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Running head: DODO BIRD’S EFFECT
Dodo Bird’s Effect: Common Therapeutic Factors in Psychotherapy Reaction Paper 3 Komal Mohan CPSY 710
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For those convinced of the singular abilities of their models and related interventions, the results have been disappointing. As therapy research has evolved, some researchers have taken a closer look at the common components of the various approaches rather than comparing different orientations/ theories of psychotherapy. This paper addresses the definition and aim of common factors and their importance based on empirical studies while outlining what they are across the many brief therapies and what are some of the limitations of this thought process. Common factors are those dimensions of the treatment setting (therapist, therapy, client) that are not specific to any particular technique. The term common factors is suggested as a replacement for terms like placebo (Rosenthal and Frank, 1956) and nonspecific factors (Oie & Shuttlewood, 1996), in recognition that many therapies have ingredients that are not unique but are nonetheless efficacious. Thus, research on placebo effects might be better conceptualized as research on common factors versus the specific effects of a particular and unique technique (Lambert, 2005). The aim of common factors is to determine the core ingredients that different therapies share, with the eventual goal of creating more parsimonious and efficacious treatments based on those commonalities. Common factors, no matter how unimportant they may be from the point of view of a particular theory are central to nearly all psychological interventions in practice. As Marvin Goldfried (1980) lamented, far too often in psychotherapy we speak of who is correct rather than what is correct. Common factors are not located solely in the therapist, but also in the client; not solely in the intra-therapy alliance, but also in the broader environmental context (including managed care); not solely in formal treatment, but also as part of clients' selfchange. Lambert, Weber, and Sykes (1993) summarized studies comparing the effect sizes of psychotherapy, placebo, and no-treatment controls. The results the average client undergoing a
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placebo treatment is better off than 66% of the notreatment controls. On the other hand, the average client undergoing psychotherapy is better off than 79% of the no-treatment controls specific techniques are estimated to account for only about 15% of the improvement in psychotherapy clients (Lambert, 1992). Common therapeutic factors can be divided into four broad areas: client factors and extra-therapeutic events, relationship factors, expectancy and placebo effects, and technique/model factors. Lambert (1992) concluded that as much as 40% of the improvement in psychotherapy clients is attributable to client variables and extra-therapeutic influences. These spontaneous remissions of clients improving without formal psychotherapeutic interventions highlights the importance of supportive and therapeutic aspects of the natural environment in which clients live and function. For instance help from friends, family, teachers, clergy, self help literature/ groups bears mentioning. The second common factor is that of relationships, which account for approximately 30% of client improvement (Lambert, 1992). Rogerian psychotherapy states that certain necessary and sufficient relationship conditions are necessary (empathy, positive regard, and genuineness) for change to occur in a client. WRITE HERE OF THE OTHER THERAPIES In can be concluded that therapists are differentiated almost entirely by nonspecific (relationship) factors rather than specific (technical) factors. The third common factor as per Lambert (1992) is expectancy effect, which accounts for 15% of the variance in client change. WRITE HERE OF THE OTHER THERAPIES Frank (1973) argued that the therapeutic enterprise carries the strong expectation that the client will, in fact, be helped. Underlying factor unites all the seemingly different approaches to psychotherapy. The forth common factor is specific techniques which are estimated to account for only about 15% of the improvement in psychotherapy clients (Lambert, 1992). As the use of
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therapy manuals becomes more frequent there will be a reduction in the variability in outcome by allowing for more accurate comparisons in comparative outcome studies. The use of and adherence to treatment manuals also helps enhance the effects of specific therapy procedures (Crits-Christoph, 1992).
Conclusion : From this perspective, the study confirms the “Dodo bird verdict”—all have won so all must have prizes. Indeed, had the study included a cognitive-therapy-only group, the experimenters may have found that the CT-only treatment group also improved. While the results of studies that use placebo controls suggest that psychotherapists are not merely “placebologists,” the placebo control group is only one of many methods aimed at isolating the presumed causes of patient improvement. In fact, the placebo control group has been largely replaced by other control groups that overcome the conceptual and ethical dilemmas associated with their use. The contributors concur that more than commonalities are evident across the therapies: There are unique or specific factors attributable to different therapies as well. One of the seminal achievements of psychotherapy research, as Asay and Lambert note in chapter 2, is the demonstration of the differential effectiveness of psychotherapies with specific disorders (e.g., behavior therapy for child conduct disorders, conjoint therapy for marital conflict, and cognitive therapy for panic disorder). Psychotherapies are also differentially effective with clients at different stages of change, as Prochaska notes in chapter 8,
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and with clients of different personalities and goals, as other contributors note. Effective clinicians will thus implement those factors common across therapies while capitalizing on the contributions of specific techniques. Further older meta-analytic reviews of this research literature generally have shown small effect size differences between comparison groups (e.g., Durlak, 1979; Hattie, Sharpley, & Rogers, 1984). of More and Less Trained Therapists, which shows that positive patient outcomes occur with and without training in specific therapeutic therapy techniques (Lambert, 2005). Research on the broader concept of common factors investigates causal mechanisms such as expectation for improvement, therapist confidence, and a therapeutic relationship that is characterized by trust, warmth, understanding, acceptance, kindness, and human wisdom. But also can be expanded to include some mechanisms that are often regarded as unique to a particular form of treatment such as exposure to anxiety-provoking stimuli, encouragement to participate in other risk-taking behavior (facing rather than avoiding situations that make the patient uncomfortable), and encouraging client efforts at mastery such as practicing and rehearsing behaviors. Such a view of common factors recognizes that while specific theories of psychotherapy may emphasize systematic in vivo or in vitro exposure to frightening situations, or social skills training, nearly all therapies encourage people to review and discuss the things they fear and face rather than avoid such situations (Lambert, 2005).
Limitations/ future research: Few studies have investigated the timing of response in psychotherapy with the intent of understanding the active ingredients of treatment and the place of common and unique
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therapeutic factors. This is important because early response may simply indicate a response to common factors (e.g. a client’s readiness to change) rather than specific interventions (i.e., substantial improvement occurs before, not after, most of the specific therapeutic operations have been initiated). Given the findings on early treatment response, it can be argued that early rapid response is another piece of evidence for the common factors’ hypothesis, but one that is in need of further research and improved methodology. Common factors loom large as mediators of treatment outcome.
Durlak, J.A. (1979). Comparative effectiveness of paraprofessional and professional helpers. Psychological Bulletin, 86, 80–92. Hattie, J.A., Sharpley, C.F., & Rogers, H.F. (1984). Comparative effectiveness of professional and paraprofessional helpers. Psychological Bulletin, 95, 534–541. Lamber, M. J. (2005). Early response in psychotherapy: further evidence for the importance of common factors rather than “placebo effects”. Journal of Clinical Psychology, 61(&), 855- 869 Oei, T.P.S., & Shuttlewood, G.J. (1996). Specific and nonspecific factors in psychotherapy: A case of cognitive therapy for depression. Clinical Psychology Review, 16, 83–103. Rosenthal, D., & Frank, J.D. (1956). Psychotherapy and the placebo effect. Psychological Bulletin, 53, 294–302.
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