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Clinical Psychology and Psychotherapy

Clin. Psychol. Psychother. 21, 8296 (2014)


Published online 6 November 2012 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/cpp.1822

Towards a Taxonomy of Common Factors in


PsychotherapyResults of an Expert Survey
Wolfgang Tschacher,* Ulrich Martin Junghan and Mario Pfammatter
Department of Psychotherapy, University Hospital of Psychiatry, University of Bern, Bern Switzerland
Background: How change comes about is hotly debated in psychotherapy research. One camp considers
non-specic or common factors, shared by different therapy approaches, as essential, whereas
researchers of the other camp consider specic techniques as the essential ingredients of change. This
controversy, however, suffers from unclear terminology and logical inconsistencies. The Taxonomy
Project therefore aims at contributing to the denition and conceptualization of common factors of
psychotherapy by analyzing their differential associations to standard techniques.
Methods: A review identied 22 common factors discussed in psychotherapy research literature. We
conducted a survey, in which 68 psychotherapy experts assessed how common factors are implemented
by specic techniques. Using hierarchical linear models, we predicted each common factor by techniques and by experts age, gender and allegiance to a therapy orientation.
Results: Common factors differed largely in their relevance for technique implementation. Patient
engagement, Affective experiencing and Therapeutic alliance were judged most relevant. Common
factors also differed with respect to how well they could be explained by the set of techniques. We
present detailed proles of all common factors by the (positively or negatively) associated techniques.
There were indications of a biased taxonomy not covering the embodiment of psychotherapy
(expressed by body-centred techniques such as progressive muscle relaxation, biofeedback training
and hypnosis). Likewise, common factors did not adequately represent effective psychodynamic and
systemic techniques.
Conclusion: This taxonomic endeavour is a step towards a clarication of important core constructs of
psychotherapy. Copyright 2012 John Wiley & Sons, Ltd.
Key Practitioner Message:
This article relates standard techniques of psychotherapy (well known to practising therapists) to the
change factors/change mechanisms discussed in psychotherapy theory.
It gives a short review of the current debate on the mechanisms by which psychotherapy works.
We provide detailed proles of change mechanisms and how they may be generated by practice
techniques.
Keywords: Common Factors, Psychotherapy Techniques, Therapy Process, Change Mechanism, Theory of
Psychotherapy

INTRODUCTION
Psychotherapy research has settled the question of the
efcacy of psychotherapy to the positive since several years.
Numerous studies and meta-analyses have demonstrated
that psychotherapy works for most forms of psychopathology. The eld has arrived at a consensus that psychotherapy is more effective than no treatment and than
placebo controls (Lambert & Ogles, 2004). Yet sources

*Correspondence to: Prof. Dr. Wolfgang Tschacher, Department of


Psychotherapy, University Hospital of Psychiatry, University of Bern,
Laupenstrasse 49, 3010 Bern, Switzerland.
E-mail: tschacher@spk.unibe.ch

Copyright 2012 John Wiley & Sons, Ltd.

of considerable disagreement remain: they concern the


relative efcacy of different psychotherapy approaches
as well as, importantly, the mechanisms by which psychotherapy becomes effective. In this context, major controversies have addressed the Dodo-bird verdict (i.e. all
psychotherapy approaches have similar benets; hence,
all must have prizes) and the role of common versus
specic factors of psychotherapeutic change (Wampold,
2001; Beutler, 2002; Chambless, 2002; Luborsky et al.,
2003). This controversy has split the eld into two opposing camps: one camp attributes therapeutic change to
specic ingredients and factors (DeRubeis et al., 2005),
and the other favours a common-factor model (Wampold
et al., 2001).

Taxonomy of Common Factors in Psychotherapy


The specic-ingredients camp focuses on techniques as
the causal agents of therapeutic change. In recent years,
specic ingredients have become the basis of practice
guidelines and of empirically supported therapies in
evidence-based medicine (Chambless & Ollendick, 2001).
The opposing camp emphasizes that core therapeutic
factors shared by different approaches account for
most of the benets achieved in psychotherapy. These
factors of therapeutic change are called non-specic or
common and thus may explain the Dodo-bird verdict.
Common factors are not theoretically anchored in the
treatment models of the different schools of psychotherapy, nor are they considered in the treatment models for
specic mental disorders. The concept can be traced back
to Saul Rosenzweigs (1936) implicit factors shared by
different methods of psychotherapy, such as the relationship between patient and therapist. In the 1960s, Jerome
Frank (1971) developed his Common Component Model
advocating four common factors: a conding relationship;
a socially sanctioned institutional context; a therapeutic
rationale (myth) offering an explanation of a patients
problems; and particular tasks and procedures to solve
these problems (rituals). Subsequently, a series of authors
have proposed further sets of common factors, such as
affective experiencing, cognitive mastery and behavioural
regulation (Karasu, 1986); problem confrontation, corrective
emotional experience (Weinberger, 1995); resource activation, clarication and coping (Grawe, 1995).
The controversy between specic and common factors
(. . .) has pervaded several decades and is still the guiding
inuence that directs the reections in the eld about
factors responsible for change (Castonguay & Beutler,
2006, p. 632). It is becoming increasingly evident, however, that this horse race of determining the most
relevant change principle assumes a dichotomy of specic and common factors that is based on terminological
and conceptual inconsistencies, has little empirical validity and fails to do justice to the complexity of the therapeutic change process.
Especially how the term common factor is currently
being used is confusing (Lampropoulos, 2000): the literature
shows great inconsistency as to which levels of the Generic
Model of Psychotherapy (Orlinsky et al., 2004) common
factors refer to. Specic factors, however, solely refer to
the technical aspect of the therapeutic process, i.e. they
are identical to psychotherapeutic techniques. In other
words, common and specic factors address different
aspects and levels of the psychotherapeutic process
(Pfammatter & Tschacher, 2012). It is therefore inadequate
to contrast common factors with specic factors because
these concepts reside at incommensurate logical levels.
Rather than competing in a horse race against each
other, specic factors, i.e. techniques, and common
factors should be viewed by their interaction (Karasu,
1986; Goldfried, 1980; Butler & Strupp, 1986).
Copyright 2012 John Wiley & Sons, Ltd.

83
In addition, a dichotomy of common versus specic
factors has not received empirical support. For both,
signicant relations to outcome have been shown: A series
of meta-analyses demonstrated that several aspects of the
common factor therapeutic alliance, such as empathy or
goal consensus, are clearly related to positive outcome
(Lambert & Cattani, 2012; Norcross & Wampold, 2011a).
At the same time, also techniques such as exposure,
empty-chair technique, paradoxical intention and particular forms of interpretations were (. . .) found to be consistently and strongly associated with positive therapeutic
outcome (Orlinsky et al., 2004, p. 341). Thus, the question
is less which of both, techniques or common factors, are
more important but how each relate to the other so that
they can be successfully tailored to a specic patient
(Norcross & Wampold, 2011b).
Clear terminology and accurate conception of process
variables is of paramount importance in this context. Currently, several projects aim at creating a common language
for techniques, such as the development of a Comprehensive Psychotherapeutic Interventions Rating Scale by
Trijsburg et al. (2002), the Multitheoretical List of Therapeutic Interventions by McCarthy and Barber (2008) and
the web-based project Common Language for Psychotherapy by Marks (2010). The Taxonomy Project presented here
is an attempt to empirically arrive at a more precise
language for, and conception of, common factors in psychotherapy. The Taxonomy Project deviates from the either-or
mentality prominent in the camp of school-specic and
disorder-specic factors (medical model) and the camp
of the proponents of common factors (contextual model;
Wampold et al., 2001). Rather than mutually exclusive
causes of change, we consider specic techniques and common factors as associated components of psychotherapy
process.
For the present study, we decided to analyze the
relationships between specic techniques and common
factors through the use of expert opinion. We collected
assessments of psychotherapy experts in the framework
of an extensive survey, to which researchers of psychotherapy were invited. Techniques were treated as given
anchor points (i.e. as independent variables) because techniques are operationalized and dened in the manuals
and textbooks of different psychotherapy schools. In other
words, we used techniques as the entities that allow
describing the dependent variables in our study: the
common factors of psychotherapy. Doing this, the goal
of the Taxonomy Project was to contribute to a clearer
denition and conception of common factors. Thereby, we
also wished to introduce a novel understanding of specicity in the common versus specic debate: common factors
may be considered specic insofar as they may be generated by specic subsets of techniques and possibly inhibited
by other subsets of techniques. We hypothesized that
common factors would markedly differ with respect to
Clin. Psychol. Psychother. 21, 8296 (2014)

W. Tschacher et al.

84
their relations to specic techniques. This would then
allow a precise operational denition of each common
factor: a common factor is that which is implemented by
a specic pattern of techniques. Therefore, the primary
goal of this study was the description of all common
factors by their idiosyncratic associations with techniques.
In this, we relied on the consensual knowledge of psychotherapy experts acting as referees who assessed these
associations step by step. Accordingly, we hypothesized in
second line that rater variables (gender, age, profession,
allegiance to a psychotherapy approach) would inuence
the assessments to a limited degree only.

METHODS
Selection of Common Factors and Specic Techniques
A recent comprehensive literature search identied all
constructs discussed as non-specic or common factors of
therapeutic change in psychotherapy research literature.
Pfammatter and Tschacher (2012) included all factors that
were described by at least two authors. For the present
study, we adopted this list of 22 common factors, which
are dened in Table 1.
Simultaneously, based on textbooks of the four major
approaches of psychotherapy (cognitive behavioural therapy, psychodynamic therapy, humanistic therapy and
systemic therapy), we selected 22 standard techniques
(Table 2) of these approaches (numbers of factors and
techniques are equal by coincidence). Our selection of
techniques was subjective. We selected techniques that
represent the most characteristic procedures of the major
psychotherapy approaches, particularly those techniques
that a group of experienced psychotherapy researchers
would supposedly be familiar with, even if a technique
originated from a different psychotherapy approach than
the researchers own.

Survey
An internet-based survey consisting of the 22 common
factors and 22 specic techniques was developed. After
logging into the system, a participant was briefed on the
objectives of the study: to investigate the relationship
between techniques and common factors, with the ultimate
goal of arriving at a taxonomy of common factors. On
the next page, as an initial common factor, Therapeutic
Alliance1 was introduced and dened (Table 1). The
instruction was: Please assess how much, in your opinion,
1

In the following text, common factors will be printed bold, techniques in italics

Copyright 2012 John Wiley & Sons, Ltd.

this common factor is implemented by each of the following


standard techniques, and the participant was presented the
list of 22 psychotherapy techniques. Adjacent to each of the
listed techniques, a brief description of the technique was
printed, e.g.: Positive reinforcement technique: the therapist
commends and rewards desirable behaviour of the patient.
For each technique, a 5-point Likert scale (not, little, moderate, marked, strong) was provided to record the participants response. We assigned the values 2, 1, 0, 1, 2 to
the points of the scales. The list of techniques was presented
in xed sequence in the order of Table 2. This procedure was
repeated on new pages until all common factors had been
presented to the participant, or until the participant
stopped the survey. The point of stopping was bookmarked so that it was possible to resume the survey at a
later time. A complete survey lasted approximately
50 min and contained 22  22 = 484 items per participant.

Participants
Experienced researchers of psychotherapy, most of whom
were also active psychotherapists, were contacted via
personal e-mails and invited to participate as expert raters
in an internet-based survey (using the platform SurveyMonkey). We contacted, in rst line, German-speaking
members of the Society for Psychotherapy Research, and
in second line, further psychotherapy researchers with a
psychiatric afliation. Most addressees had an academic
background. Of 140 researchers addressed, 68 nally
participated in the survey (mean age 50.2 years, standard
deviation (SD) = 11.1; 47 (69%) men). Non-responders did
not signicantly differ from participants with respect to
gender, yet mean age of non-responders was higher:
54.6 years; t(138) = 2.47, p < 0.05. Participants mean professional experience in psychotherapy research (independent
variable Experience) was 18 years (SD = 11.0), and current
active psychotherapeutic work was 9 h/week (SD = 8.8).
As for their professional and scientic backgrounds (independent variable Profession), 54 participants (79.4%) were
psychologists, nine (13.2%) were psychiatrists, four (5.9%)
were both psychologists and psychiatrists and one (1.5%)
was trained in another profession. Professions of nonresponders were not signicantly different (chi2(3) = 2.37,
p = 0.50). Participants (variable Rater) noted their predominant psychotherapeutic orientations (independent variable
Allegiance) as cognitivebehavioural (n = 29, 42.6%),
psychodynamic (n = 19, 27.9%), eclectic (n = 14, 20.6%),
systemic (n = 4, 5.9%) and client-centred (n = 2, 2.9%).

Statistical Procedures
Each participating rater assessed the associations between
22 techniques and 22 common factors, i.e. he or she
responded to a maximum of 22  22 = 484 items. With
Clin. Psychol. Psychother. 21, 8296 (2014)

Taxonomy of Common Factors in Psychotherapy

85

Table 1. List of common factors with denition given in the survey; Relevance, intercepts of all ratings of a common factor (test against
zero: * p < 0.05; ** p < 0.01; *** p < 0.001; **** p < 0.0001); Explanation, % variance of a common factor explained by all techniques (cf. text)

Common factor
Therapeutic alliance

Mitigation of social
isolation
Provision of an
explanatory scheme
Instillation of hope

Readiness to change

Patient engagement

Resource activation
Affective experiencing
Affective catharsis
Problem
confrontation
Desensitization

Corrective emotional
experience

Mindfulness

Emotion regulation

Denition

Relevance

Patient and therapist establish a trusting, cooperative relationship;


characterized on the therapist side by afrmation and affective
warmth towards the patient as a person (interactional variables of
Rogers, 1951). Alliance includes mutual connectedness and consensus
about therapeutic goals and tasks (see Bordins (1979) concept of
working alliance)
Patient experiences a reduction of social isolation and alienation
(according to Lambert & Ogles, 2004)
Patient is offered a theoretical scheme which provides a plausible
explanation of her or his problems and which prescribes a
procedure (ritual) for the resolution of problems (see the common
factor credible rationale (myth) by Frank, 1971)
Patient forms the expectation that the therapy will succeed and her or
his problems will be improving (refers to the common factors
instillation of hope by Frank (1971) and induction of positive
change expectations by Grawe, 2004)
Patient develops the readiness to change her or his situation or
behaviour (refers to the common factors persuasion to change by
Tracey et al. (2003) and encouragement to try new behaviours by
Lambert & Ogles, 2004)
Patient actively participates, is engaged in the therapeutic process
(see common factors client active participation by Lambert &
Ogles (2004) and patient role engagement of the Generic Model of
Psychotherapy, Orlinsky et al., 2004)
Therapist emphasizes and vitalizes strengths, abilities and resources
of the patient (see the common factor resource activation by Grawe,
2004)
Patient experiences emotions and affects that are associated with her or
his problems (see common factor affective experiencing by Karasu,
1986)
Patient expresses yet repressed feelings (refers to the psychoanalytic
catharsis thesis)
Patient is encouraged to face, experience and deal with her or his
problems (see the common factors encouragement to face
problematic issues by Weinberger (1995) and problem actualization
by Grawe, 2004)
Patient experiences progressing attenuation of emotional reactions to
aversive stimuli (see the common factors desensitization and
extinction of anxiety-associated responses by Lambert & Ogles,
2004)
Patient learns that the real experiences in problematic situations are
not as devastating as the imagined or feared consequences (see the
change factor corrective emotional experience originally
conceptualized by Alexander (1950) in the context of
psychodynamic therapies)
Patient develops the ability of nonjudgmental awareness of her or his
thoughts, perceptions and feelings. She or he learns to be aware of
inner processes in the here and now without judging them (refers
to the Buddhist attitude of an evenminded-accepting attention to
all sensations, emotions and thoughts)
Patient learns to perceive, express and control her or his emotions
more adequately (refers to affect regulation, according to Fonagy
et al. (2002) the process by which individuals inuence which
emotions they have, when they have them and how they
experience and express these emotions)

0.17

Explanation
16.90

0.26**

24.72

0.03

22.04

0.05

24.39

0.04

19.91

0.22**

23.71

0.04

27.90

0.17*

29.81

0.14

29.44

0.14*

35.75

0.39****

25.98

0.10

20.98

0.43****

17.00

0.15*

22.75

(Continues)

Copyright 2012 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 21, 8296 (2014)

W. Tschacher et al.

86
Table 1.
0. (Continued)
Common factor
Insight

Assimilating
problematic
experiences
Cognitive
restructuring
Mentalization

Behaviour regulation

Mastery experiences
Self-efcacy
expectation
New narrative about
self

Denition

Relevance

Explanation

Patient develops awareness of her or his problems and a conception of


their causal relation and their relation with recurring patterns of her or
his behaviour (see the common factors foster insight/awareness by
Grencavage & Norcross (1990) and motivational clarication by
Grawe, 2004)
Patient approximates problematic experiences to pre-existing own
cognitive schemata and is thereby able to be more familiar with
them (refers to the distinction introduced by Piaget between
Assimilation and Accommodation as to two different types of
developing and changing cognitive representations of the world)
Patient gradually accommodates conceptualizations of problems,
acquires new perceptions and thinking patterns, which promote
understanding and integration of problematic experiences (see
common factor cognitive mastery, Karasu, 1986)
Patient learns to understand herself or himself and others in terms of
mental states (i.e. feelings, thoughts, intentions) and thereby
develops the ability of anticipating the behaviours and reactions of
others (theory of mind) (see the capacity to read, (. . .) predict and
explain other peoples actions by inferring and attributing causal
intentional mind states to them (Fonagy et al., 2002))
Patient learns new behavioural responses and social skills to modify
habits and to manage and control actions (see the common factors
behavioural regulation by Karasu (1986) and learning of mastery
behaviours by Lambert & Ogles, 2004)
Patient gathers successful coping experiences (see the common
factors mastery efforts and success experience by Lambert &
Ogles (2004) and coping by Grawe, 2004)
Patient increases her or his sense of personal inuence and control
(see the common factor changing expectations of personal
effectiveness by Lambert & Ogles (2004), derived from Banduras
conceptualization of self-efcacy)
Patient develops a new sense of coherence regarding her or his past,
present and future life, as well as her or his being in the world (see
the common factor construction of a meaning-generating
narrative by Jorgensen, 2004)

0.03

31.51

0.22**

20.64

0.16

26.78

0.24**

31.25

0.24**

35.12

0.25**

33.25

0.22**

34.27

0.21**

25.64

common factor as dependent variable and a sample of 68


raters, the dataset available for each common factor comprised a maximum of 22  68 = 1496 records. The internet-based survey, however, did not enforce complete
datasets, thus the actual number of responses received
for a common factor ranged between 920 and 1338 records
(see the row Observations (n) in Table 3). In other words,
dependent variables had varying missing information in
the predicting variables. Because of the expected missing
data and in order to account for statistically dependent
data (each rater performed repeated assessments), we
applied mixed-effects hierarchical analyses to model the
dependent variables (i.e. the common factors) by the
independent variables (i.e. the techniques and raters
demographic variables). The software package used in
all analyses was JMP 9 (SAS Institute Inc., Cary, NC). A
dataset of 22 techniques  68 raters was thus available
Copyright 2012 John Wiley & Sons, Ltd.

for each common factor and served as the basis for all
subsequent analyses in approaches a and b.
Approach a: in an initial modelling approach, we
described each common factor by dening two separate
dimensions, Relevance and Explanation (Table 1). These
dimensions were operationalized as follows: The dimension
Relevance was computed, in each common factor as the
dependent variable, by the intercept of a model with only
the variable Rater entered as a random effect (approach a.1).
The single ratings constituted level 1, Rater identied
level 2 of the data. The intercepts operationalize the overall
relevance of a common factor. These intercepts were very
similar in value to the mean of response (r = 0.99), i.e. the
mean of all single ratings a common factor received (ratings
ranging between 2 and 2). In the column Relevance of
Table 1, we listed these intercepts. The intercepts were tested
against zero, the midpoint of the scales.
Clin. Psychol. Psychother. 21, 8296 (2014)

Taxonomy of Common Factors in Psychotherapy

87

Table 2. List of techniques with denition given in the survey

Technique
Positive reinforcement technique
Exposure with response prevention
Role play technique
Problem-solving training
Reality testing
Free association technique
Therapeutic abstinence
Transference interpretation
Resistance interpretation
Verbalization of emotional
reactions
Focusing
Empty-chair and two-chair
technique
Creative expression technique
Circular questions technique
Sculpture work
Paradoxical intention technique

Prescription of rituals
Reecting team technique
Progressive muscle relaxation
Hypnosis
Biofeedback training
Counselling

Denition
Therapist praises/rewards desired, adequate patient behaviour.
Therapist confronts patient in imagination or in vivo, gradually or by ooding,
massed or in intervals with a problematic situation and prevents escape.
Therapist simulates difcult social interactions in a play with patient as
participant, and instructs, models and corrects the performance.
Therapist teaches patient to identify and dene the problem, to systematically
generate and evaluate alternative problem solutions, to implement and verify
selected problem solution.
Therapist encourages patient to test the evidence for the validity of
dysfunctional thoughts and beliefs, runs behavioural experiments and
provides alternative explanations.
Therapist encourages patient to talk about whatever comes to her or his mind.
Therapist deliberately does not comment statements, disclosures or behaviour
of patient.
Therapist links patienttherapist relationship to other interactions of patient to
point out recurring problematic themes in her or his relationships.
Therapist draws attention to the patients opposition to or avoidance of certain
topics, experiences or feelings by pointing out evasions, sudden thematic shifts
or behavioural inconsistencies.
Therapist listens carefully to what patient is saying, uses empathic statements,
repeats back (paraphrases), explores its personal meaning and reects the
internal frame of reference (mirroring).
Therapist draws attention to unexpressed feelings, promotes deeper
experiencing, encourages patient to explore and express feelings.
Therapist guides patient to speak to an empty chair for unnished business, or
engages patient in a two-chair dialogue for analyzing and resolving inner
conicts.
Therapist encourages patient to use creative media to actualize experiences and
express feelings.
Therapist explores the meaning of a problematic behaviour of a family member
for another family member with a third family member.
Therapist asks the family to spatially illustrate the familial relationships
(afnity, distance, hierarchical structure) by building a sculpture.
Therapist offers a new interpretative framework (reframing), assigns a positive
meaning to the problem (positive connotation), invites patient to deliberately
show the problem behaviour (symptom prescription) or offers lots of problem
solutions (confusion technique).
Therapist prescribes formalized and symbolic actions that disrupt problematic
behaviour.
A team of experts monitors therapy and discusses the observations with
participants.
Therapist guides patient to rhythmically and sequentially contract and relax
different groups of muscles.
Therapist asks patient to bring up pictures or scenes, or induces hypnotic trance
by verbal suggestions and motoric procedures.
Therapist guides patient to deliberately inuence and control physiological
processes by feedback signals, discriminative learning and relaxation techniques.
Therapist gives advice.

As a second dimension, we assessed Explanation. We


computed models with Rater entered as a random effect
and Technique as the xed effect (approach a.2). The
corresponding explained variances operationalize the
degree of differential explanation of each common factor
by the set of techniques. Finally, to integrate the two
Copyright 2012 John Wiley & Sons, Ltd.

dimensions of approach a, the ratio Relevance/Explanation


was computed which is positive if both Relevance and Explanation assume positive values.
Approach b addressed the primary goal of the study by
comprehensive modelling including the inuence of rater
characteristics. We modelled each of the 22 common factors
Clin. Psychol. Psychother. 21, 8296 (2014)

Therapeutic alliance

Copyright 2012 John Wiley & Sons, Ltd.

Negatively associated
techniques

- Biofeedback training
(t = 6.35)
- Reecting team technique
(t = 4.51)
- Progressive muscle
relaxation (t = 3.4)
- Resistance interpretation
(t = 2.2)
- Sculpture work (t = 2.2)

Observations (n)
1338
% of variance explained
52.01
by model
% of variance explained
28.29
by rater (random effect)
% of variance explained
23.72
by xed effects
Fixed effect tests
Technique
F = 10.69
Allegiance
F = 2.26
Technique  Allegiance
F = 1.76
Profession
F = 0.51
Experience
F = 0.14
Age
F = 0.33
Gender
F = 2.02
Positively associated
- Verbalization of emotional
techniques
reactions (t = 7.19)
- Positive reinforcement
technique (t = 6.4)
- Focusing (t = 5.62)

Model

- Free association
technique (t = 5.12)
- Therapeutic
abstinence
(t = 5.07)
- Resistance
interpretation
(t = 4.33)
- Transference
interpretation
(t = 3.49)
- Sculpture work
(t = 3.07)
- Progressive muscle
relaxation (t = 2.59)
- Circular questions
technique (t = 2.38)

- Biofeedback training
(t = 6.43)
- Progressive muscle
relaxation (t = 6.09)
- Therapeutic
abstinence (t = 4.43)
- Free association
technique (t = 4.25)
- Resistance
interpretation
(t = 2.71)
- Hypnosis (t = 2.11)

29.26

31.86
F = 12.24
F = 0.72
F = 1.16
F = 1.48
F = 0.02
F = 0.19
F = 2.8
- Problem-solving
training (t = 7.51)
- Positive
reinforcement
technique (t = 7.10)
- Reality testing
(t = 4.4)
- Exposure with
response
prevention (t = 3.48)
- Role play technique
(t = 3.32)

25.37

25.08

F = 11.19
F = 1.18
F = 1.08
F = 1.75
F = 0.75
F = 0.13
F = 3.51
- Positive reinforcement
technique (t = 6.07)
- Role play technique
(t = 5.09)
- Problem-solving
training (t = 3.31)
- Verbalization of
emotional reactions
(t = 3.09)
- Circular questions
technique (t = 2.89)
- Focusing (t = 2.46)

1110
54.63

F = 11.02
F = 1.29
F = 1.35
F = 1.24
F = 0.22
F = 0.03
F = 4.83
- Problem-solving
training (t = 6.57)
- Positive reinforcement
technique (t = 6.53)
- Role play technique
(t= 5.29)
- Reality testing
(t= 3.52)
- Exposure with
response prevention
(t = 2.72)

27.8

25.14

1113
52.94

Readiness to
change

31.9

23.41

1092
55.31

Patient engagement

(Continues)

F = 14.3
F = 0.68
F = 1.5
F = 2.29
F = 2.9
F = 1.66
F = 3.68
- Role play technique
(t = 5.82)
- Positive
reinforcement
technique (t = 4.28)
- Empty/two-chair
technique (t = 4.23)
- Problem-solving
training (t = 4.12)
- Exposure with
response prevention
(t = 3.8)
- Sculpture work
(t = 3.63)
- Creative expression
technique (t = 3.62)
- Reality testing
(t = 3.51)
- Progressive
- Free association
- Resistanceinterpretation
muscle relaxation
technique (t = 5.04) (t= 5.94)
- Transference
(t = 6.22)
- Progressive
interpretation
- Therapeutic abstinence muscle relaxation
(t = 5.72)
(t = 5.38)
(t = 4.47)
- Therapeutic
- Hypnosis (t = 3.99)
- Therapeutic
abstinence (t = 5.62)
- Biofeedback training abstinence
-Reectingteamtechnique
(t = 3.44)
(t = 4.04)
(t = 4.42)
- Free association
- Resistance
- Hypnosis (t = 3.75)
technique (t = 2.93)
interpretation
- Paradoxical
- Prescription of rituals (t = 3.15)
intention technique
(t = 2.67)
- Biofeedback
(t = 3.32)
training
- Biofeedback training
(t = 3.08)
(t = 3.00)
- Transference
- Progressive muscle
interpretation
relaxation (t = 2.19)
(t = 2.75)
- Hypnosis
(t = 2.15)

30.03

17.37

Provision of an
explanatory
scheme
1111
47.40

F = 9.68
F = 1.15
F = 1.27
F = 1.76
F = 0.32
F = 0.53
F = 1.16
- Reality testing
(t = 5.13)
- Verbalization of
emotional
reactions (t = 3.84)
- Focusing (t = 3.35)
- Transference
interpretation (t = 2.65)
- Resistance
interpretation (t = 2.58)
- Empty/two-chair
technique (t = 2.36)
- Reecting
team technique (t = 2.34)
- Circular questions
technique (t = 2.12)

Common factors
Instillation of hope

1045
56.94

Mitigation of social
isolation

Table 3. ad. Results of mixed-effects modelling of each common factor. Common factor, dependent variable; techniques and rater characteristics, xed effects: * p < .05; ** p < .01; *** p < .001; ****
p < .0001, bold print in cases of Bonferroni-signicance. Only signicantly predictive techniques are listed

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Resource activation

Copyright 2012 John Wiley & Sons, Ltd.

Negatively associated
techniques

- Resistance interpretation
(t = 5.85)
- Transference interpretation
(t = 5.59)
- Therapeutic abstinence
(t = 4.6)
- Free association technique
(t = 3.97)
- Progressive muscle
relaxation (t = 2.05)
- Reecting team technique
(t = 2.05)

Observations (n)
1089
% of variance explained
57.42
by model
% of variance explained
25.56
by rater (random effect)
% of variance explained
31.86
by xed effects
Fixed effect tests
Technique
F = 12.96
Allegiance
F = 0.33
Technique  Allegiance
F = 1.39
Profession
F = 1.03
Experience
F = 0.44
Age
F=0
Gender
F = 1.21
Positively associated
- Positive reinforcement
techniques
technique (t = 7.66)
- Problem-solving training
(t = 6.33)
- Creative expression
technique (t = 5.6)
- Role play technique
(t = 4.17)
- Verbalization of emotional
reactions (t = 2.92)

Model

Table 3. (Continued)

34.52

24.68

1137
59.2

Catharsis

F = 17.17
F = 1.78
F = 1.31
F = 0.16
F = 0.13
F = 0.37
F = 2.25
- Empty/two-chair
technique (t = 7.3)
- Focusing (t = 7.04)
- Verbalization
of emotional
reactions (t = 6.07)
- Creative expression
technique (t = 5.24)
- Role play technique
(t = 4.72)
- Exposure with
response prevention
(t = 4.48)
- Sculpture work
(t = 2.37)
- Progressive muscle
- Progressive muscle - Progressive muscle
relaxation (t = 7.6)
relaxation (t = 8.25) relaxation (t = 6.05)
- Biofeedback training
- Biofeedback
- Biofeedback
(t = 5.19)
training (t = 7.02)
training (t = 7.78)
- Problem-solving
- Therapeutic
- Therapeutic
abstinence (t = 5.36) abstinence (t = 6.36) training (t = 4.22)
- Reality testing
- Positive
- Reecting
(t = 3.75)
reinforcement
team technique
- Positive reinforcement
technique (t = 3.6)
(t = 5.72)
technique (t = 3.51)
- Free association
- Prescription of
- Reecting team
technique (t = 2.11)
rituals (t = 4.02)
technique t = 3.18)
- Paradoxical
- Circular questions
intention technique
technique (t = 2.36)
(t = 2.93)
- Prescription of rituals
- Problem-solving
(t = 2.22)
training (t = 2.77)
- Circular questions - Therapeutic abstinence
technique (t = 2.72) (t = 2.17)

39.25

42.75
F = 14.16
F = 2.41
F = 1.69
F = 1.57
F = 1.72
F = 1.81
F = 2.05
- Focusing (t = 6.95)
- Empty/two-chair
technique (t = 6.21)
- Verbalization of
emotional reactions
(t = 5.97)
- Role play
technique (t = 5.77)
- Exposure with
response prevention
(t = 4.98)
- Creative expression
technique (t = 2.76)

17.88

14.91

F = 14.44
F = 1.96
F = 1.23
F = 0.74
F = 2.51
F = 1.61
F = 4.39
- Exposure with
response prevention
(t = 6.65)
- Role play
technique (t = 6.42)
- Empty/two-chair
technique (t = 5.17)
- Focusing (t = 3.97)
- Verbalization of
emotional reactions
(t = 2.69)
- Problem-solving
training (t = 2.14)

1115
57.13

Common factors
Affective experiencing

1159
57.66

Problem confrontation

F = 12.8
F = 2.27
F = 1.1
F = 0.17
F = 2.33
F = 0.99
F = 0.73
- Exposure with
response
prevention
(t = 10.21)
- Role play technique
(t = 5.38)
- Problem-solving
training (t = 3.54)
- Hypnosis
(t = 3.48)
- Empty/two-chair
technique
(t = 3.12)
- Reality testing
(t = 2.71)
- Therapeutic
abstinence
(t = 4.68)
- Free association
technique
(t = 4.36)
- Circular questions
technique
(t = 3.68)
- Resistance
interpretation
(t = 3.62)
- Reecting team
technique (t = 3.24)
- Transference
interpretation
(t = 3.2)
- Creative expression
technique (t = 2.32)

32.18

22.35

1159
54.53

Desensitization

(Continues)

- Progressive muscle
relaxation (t = 3.68)
- Biofeedback
training
(t = 3.44)
- Therapeutic
abstinence (t = 3.23)
- Free association
technique (t = 3.14)
- Circular questions
technique (t = 2.99)
- Resistance
interpretation
(t = 2.68)
- Reecting team
technique (t = 2.4)

F = 8.56
F = 1.71
F = 1.38
F = 1.57
F = 0.42
F = 0.02
F = 1.5
- Exposure with
response
prevention (t = 5.67)
- Role play technique
(t = 5.38)
- Positive
reinforcement
technique (t = 3.98)
- Empty/two-chair
technique (t = 3.55)
- Verbalization of
emotional reactions
(t = 3.23)
- Focusing (t = 2.2)

28.93

18.72

Corrective emotional
experiences
1157
47.65

Taxonomy of Common Factors in Psychotherapy


89

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Emotion regulation

Copyright 2012 John Wiley & Sons, Ltd.

Negatively associated
techniques

- Therapeutic abstinence
(t = 4.46)
- Transference
interpretation (t = 3.24)
- Resistance interpretation
(t = 3.19)
- Free association technique
(t = 3.05)
- Reecting team technique
(t = 2.99)
- Circular questions
technique (t = 2.90)

Observations (n)
1075
% of variance explained
50.52
by model
% of variance explained by
18.45
rater (random effect)
% of variance explained by
32.07
xed effects
Fixed effect tests
Technique
F = 9.5
Allegiance
F = 1.4
Technique  Allegiance
F = 1.6
Profession
F=2
Experience
F = 0.33
Age
F = 1.33
F = 3.08
Gender
Positively associated
- Exposure with response
techniques
prevention (t = 5.88)
- Role play technique (t = 5.54)
- Verbalization of emotional
reactions (t = 5.28)
- Focusing (t = 4.77)

Model

Table 3. (Continued)

- Prescription of rituals
(t = 3.11)
- Transference
interpretation (t = 2.8)
- Resistance
interpretation
(t = 2.63)
- Problem-solving
training (t = 2.39)
- Paradoxical intention
technique (t = 2.33)

- Progressive muscle
relaxation (t = 6.84)
- Biofeedback
training (t = 5.32)
- Therapeutic
abstinence (t = 3.72)
- Hypnosis (t = 2.11)

F = 7.14
F = 0.94
F = 1.35
F = 1.36
F = 0.4
F = 0.15
F = 7.73
- Verbalization of
emotional
reactions (t = 4.08)
- Reality testing
(t = 3.33)
- Focusing (t = 3.11)
- Sculpture work
(t = 2.07)

32.46

24.86
F = 6.11
F = 1.51
F = 1.47
F = 0.22
F=0
F = 0.02
F = 2.32
- Focusing (t = 4.82)
- Verbalization of
emotional reactions
(t = 4.46)
- Free association
technique (t = 3.35)
- Progressive muscle
relaxation (t = 2.99)
- Hypnosis (t = 2.7)
- Biofeedback training
(t = 2.09)

18.08
39.58

13.84

1054
53.42

Insight

- Progressive muscle
relaxation (t = 7.52)
- Biofeedback training
(t = 6.83)
- Therapeutic
abstinence (t = 4.7)
- Hypnosis (t = 3.62)
- Positive reinforcement
technique (t = 2.31)
- Prescription of rituals
(t = 2.27)
- Exposure (t = 2.22)

F = 12.23
F = 1.49
F = 1.2
F = 1.9
F = 0.44
F=0
F = 5.87
- Reality testing
(t = 5.23)
- Transference
interpretation (t = 4.03)
- Verbalization of
emotional
reactions (t = 3.83)
- Resistance
interpretation (t = 3.63)
- Focusing (t = 3.44)
- Empty/two-chair
technique (t = 2.9)
- Reecting team
technique (t = 2.46)
- Role play technique
(t = 2.09)

Common factors
Assimilating
problematic experiences
967
50.54

29.91

1074
54.77

Mindfulness

F = 12.36
F = 0.25
F = 1.43
F = 1.22
F = 0.65
F = 0.45
F = 0.66
- Reality testing
(t = 5.61)
- Problem-solving
training (t = 4.68)
- Exposure with
response
prevention
(t = 3.54)
- Paradoxical
intention technique
(t = 3.24)
- Role play
technique (t = 2.51)
- Transference
interpretation
(t = 2.26)
- Resistance
interpretation
(t = 2.06)
- Focusing (t = 2.01)
- Empty/two-chair
technique (t = 2)
- Progressive
muscle relaxation
(t = 6.93)
- Biofeedback
training (t = 6.51)
- Therapeutic
abstinence
(t = 5.44)
- Free association
technique
(t = 4.18)
- Creative
expression
technique (t = 4)
- Hypnosis (t = 2.97)

32.28

28.28

Cognitive
restructuring
943
60.56

(Continues)

F = 15.11
F = 0.61
F = 1.89
F = 1.34
F = 1.16
F = 0.53
F = 1.75
- Role play technique
(t = 6.26)
- Circular questions
technique (t = 5.13)
- Empty/two-chair
technique (t = 4.92)
- Reality testing
(t = 4.65)
- Verbalization of
emotional reactions
(t = 4.24)
- Focusing (t = 2.61)
- Reecting team
technique (t = 2.51)
- Sculpture work
(t = 2.35)
- Transference
interpretation
(t = 2.31)
- Resistance
interpretation
(t = 2.08)
- Progressive muscle
relaxation (t = 7.19)
- Biofeedback
training (t = 6.64)
- Therapeutic
abstinence (t = 4.15)
- Hypnosis (t = 3.83)
- Exposure (t = 3.45)
- Prescription of
rituals (t = 3.38)
- Creative expression
technique (t = 2.97)

39.98

21.54

920
61.52

Mentalization

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Clin. Psychol. Psychother. 21, 8296 (2014)

Copyright 2012 John Wiley & Sons, Ltd.


- Free association
technique (t = 2.39)

- Free association technique


(t = 6.09)
- Therapeutic abstinence
(t = 5.8)
- Circular questions
technique (t = 4.26)
- Sculpture work (t = 4.11)
- Transference interpretation
(t = 3.6)
- Resistance interpretation
(t = 3.5)
- Creative expression
technique (t = 3.36)
- Reecting team technique
(t = 3.34)

Negatively associated
techniques

46.45

43.27
F = 12.46
F = 0.87
F = 1.44
F = 2.93
F=0
F = 0.03
F = 4.52
- Problem-solving
training (t = 6.19)
- Role play technique
(t = 5.97)
- Exposure with
response
prevention (t = 5.84)
- Positive
reinforcement
technique (t = 5.77)
- Reality testing
(t = 4.69)
- Empty/two-chair
technique (t = 2.15)
- Therapeutic
abstinence (t = 5.07)
- Free association
technique (t = 4.91)
- Reecting team
technique (t = 3.78)
- Transference
interpretation
(t = 3.35)
- Resistance
interpretation
(t = 3.24)
- Circular questions
technique (t = 3.13)

12.43

20.82

F = 14.29
F = 0.91
F = 1.22
F = 3.26
F = 0.7
F = 0.04
F = 1.74
- Exposure with
response prevention
(t = 3.44)
- Problem-solving
training (t = 2.62)
- Role play technique
(t = 2.53)
- Positive reinforcement
technique (t = 2.05)

d
Common Factors
Mastery experiences Self-efcacy expectation
922
924
64.09
58.88

Behaviour regulation
Observations (n)
922
% of variance explained
62.8
by model
% of variance explained by
19.72
rater (random effect)
% of variance explained by
43.08
xed effects
Fixed effect tests
Technique
F = 16.4
Allegiance
F = 1.07
Technique  Allegiance
F = 1.22
Profession
F = 2.01
Experience
F=0
Age
F = 0.58
Gender
F = 4.85
Positively associated
- Problem-solving training
techniques
(t = 7.82)
- Role play technique
(t = 7.58)
- Positive reinforcement
technique (t = 6.2)
- Exposure with response
prevention (t = 5.85)
- Reality testing (t = 2.48)

Model

Table 3. (Continued)

- Progressive muscle
relaxation (t = 6.51)
- Biofeedback training
(t = 6.01)
- Therapeutic abstinence
(t = 3.27)
- Prescription of rituals
(t = 2.85)

F = 8.6
F = 0.44
F = 1.34
F = 2.08
F = 1.41
F = 0.4
F = 1.74
- Verbalization of
emotional reactions
(t = 4.88)
- Role play technique
(t = 3.08)
- Reality testing (t = 2.75)
- Sculpture work (t = 2.54)
- Transference
interpretation (t = 2.41)
- Empty/two-chair
technique (t = 2.15)
- Focusing (t = 2.03)

35.97

17.1

New narrative about self


920
53.07

Taxonomy of Common Factors in Psychotherapy


91

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92
by the following xed effects (predictors): Technique (as in
approach a.2), Allegiance, Technique  Allegiance, Profession, Experience, Age, Gender. In all models, Rater
was again entered as a random effect (Table 3). The random
effect operationalizes the variance components: how much
variance (% of total variance) is attributable to the person
of the rater. The xed effects are assigned an F-value each;
the F-value designates how strongly the respective xed
effect is regressed on the common factor. The higher the
F-value of the xed effect Technique, the better can a common factor be differentially (positively or negatively)
described by the single techniques. In other words, this
F-value operationalizes how well a common factor is
explained by the whole set of 22 different techniques
(cf. the degree of explanation due to Technique in approach a.2). Some single techniques may signicantly implement the common factor (they have positive t-values
in the parameter estimates of single techniques), whereas
other techniques are negatively associated to the common
factor (indicated by negative t-values). These signicant
positive (negative) parameter estimates are therefore
valid descriptors of a common factor since they show by
which psychotherapeutic procedures a common factor
can (not) be realized. The technique Counselling is not
listed since it is used as a reference value in the analysis.
We computed Akaikes Information Criterion (AIC), a
criterion of model accuracy and parsimony. The single
AIC values are not reported for reasons of brevity; it
was found that according to AIC, all 22 models in Table 3
were superior to the respective models where Technique
was the only xed effect (approach a.2). In Table 3, we therefore report all models with the full set of xed effects.

RESULTS
The two dimensions Relevance and Explanation describe
how strongly the common factors were implemented by the
set of techniques, in the view of the expert raters. The rst
dimension Relevance, denoted by the intercept, indicates
how close a common factor is related to (implemented by)
the complete set of techniques, irrespective of the differential contribution of the single techniques. The second
dimension Explanation is given by the variance of each
common factor when explicitly and differentially explained
by the techniques. These two dimensions (see respective
columns in Table 1) were almost orthogonal (correlation
r = 0.02) descriptors of the common factors (for a graphical
depiction, see Figure 1). All common factors were highly
signicantly, yet to varying degrees, described by techniques (Explanation in Table 1), the highest explanation
was found for the factors Problem confrontation, Behaviour regulation and Self-efcacy expectation. The most
relevant factors (see approach a.1, Relevance in Table 1),
however, were Patient engagement, Therapeutic alliance
Copyright 2012 John Wiley & Sons, Ltd.

W. Tschacher et al.
and Affective experiencing, which produced the highest
intercepts on the scales. Some common factors were both
well explained and relevant, notably Patient engagement, Affective experiencing, Therapeutic alliance and
Problem confrontation (positive ratios in Figure 1). Other
factors were assessed as having very low overall relevance
but were still well explained by techniques, especially
Desensitization and Mindfulness (negative ratios).
Approach b provides a detailed picture of how each common factor is described by an ensemble of predictors which
included, additional to techniques, characteristics of the
expert raters themselves such as their allegiance to a therapeutic school, their professional background, their years of
therapeutic experience, their age and gender. All results of
22 mixed effects models are portrayed in Table 3ad; here,
we will focus on Bonferroni-signicant ndings with a
probability < 0.001 in order to correct for alpha ination
due to repeated testing (0.05/22  0.002); Bonferronisignicant predictors are printed bold in Table 3ad.
The variance explained by the whole models ranged
between 47.4% (Provision of an explanatory scheme)
and 64.1% (Mastery experiences). The variance that
goes back explicitly to the raters, with the mentioned
predictors of rater characteristics accounted for, varied
between 12% and 30%: Self-efcacy expectation, Insight
and Problem confrontation had low rater variances, hence
high inter-rater agreement, whereas Mindfulness, Therapeutic alliance and Cognitive restructuring received more
heterogeneous assessments, i.e. showed elevated rater
variance. None of the characteristics of raters were predictors
at the level of Bonferroni-corrected signicance. Raters
allegiance, age and experience were statistically unrelated to the assessments (p > 0.05) throughout. Their gender was a signicant predictor of some common factors
(p < 0.05: Assimilating problematic experiences, Insight,
Behaviour regulation, Readiness to change, Self-efcacy
expectation, Problem confrontation, all of which were
rated lower by male raters), but these effects did not survive
Bonferroni-correction. Raters profession played a role in the
assessments of Mastery experiences and Self-efcacy expectation, but again these effects were not Bonferroni-signicant.
All 22 common factors were highly signicantly associated with techniques, and each common factor was linked
to a specic set of techniques that were either positively or
negatively associated to this factor. The unique description
of each common factor is given in Table 3a-d. Here, we will
outline three examples: (i) The common factor Therapeutic
alliance (Table 3a) was described as that entity which is best
implemented by Verbalization of emotional reactions, Positive
reinforcement technique and Focusing, but which would be
counteracted by the application of Biofeedback training, the
Reecting team technique and Progressive muscle relaxation.
(ii) The common factor Problem confrontation (Table 3b)
is implemented by Exposure with response prevention, Role
play technique, Empty-chair and two-chair technique and
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Taxonomy of Common Factors in Psychotherapy

93

Figure 1. Graphical representation of the descriptors of common factors (see Table 1). Relevance is operationalized by the intercepts
of approach a.1 (rescaled 100 for better visualization); Explanation is operationalized by percentage of variance explained by
techniques in approach a.2. The ratio Relevance/Explanation is represented by a line (rescaled 1000 for better visualization). The
abscissa is a dimensionless scale for Relevance and ratio; for Explanation, the scale equals % variance

Focusing. In contrast, Progressive muscle relaxation, Biofeedback training, Therapeutic abstinence and Positive reinforcement
technique are negatively associated to the implementation of
this common factor. (iii) The common factor Self-efcacy
expectations (Table 3d) is realized by Problem-solving training, Role play technique, Exposure with response prevention,
Positive reinforcement technique and Reality testing. Therapeutic abstinence, Free association technique, the Reecting team
technique and Transference interpretation, however, would
down-regulate this common factor.
Figure 2 represents the frequencies by which each technique
was positively and negatively associated to any of the 22 common factors. These frequencies were dened by counting the
Bonferroni-signicant occurrences of techniques among predictors in Table 3ad. It was found that techniques developed by cognitivebehavioural and by humanistic
psychotherapy were predominantly used as positive
descriptors of common factors, whereas psychodynamic,
systemic and body-oriented techniques were predominantly used as negative descriptors.
Copyright 2012 John Wiley & Sons, Ltd.

There were signicant effects of Technique  Allegiance


in 15 of 22 common factors. This means that on top of
the differential importance of specic techniques for the
realization of a common factor, this importance of a technique depended on the psychotherapeutic orientations
(allegiances) of raters. In four instances, this interaction
effect was signicant at the Bonferroni level: Mentalization, Therapeutic alliance, Affective experiencing and
Emotion regulation. In other words, some aspects of these
common factors were divergently characterized by raters
with different psychotherapy backgrounds. For example,
raters with a cognitivebehavioural background viewed
Therapeutic alliance more as having to do with techniques such as Exposure with response prevention and saw
a negative correlation between Therapeutic alliance and
the technique Therapeutic abstinence. Raters with a psychodynamic background, however, viewed Therapeutic
alliance in the context of Transference interpretation
and, positively (!), Therapeutic abstinence. The common
factor Affective experiencing was viewed, by
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94

W. Tschacher et al.

Figure 2. Counts of how many single techniques were Bonferroni-signicantly (p < 0.001) associated to any of the common factors in
Table 3 (red bars to the left: frequency of negative associations; black bars to the right: frequency of positive associations)

psychodynamic raters, as implemented by Transference


and Resistance interpretation and the Free association
technique; cognitivebehavioural experts additionally saw
a connection to Exposure with response prevention; systemic
raters viewed Affective experiencing as linked to the
Prescription of rituals.

DISCUSSION
The Taxonomy Project focuses on conceptual inconsistencies associated with the core construct of common factors;
such inconsistencies are currently hampering psychotherapy research. Without concise concepts, further scientic
progress is unlikely. We therefore personally invited a panel
of experts with mixed professional and allegiance backgrounds to participate in a survey and to help clarify the
common factor concept. In this survey, we used standard
psychotherapy techniques as tools for the better description
and denition of common factors. The internet-based
survey was successfully implemented; it delivered a specic
operational description of each of the 22 common factors
discussed in the eld, based on these factors differential
associations to the techniques of psychotherapy.
Copyright 2012 John Wiley & Sons, Ltd.

We analyzed the expert data using hierarchical linear


models of each common factor. Findings supported the
premise of the Taxonomy Project that common factors and
specic techniques are associated rather than mutually
exclusive concepts. The variance of each common factor
was signicantly explained by its differential associations
to specic techniques: thus, a common factor can be
described and dened by the prole of techniques that
contribute to this factor. Our analysis supported some of
the relationships between common factors and techniques
proposed, on theoretical grounds, by Karasu (1986), yet
shows a much more detailed picture.
The individual characteristics of raters played only a
modest role in these denitions, with predictors such as
allegiance to a therapeutic school, professional background,
years of therapeutic experience, age and gender not reaching Bonferroni-corrected signicance levels. None of the
common factors were overestimated or underestimated
because of the raters allegiances, which speaks for the
validity of expert opinion and a considerable degree of
consensus among experts with differing backgrounds.
Nevertheless, we found some interaction effects of the
predictor Technique  Allegiance, indicating that allegiance
may, in a minority of instances, inuence the assessments of
how much a certain technique implements a certain
Clin. Psychol. Psychother. 21, 8296 (2014)

Taxonomy of Common Factors in Psychotherapy


common factor. In sum, the resulting specic proles of
common factors represent a step towards a clearer conception of these important constructs.
As expected, experts did not consider all common factors as being equally meaningful. Patient engagement,
Affective experiencing and Therapeutic alliance were
judged most relevant. This conforms to the coverage in
the literature where numerous process-outcome studies
have addressed aspects of the therapeutic bond and
patients contributions to therapy process, nding positive
process-outcome links for these factors (Orlinsky et al.,
2004). Therapeutic alliance and Affective experiencing
were also among the common factors with allegiancedependent assessments. As a contrast, there also exist less
common common factors, especially Desensitization and
Mindfulness were viewed as less strongly implemented
by techniques. These common factors also had the lowest
ratios of Relevance/Explanation, with negative relevance
and low explanation. One may speculate about reasons for
these assessments: Desensitization may have lost relevance
as a common factor in behavioural research in past decades,
whereas Mindfulness is a comparatively novel concept
in the eld, which may therefore not (yet) be seen as
relevant as the other concepts and not as strongly connected to techniques.
An unexpected result of this survey was that the present
list of common factors, which comprehensively depicts
the literature, appears to be biased. For some well-known
standard techniques of psychotherapy, no common factors
were available. As becomes evident in the overview of
Figure 2, body-centred techniques such as Progressive
muscle relaxation, Biofeedback training and Hypnosis were
predominantly used as negative descriptors, i.e. these techniques were associated signicantly with the inverse of a
common factor. It seems that embodied cognition, the
acknowledgement that bodily and motor variables are intrinsically connected to mental processes (Ramseyer &
Tschacher, 2011; Tschacher & Bergomi, 2011), is insufciently represented at the current stage of psychotherapy
research. In psychodynamic and, to a lesser degree,
systemic techniques such negative associations also
dominated. With the exception of Paradoxical intention
technique, the efcacy of single systemic techniques is
not well established in the process-outcome literature.
This may have been the reason that no common factor
was allocated to these techniques in our analysis. In the
case of psychodynamic methods the picture is more complex: According to the review of Orlinsky et al. (2004),
therapists interpretations in general may be benecial,
yet Transference interpretation was frequently found associated with negative outcomes, and Therapeutic abstinence
is probably indifferent with respect to outcome. Thus, the
lack of concepts to represent these techniques at the level
of common factors, found in our data, may reect a lack of
condence in the empirical support for these techniques.
Copyright 2012 John Wiley & Sons, Ltd.

95
It must be borne in mind that our ndings are based on
the opinions of expert psychotherapy researchers. The
ndings may not sufciently portray the perspective of
psychotherapy patients, nor can they substitute empirical
analyses of the therapeutic process. This limitation is however justied by the present goal of exploring the structure of theoretical constructs. It will be a subsequent
concern to test how these constructs may translate into
the practice of psychotherapy and into the training of
psychotherapists. A further limitation is that in some of
the ratings, especially the complex interaction effects,
the assessment of certain techniques depended on the
adherence of raters to psychotherapy schools. The predominance of cognitivebehavioural backgrounds in the
present sample of raters, although depicting the current
proportions among psychotherapy researchers, may have
had an inuence on some results of the present study.
In conclusion, we hold that the taxonomy of common
factors based on their differential associations to specic
techniques is promising. It will support elaborating concepts
in such a way that common factors increasingly portray and
unify the whole spectrum of the psychotherapeutic endeavour. In the present analysis, this taxonomic approach was
conducive to arrive at a clearer denition and conception
of common factors. We suggest that the currently prevailing
set of common factors of psychotherapy-induced change
should be adapted in two respects: rst, common factors
must cover all effective treatment approaches in an integrative manner. Here, we have found indications that the
current taxonomy is biased, because it does not cover the
embodiment of psychotherapy and does not do justice to
effective psychodynamic and systemic techniques of
psychotherapy. Second, however, this should not lead
to inating the number of common factors, since there
is already a wide variety of terminology for largely
congruent concepts. Reduction of present tautology must
be an important goal of future taxonomic work.
Such conceptual work should be embedded in a bridging
theory. We foresee that this theory will be provided neither
by neuroscientic physicalism nor qualitative theory alone,
but likely by a metatheory such as dynamical systems
theory (Grawe, 2004; Anchin, 2008). On this basis, taxonomic
work will converge in more theoretical clarity and feed into
developing a common scientic theory of psychotherapy
that can inform future research and practice.

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