Therapy Process Factors
•What patient and therapist characteristics influence the outcome of therapy?
•What makes therapy work? What factors explain that many types of treatment can be
effective for same problem?
•What’s more important – what you do in therapy (specific techniques) or how you do it
(process)?
•Are all therapies equally effective?
Client demographic variables
•SES
•Ethnicity
•Gender
•Age
Client severity and
Poorer outcomes associated with
•Greater severity
•Greater impairment in functioning
•Axis II diagnoses
•Better treatment-outcome associated with
–Positive expectations for tx
–Psychological mindedness
Reactance
•Tendency to react against attempts to directly influence one’s behaviour
Therapist Variables
•Unrelated to outcome
–Therapist age & gender
•Related to outcome
–Therapist experience
–Therapist emotional wellbeing
–Therapist self-disclosure
Between Session Work
•Homework
Common Factors
•Rosenzweig’s beliefs (1936)
•Jerome Frank (1970’s)
•Weinberger
Therapeutic Alliance
Support for Therapy Equivalence
•Luborsky et al (1975-2002)
•Wampold (1997)
Evidence against Therapy Equivalence
•Smith, Glass, Miller (1980) meta-analysis
•Child/adolescent treatment literature
Empirically supported therapy relationships (ESRs)
•Include evidence from experimental and correlational studies of adults
•Categorize as
–Demonstrably effective
–Promising and probably effective
–Insufficient research to judge
Integration in Practice
•Integrate empirically supported treatments (specific techniques) with elements of
empirically supported relationships (alliance, empathy, goal consensus).
Exposure Therapy for Anxiety:
A behavioural approach
•Origins of behaviour therapy
•Application of exposure therapy to
–Specific phobias
–Obsessive compulsive disorder (OCD)
•Conditioning models
–Pavlov - classical conditioning
–Skinner - operant conditioning
•Human Applications
-Watson
-Systematic desensitization
Specific Phobia
•Animals
•Natural environment
•Situational
•Blood-injection-injury
•Other
Facts: Specific Phobias
•Prevalence: 4-8%
•First symptoms usually occur in childhood
•How develop
–Traumatic events
–Observation of others in traumatic situation or exhibiting anxiety
–Information transfer
•How maintained over time?
--Avoidance
Exposure as alternative
Guiding Rules of Exposure
• Exposure tasks must provoke anxiety
• Prolonged
• Repeated as often as possible
• No avoidance/escape
• Gradual
Creation of a hierarchy
DVD: Hierarchy Building
•Note factors that influence clients fear level
OCD Facts
•Lifetime prevalence 2-3%
•Chronic wax and wane course
•In adults, equally common in men and women
–Age onset earlier males (childhood) vs. females (20’s)
Exposure and Response Prevention for OCD
•In vivo Exposure
•Imaginal Exposure:
•Ritual Prevention:
Video: Exposure for OCD
•What see therapist doing to assist client in exposure?