the therapy relationship.
Accreditation & certification bodies are encouraged to develop criteria for assessing training in ESRs in their evaluation process.
Graduate training is encouraged to offer ESR modules on systematically adapting the therapy rel. to the individual patient.
So, are you saying that the therapy relationship (in addition to method) is crucial, that it can be improved by certain therapist contributions, and that it can be effectively tailored to individual patient?
Cultivate the therapy relationship
Customize the relationship (and tx) to individual patient & context
Simultaneously use (inclusively defined) EBPs and avoid (consensually identified) discredited practices
1.What Qualifies as Evidence of Effective Practice?
Clinical expertise, scientific research, patient values
2.What Qualifies as Research for Effective Practice?
Case studies, single-participant, qualitative, change process, effectiveness, RCTs
3.What Tx Outcomes Should Establish EBPs?
Self-report, objective behavioral indices, therapist judgment, external/society decisions
4.Does Manualization Improve Therapy Outcomes?
5.Are Research Patients & Clinical Trials Represent-ative of Practice?
6.What Should be Validated?
Tx method, therapist, therapy relationship, patient, principles of change
7.What Materially Influences What is Published as Evidence?
Theoretical allegiance, funding source
8.Do ESTs Produce Outcomes Superior to Non-ESTs?
9.How Well Do EBPs Address of Diversity?
Ethnicity, gender, sexual orientation, disability status
10.Are Efficacious Laboratory-Validated Treatments Readily Transportable to Clinical Practice?