輔 導 與 諮 商 學 報
民 94 年，27 卷 1 期，1-22 頁
Conceptualizing Common Factors in Counseling
Yii-Nii Lin
National Tsing Hua University
Abstract
The purpose of this study was to conceptualize the common factors across many
counseling approaches that were crucial for the process and outcome of counseling. The
proposed conceptual framework consisted of four constructs comprising common factors:
the client's characteristics, the therapist's characteristics, the process of change (counseling relationship; counseling techniques; placebo, hope and expectancy; and rituals),
and the counseling context. All of the common factors, derived from preceding literature
and integrated into a systematic form, were interactive and embedded within a process-based holistic framework. Implications for counseling research, practice and education/training were elaborated.
Keywords: common factor, counseling, psychotherapy
Yii-Nii Lin
Center for Teacher Education, Counseling Center, National Tsing Hua University
E-mail: ynlin@mx.nthu.edu.tw
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輔導與諮商學報
to all forms of treatment than from examining
Conceptualizing Common Factors in
Counseling
features specific to particular therapies. As a
result of considerable therapy outcome research, a typical conclusion has been drawn
Throughout the development of counsel-
that for many disorders, no one theoretical
ing, more than 400 distinct, popular counsel-
approach has been shown to be consistently
ing schools have evolved in the modern
more effective than any other and common
counseling field (Bergin & Garfield, 1994;
factors exist in all forms of therapy that might
Prochaska
Different
partly explain this failure in finding any con-
therapies require the client to undergo differ-
sistent differential effectiveness (Goldfried &
ent experiences and engage in different be-
Norcross, 1995; Sexton et al., 1997). Due to
haviors. Although there are a large number of
the failure to find consistent differential ef-
therapies and each has its own rationale and
fectiveness across approaches, there is a
specific techniques, therapies embody com-
growing awareness and appreciation of the
mon factors that are curative across a variety
common factors that exist in all forms of
of schools. These common factors are active
therapy (Lambert, Shapiro, & Bergin, 1986).
&
Norcross,
1999).
ingredients shared by a variety of psycho-
Current evidence supports that the era of
therapies and seek to abstract similarities
"theory specific" research and practice may be
across different therapies. Common factors are
gone (Bergin & Garfield, 1994), and the focus
those dimensions of the treatment setting that
of attention for both researchers and practi-
are not specific to any particular techniques
tioners are those common elements that con-
(Blow & Sprenkle, 2001; Lambert & Bergin,
tribute to successful therapy (Lambert, 1992;
1994), and are the elements that various
Lambert & Cattani-Thompson, 1996; Sexton
counseling approaches share with the eventual
& Whiston, 1994). Rosenzweig (1936) notes
goal of developing more parsimonious and
that all forms of therapy have cures to their
efficacious treatments based on those com-
credit, and labels this phenomenon the "dodo
monalities (Goldfried & Norcross, 1995).
bird verdict" (cited from Luborsky, Singer, &
Luborsky,
Accumulated evidence of meta-analyses
1975).
Factors
common
across
reveals that researchers have repeatedly failed
treatments are accounting for a substantial
to find convincing evidence that different
amount of improvement found in psychother-
psychotherapies are differentially effective.
apy. Common factors account for most of the
Therapy equivalence also suggests that com-
gains that result from psychological interven-
mon beneficial ingredients among the differ-
tions and contribute a great deal to positive
ent treatments are mostly or completely re-
outcome (Lambert & Ogles, 2004).
sponsible for the similar outcomes (Sexton,
If the effects of various influences that
Whiston, Bleuer, & Walz, 1997). Berman and
contribute to client change are partialed out,
Norton (1985) recognize the importance of the
approximately 30% of the outcome variance can
common factor and emphasize that the effec-
be attributed to common factors that seem evi-
tiveness of psychotherapy work may be en-
dent in all therapies, regardless of the theoreti-
hanced more from identifying factors common
cal allegiance (Sexton et al., 1997). Compared
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Conceptualizing Common Factors in Counseling
to the 15% attributable to specific therapeutic
erature: the counseling relationship (e.g., Cas-
techniques, 30% of the outcome variance is at-
tonguay, 1993; Frank & Frank, 1991; Lambert
tributed to the impact of common factors on the
& Ogles, 2004); placebo, expectancy and hope
therapeutic outcome (Lambert, 1992; Sexton et
(e.g., Grencavage & Norcorss, 1990); counsel-
al., 1997). This finding capitalizes the impor-
ing techniques (e.g., Lambert & Bergin, 1994;
tance of common factors in therapy.
Walborn, 1996), and rituals (e.g., Hubble,
Duncan, & Miller, 1999). In addition, a healing
Despite the fact that the importance of
and
setting or context (e.g., Frank, 1982; Frank &
multi-aspects of common factors have been
Frank, 1991; Walborn, 1996; Wampold, 2001)
proposed, there is a lack of a systematic and
for counseling has also been emphasized as an
comprehensive framework to identify and or-
important common factor. This article reviews
ganize
common
factors
common
framework
greater
of
has
been
The
conceptual
theorists' viewpoints on common factors within
factors
encourages
a specific time frame, and then summarizes the
factors.
common
cooperation
and
confirmed
harmony
major themes of common factors.
between
competing approaches, ultimately increasing
Rosenzweig (1936) pointed out the im-
the effectiveness of psychotherapy. This article
portance of providing the client with alterna-
proposes a conceptual framework of common
tive and more plausible ways of viewing
factors with an attempt to organize these fac-
him/herself and the world; the ability of
tors into a comprehensive, systematic, and
therapists to instill a sense of hope in their
meaningful framework to serve as an effective
patients; the therapist's ability to make inter-
reference for counseling clinicians, researchers,
pretations; and the synergistic nature of the
and trainers/educators. A review of related lit-
change process. Alexander and French (1946)
erature of common factors is presented first,
believed that a corrective emotional experi-
followed by a conceptual framework.
ence within therapy was the common factor,
and the corrective emotional experience pro-
Literature Review
vided by the therapist was the core that made
all forms of counseling effective. Fiedler
After reviewing related literature, Lambert
(1950) focused on the relationship as a source
and Ogles (2004) summarize common factors
of common factors in therapy and provided a
attributable to the therapist, the therapy pro-
fascinating, although indirect, examination of
cedures, and the clients. This notion responds
some of these factors.
to a proposal by Sexton and his colleagues
Garfield (1957) suggested that the fun-
(1997) that what is common to successful
damental elements of counseling were that
therapy is a process conducted by a skilled
therapists were sympathetic and not moraliz-
therapist who helps the client get invested and
ing; that a therapeutic relationship ensued; and
involved in the counseling process and uses
that clients were provided with new cognitive
techniques that are matched to the client and
understanding for their problems. Common
based on a therapeutic relationship. Looking at
factors consisted of the therapist's under-
the construct of the counseling process, four
standing and support, and the client's oppor-
chief themes can be derived from previous lit-
tunity to experience an emotional catharsis
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輔導與諮商學報
(Garfield,
process variables: providing the client with
1957). The mechanism of change in virtually
new, corrective experiences, and direct feed-
all approaches was rooted in the therapeutic
back to increase clients' awareness of thoughts,
relationship,
toward
feelings, and actions through the therapist's
counseling, emotional release, explanation and
interventions. The common factors included
interpretation, reinforcement, desensitization,
the
confronting a problem, and skills training
treatment, the existence of an optimal rela-
(Garfield, 1980).
tionship,
and
to
gain
self-understanding
positive
expectations
facilitation
of
feedback
client
for
expectations
the
promotion
of
of
awareness, a corrective experience, and con-
Rogers (1957) indirectly contributed to
tinued reality testing (Goldfried, 1982).
the common factors theme by proposing that
therapy was effective not because of specific
Brady and his colleagues (1980) claimed
techniques but because it provided a particular
that the practice of prominent therapists in
type of human relationship within which
providing the client with new experiences,
change could occur. Truax and Mitchell (1971)
both inside and outside of therapy, was a cen-
emphasized the importance of warmth, empa-
tral ingredient of all therapies. These new ex-
thy, and unconditional positive regard on the
periences were considered important because
outcome of therapy. Strupp (1973) and Gar-
they led to changes in the way clients think
field
emotionally
about themselves. Luborsky (1984) reported
charged affectional relationship as one com-
three central curative factors or process vari-
mon factor.
ables underlying change: self-understanding, a
(1973)
highlighted
an
Frank (1961) identified a variety of
helping alliance, and the incorporation of
common methods for clients' healing, includ-
gains (e.g., new insight to foster change).
ing the placebo effect, an expectation for
Torrey (1986) identified four common process
change or improvement, arousing hope, caus-
variables of therapy: a shared worldview be-
ing emotional arousal, encouraging changed
tween therapist and client, personal qualities
activity outside of the session, and encourag-
of the therapist, expectations and emotional
ing new ways of understanding oneself and
arousal, and a sense of mastery.
Grencavage
one's problems through interpretations and
and Norcross (1990)
dis-
corrective emotional experiences. Common
cussed commonalities and coded the common-
factors consisted of an emotionally charged
alities into five areas: client characteristics
confiding relationship with a helping person; a
(positive expectations/hope or faith, client dis-
healing setting; a rational conceptual scheme
tressed or incongruent, client actively seeing
or myth to explain symptoms and a ritual to
help), therapist qualities (general positive de-
help resolve symptoms (Frank, 1982).
scriptors, cultivating hope and enhancing expectations,
Applebaum (1982) suggested six neces-
warmth
and
positive
regard),
sary conditions for change: an explanation, a
change processes (opportunity for catharsis and
therapeutic relationship, client expectations, a
ventilation, acquisition and practice of new
corrective emotional experience, emotional
behaviors, and provision of rationale), treat-
release, and an altered state of consciousness.
ment structures (use of techniques and rituals,
Goldfried (1980) recognized two common
focusing on an inner world and exploration of
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Conceptualizing Common Factors in Counseling
emotional issues, adherence to theory), and
tery, facing fears, mastery efforts, and suc-
relationship elements (development of alli-
cessful experiences. Weinberger (1995) em-
ance/relationship, engagement, and transfer-
phasized the common factors of the therapeu-
ence). They proposed consensual commonal-
tic relationship, such as expectations, con-
ities that included a warm, inspiring, and so-
fronting problems, mastery, and attribution of
cially sanctioned therapist; opportunity for ca-
problems. In addition, expectations, confront-
tharsis; acquisition and practice of new behav-
ing problems, mastery, and attributions of
iors; exploration of the inner world of the client;
outcome were also emphasized by Weinberger
suggestion; and interpersonal learning.
(1995) as common factors.
Six elements that were common to the
Walborn (1996) claimed that common
rituals and procedures of therapy were pro-
features included such variables as providing a
posed by Frank and Frank (1991): (1) the
non-threatening environment; developing a
therapist combated the client's sense of alien-
relationship in which the client and therapist
ation by developing a relationship that was
worked together as a team; and offering a
maintained after the client divulged feelings
plausible explanation for the client's suffering.
of demoralization; (2) the therapist maintained
He pointed out that the counseling relationship,
the client's expectation of being helped by
client expectations, cognitive insight, and
linking hope of improvement with the process
emotional arousal were crucial common fac-
of therapy; (3) the therapist provided new
tors during the process of counseling.
Castonguay
learning experiences; (4) the client's emotions
and
his
colleagues
(1996)
were aroused as a result of the therapy; (5) the
noted three distinct meanings that could be ap-
therapist enhanced the client's sense of mas-
plied to understanding common factors in ther-
tery or self-efficacy; and (6) the therapist
apy: global aspects of therapy that were not
provided opportunities for practice. They also
specific to any one approach; aspects of treat-
emphasized the role of the relationship and of
ment that were auxiliary to treatment and re-
cognitive
emotional
ferred primarily to interpersonal and social fac-
arousal in order to produce change, and the
tors; and those aspects of treatment that influ-
client's positive expectations and confidence
enced outcomes but that were not therapeutic
in therapy.
activities or related to the interpersonal/social
insight,
the
client's
organized
context. In addition, Stevens, Hynan, and Allen
common factors into three categories: 1) sup-
(2000) stressed expectancy effects and rela-
port factors including catharsis, a positive re-
tionship variables, such as persuasion, warmth,
lationship with the therapist, a therapeutic al-
attention, understanding, and encouragement, as
liance, and the therapist's warmth, respect, and
important common factors.
Lambert
&
Bergin
(1994)
empathy toward and trust of the client; 2)
Also, Fischer, Tokar and Serna (1998)
learning factors including advice, affective
classified common factors into four areas: the
experiencing,
experi-
therapeutic relationship, a shared worldview
encing, feedback, and assimilation of prob-
between client and therapist, meeting client
lematic experiences; and 3) action factors in-
expectations, and the use of ritual or interven-
cluding behavioral regulation, cognitive mas-
tion that was perceived as appropriate by both
corrective
emotional
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輔導與諮商學報
client and therapist. They suggested that the
various common factors with those utilizing
therapist had to develop a good relationship
traditional counseling styles is necessary to
with the client, discover or construct with the
examine the effect of common factors.
client a shared worldview or plausible ration-
In addition, one of the major weaknesses
ale for distress, create an environment in
of previous literature is that scholars present
which the client's expectations could be raised,
only a part of common factors and thus are not
and plan a healing procedure in which the
able to demonstrate the whole picture. To or-
client and the therapist both had confidence.
ganize these factors, three dimensions of a
Arkowitz (2000) emphasized corrective
client's characteristics, a therapist's character-
emotional experiences in therapy and the dis-
istics, and the process of change highlighted
confirmation of dysfunctional expectancies,
by Lambert and Ogles (2004) can serve as a
the arousal of hope and positive expectancies,
reference, matching the three major sets of
changes in self-perceptions, persuasion and
variables in counseling intervention (client's
attitude change, and restoration of morale. In
variables, therapist's variables and process
addition, common factors were identified in
variables). Various common factors can be
the areas of client factors; relationship factors;
classified into these three dimensions and or-
placebo,
ganized into a systematic framework.
hope,
and
expectancy;
and
model/technique factors (Hubble, Duncan, &
Comparing the various themes of com-
Miller, 1999; Miller, Jordan, Kaplan, Stiver, &
mon factors outlined in previous literature,
Surrey, 1997). Finally, Lambert, Bergin, and
some scholars' emphases were solely on one
Garfield (2004) pointed out that common fac-
dimension of common factors. For example,
tors included the facilitation of hope, the op-
Rogers (1957), Truax and Mitchell (1971) and
portunity for emotional release, exploration
Strupp (1973) highlighted one dimension of
and integration of one's problems, support,
common factors, the counseling relationship.
advice, and encouragement to try out new be-
Frank (1961) focused on counseling tech-
haviors and thoughts.
niques in the process of change, including the
A review of preceding literature illus-
placebo effect, an expectation for change,
trates many common factors and various styles
arousing hope, emotional arousal, counseling
of classifying these factors. The ambiguity
activities, interpretations, etc. Goldfried (1980)
exists regarding the definitions and terminol-
also emphasized common techniques occur-
ogy of diverse common factors, which might
ring in the process of counseling, such as
cause confusion and misunderstanding. Clear
feedback to increase clients' awareness of
definitions and precise term usage of various
thoughts, feelings, and actions.
common factors should be presented in order
In addition, other scholars concentrated
to further identify and testify to their impor-
on two dimensions of common factors. For
tance in research. Also, empirical studies to
example, Applebaum (1982) highlighted some
examine and verify various common factors
common factors in the process of change (e.g.,
and to investigate their influence and interac-
counseling relationship, a corrective emo-
tion are necessary. Moreover, an investigation
tional experience, and an altered state of con-
comparing counseling outcomes that apply
sciousness)
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and
clients'
expectations
for
Conceptualizing Common Factors in Counseling
counseling. Torrey (1986) identified thera-
constructs and themes are briefly delineated
pist's qualities and some common factors in
below.
First, the counseling relationship has
the process of counseling, such as emotional
arousal and a sense of mastery. Walborn (1996)
been confirmed as one of the most important
noted client's expectations and some common
common factors, contributing significantly to
factors in the process of change (e.g., coun-
outcome efficacy (e.g., Fischer, Tokar & Serna,
seling relationship,
1998; Frank & Frank, 1991; Garfield, 1973;
cognitive insight,
and
Goldfried, 1982; Grencavage & Norcross,
emotional arousal).
Few scholars covered all three dimen-
1990; Lambert & Bergin, 1994; Rogers, 1957;
sions of common factors. Common factors
Strupp, 1973; Truax & Mitchell, 1971; Wal-
were classified by Grencavage and Norcross
born, 1996; Weinberger, 1995; Lambert &
(1990) into client's characteristics, therapist's
Ogles, 2004). Second, placebo, hope and ex-
characteristics, and some factors in the change
pectancy
process, including treatment structure and
across various counseling approaches (e.g.,
counseling
Arkowitz, 2000; Fischer et al., 1998; Frank &
relationship.
Frank
and
Frank
abilities,
counseling
important
roles
common
Frank, 1991; Grencavage & Norcross, 1990).
(1991) emphasized common factors, including
therapist's
played
Third,
techniques
some
counseling
techniques
(e.g., emotional arousal, self-efficacy), and
common across schools shared a certain effect
client's expectations and hope of improvement.
of outcome variance, such as corrective emo-
Based on the above discussions, many com-
tional experiences (e.g., Alexander & French,
mon factors have been addressed in previous
1946; Arkowitz, 2000; Frank & Frank, 1991;
literature but they seemed fragmented and
Goldfried, 1980; Lambert & Bergin, 1994),
unable to display a comprehensive picture.
cognitive insight (e.g., Frank & Frank, 1991;
comprehensive
Walborn, 1996), self-understanding (Frank,
and inclusive frameworks/models should be
1961; Luborsky, 1984), feedback (e.g., Gold-
provided to organize the various common
fried, 1980; Lambert & Bergin, 1994), emo-
factors in the above three dimensions, and to
tional catharsis (Applebaum, 1982; Frank &
demonstrate their interactions and connections
Frank, 1991; Grencavage & Norcross, 1990;
clearly. The three dimensions of common fac-
Lambert & Bergin, 1994), and emotional
tors (therapist's characteristics, client's char-
arousal (Frank & Frank, 1991; Torrey, 1986;
acteristics, and the process of change) were
Walborn, 1996). Fourth, the client's charac-
adopted as constructs of the proposed con-
teristics, including a client's expectations, in-
ceptual framework in this article. Four themes
volvement and experiencing of therapy (e.g.,
in the process of change during counseling
Applebaum, 1982; Frank & Frank, 1991;
were also highlighted: the counseling rela-
Grencavage & Norcross, 1990; Patterson &
tionship;
Watkins, 1996) have been identified as shared
Therefore,
systematic,
placebo,
expectancy,
and
hope;
common factors.
counseling techniques; and rituals. Finally, a
healing setting or the counseling context was
Finally, characteristics common among
addressed as one of the constructs in the con-
many therapists included a therapist's warmth,
ceptual framework of common factors. These
empathy, congruence or genuineness, uncon-
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輔導與諮商學報
ditional positive regard (e.g., Lambert & Ber-
client's characteristics, the therapist's charac-
gin, 1994; Lambert & Ogles, 2004; Rogers,
teristics, the process of change (counseling
1957; Truax & Mitchell, 1971), a therapist's
relationship; counseling techniques; placebo,
qualities of professional competence (e.g.,
hope and expectancy; and rituals), and the
Torrey, 1986; Grencavage & Norcross, 1990),
counseling context, which are delineated be-
and a therapist's ability to instill hope and
low respectively. The construct of "the process
expectancy (e.g., Garfield, 1980; Grencavage
of change" integrates three themes of the
& Norcross, 1990). One important note is that
counseling relationship; placebo, hope and
these themes occur within the counseling
expectancy; and counseling techniques. An-
context and should be understood within a ho-
other construct of "the counseling context" is
listic framework. Based on the above discus-
proposed to illustrate the interdependent and
sion,
interactive nature of the five themes.
the
author
proposes
a
conceptual
framework to incorporate these important
Client's Characteristics
common factors addressed in the previous literature.
The client is cast in the role of the chief
agent of change in therapy (Bohart, 2000;
A Conceptual Framework of
Common Factors
Duncan, 2002) and is actually the most potent
contributor to the outcome in therapy (Duncan
& Miller, 2000; Lambert & Cattani-Thompson,
Common factors are a reciprocal interac-
1996). The largest variation in therapy out-
tion rather than a linear causality (Weinberger,
come is accounted for by preexisting client
1995) and deal with the processes of change
factors,
rather than with fixed and static entities
(Lambert & Cattani-Thompson, 1996; Sexton
(Arkowitz, 2000). They may be conceptual-
et al., 1997). Client factors are ingredients in
ized through the perspectives of the therapeu-
the life and environment of the client that
tic process of change (e.g., Arkowitz, 2000;
contribute to change. Empirical outcome re-
Beutler, Consoli, & Williams, 1995; Sexton,
search attributes 40% of improvement in cli-
Whiston, Bleuer, & Walz, 1997). Therapists
ents to these client factors (Assay & Lambert,
consider the multivariate and interactive rela-
1999; Lambert, 1992; Sexton et al., 1997).
tionships among common factors as an expla-
These factors include client characteristics
nation for changes in therapy, as well as for
such as inner strength, religious faith, goal
possible changes in the role of particular
directedness,
common factors over the course of therapy in
persistence, openness, faith, optimism, capac-
the counseling context (Arkowitz, 2000; Jones,
ity for change and the enlistment of the client
Cumming, & Horowitz, 1988).
in the change endeavor. The client is actually
such
as
expectations
personal
agency,
for
change
motivation,
This proposed conceptual framework or-
the single most potent contributor to outcome
ganizes the common factors into five themes
factors (Miller et al., 1997) and the engine of
that emerged from the preceding literature into
change in therapy (Tallman & Bohart, 1999).
a comprehensive and systematic framework
Clients' positive expectations, hope, or
with four constructs of common factors: the
faith are the most important and frequently
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Conceptualizing Common Factors in Counseling
cited common factors (Grencavage & Nor-
involvement with therapy (Patterson & Wat-
cross, 1990). A client's expectation is an ac-
kins, 1996; Walborn, 1996).
tive ingredient in all systems of therapy, has
Therapist's Characteristics
been confirmed as an important common ingredient in therapy (Walborn, 1996), and is
The therapist's common factors respond
conceptualized as a critical precondition for
to Rogers' (1957) ideas, such as a therapist's
therapy to continue (Prochaska & Norcross,
warmth, empathy, and unconditional positive
1999). Facilitating a client's expectations of
regard in the outcome of counseling (Blow &
treatment is a common factor in therapy
Sprenkle, 2001; Grencavage & Norcross, 1990;
(Goldfried, 1982). Therapy can be viewed as a
Hill
process used to induce an expectation in a
tani-Thompson, 1996; Prochaska & Norcross,
client that treatment will cure them, and that
1999; Patterson & Watkins, 1996; Truax &
any resulting improvement is a function of the
Mitchell, 1971), and traits of support, empathy,
client's expectation to improve (Prochaska &
caring,
Norcross, 1999). The hypothesis of most
foundation to which the more selective effects
studies is that treatment is enhanced by the
of specific procedures can be added (Beutler
extent to which a client expects the treatment
& Consoli, 1992). These therapist-facilitative
to be effective (Prochaska & Norcross, 1999),
qualities exert their effects by enhancing the
such as the enhancement of a client's faith in
therapist's role as a benevolent agent of in-
the institution itself and confidence in the
fluence (Beutler, Consoli, & Williams, 1995).
therapist and the treatment.
&
Corbett,
1993;
acceptance,
Lambert
and respect
&
Cat-
form the
In addition, therapists' common factors
In addition, the client's experiencing of
consist of expectations for improvement, per-
therapy has been viewed as a common factor
suasion, warmth and attention, understanding
(Castonguay et al, 1996; Wiser & Goldfried,
and encouragement, use of psychological in-
1993).
now
terventions in both theory and practice, and
emerging as a general factor related to change
playing an active role in client improvement
in many counseling approaches (Castonguay
(Patterson & Watkins, 1996). The therapist's
et al., 1996). The client's experiencing of
status or reputation, including the ability to
therapy is viewed as a means for them to en-
communicate and care, and the therapist's
gage in an affective problem-solving process
competence, are also identified as common
(Greenberg, Rice, & Elliott, 1993). The cli-
factors (Frank & Frank, 1991). Therapists'
ent's change in experiential knowing is a
three sets of characteristics proposed by Truax
common important aspect of the counseling
and Carkhuff (1967) include: 1) the therapist's
processing (Bohart & Wugalter, 1991). In
ability to be integrated, mature, genuine or
summary, a client's variables account for a
congruent, 2) the therapist's ability to provide
significant
variance
a non-threatening, trusting, safe or secure at-
(Lambert & Cattani-Thompson, 1996; Sexton
mosphere by his acceptance, non-possessive
et al., 1997) and the important common fac-
warmth, unconditional positive regard, or love,
tors include the client's positive expectations,
and 3) the therapist's ability to be accurately
and the client's experiencing and/or emotional
empathic, be with the client, be understanding,
Experiencing
amount
of
of
therapy
outcome
is
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輔導與諮商學報
or grasp the client's meaning.
all approaches has been confirmed (Bordin,
In summary, therapists' common factors
1994; Castonguay et al., 1996; Gelso & Hayes,
include a manifestation of his/her personality
1998; Henry & Strupp, 1994; Horvath &
characteristics and facilitative qualities (e.g.,
Greenberg, 1994; Pinsof, 1994; Raue & Gold-
honesty, caring, genuineness, unconditional
fried,
positive regard, empathy, respect, acceptance,
Weinberger, 2002). The counseling relation-
and openness), professional competence (e.g.,
ship is responsible for most of the gains re-
the abilities of communication, caring, under-
sulting from therapy (Assay & Lambert, 1999;
standing, encouragement, persuasion, and in-
Lambert & Ogles, 2004). Extensive literature
tegration;
a
on the counseling relationship supports that
non-threatening, trusting, safe or secure at-
the importance of relationship has been an
mosphere), and the therapist's confidence in
essential and common ingredient of behavior
the his/her own abilities, in the abilities of
change (Beutler, Crago, & Arizmendi, 1986;
his/her client, and in the efficacy of therapy
Menninger & Holzman, 1973). For example,
itself.
Rogers (1957) emphasizes that the counseling
and
the
provision
of
Process of Change
1994;
Watson &
Greenberg,
1994;
relationship is as necessary and sufficient
condition of therapy. Goldfried (1980) notes a
Therapy is a process of influencing, and
facilitative therapeutic relationship as an im-
what accounts for a change can be revealed by
portant common factor in therapy. Frank and
looking at the influencing processes (Frank,
Frank (1991) stress an important common
1961). The therapy takes place in a healing
factor of an emotionally charged confiding
context in which the client, as well as the
relationship with a helping person.
therapist, believe in the rationale for therapy,
Looking more closely at the impact of the
the therapist delivers therapeutic actions con-
counseling relationship, a good therapeutic
sistent with the rationale, the client is aroused
alliance is related to positive outcomes across
and expects to improve, and a therapeutic re-
various counseling modalities (Horvath &
lationship is developed. What is common to
Greenberg,
successful therapy is a process conducted by a
therapeutic alliance appears to be the strongest
skilled therapist who helps the client get in-
predictor of outcome (Horvath & Greenberg,
vested and involved in the process (Sexton et
1994), and the presence of a therapeutic alli-
al., 1997). This article proposes that the proc-
ance seems a predictor of a favorable outcome
ess of change is a common dimension revealed
of treatment (Hovarth & Symonds, 1991;
by the interaction of the therapist and client
Krupnick et al., 1996). Therapists agree that
within the context of counseling, which con-
the development of a strong therapeutic alli-
sists of the following aspects: the counseling
ance is one of the most important common
relationship; counseling techniques; placebo,
factors during the process of therapy (Gren-
hope, expectancy; and rituals.
cavage & Norcross, 1990; Prochaska & Nor-
Counseling Relationship
The counseling relationship common to
1994;
Luborsky,
1994).
The
cross, 1999). Finally, other crucial common
factors identified within the counseling relationship include accurate empathy, positive
- 10 -
Conceptualizing Common Factors in Counseling
regard, nonpossessive warmth, and congru-
ticular theory or a set of techniques influence
ence or genuineness (Lambert & Ogles, 2004).
and bring his/her power to the therapy process
(Patterson & Watkins, 1996). The emergence of
Placebo, Hope, and Expectancy
a client's hope through therapy (Snyder, Michael,
& Cheavens, 1999) and the stimulation of a
Placebo, hope and expectancy contribute
to about 15% of the therapy outcome (Assay &
naturally
occurring
self-healing
process
Lambert, 1999; Lambert, 1992). Placebo is
(Tallman & Bohart, 1999) are both viewed as
defined as any therapy or component of ther-
common factors.
On the other hand, the client's engagement
apy that is deliberately used for its nonspecific,
psychological, or psychophysiological effect,
in the process of self-exploration and motiva-
or that is used for its presumed specific effect,
tion to change within sessions has been viewed
but is without specific activity for the condi-
as a common aspect of therapy. The client's
tion being treated (Shapiro & Morris, 1978).
belief is that change is possible and expectation
Placebo factors reflect therapeutic changes
of change contributes to the process of therapy.
that occur simply because the client is in
In order to have a positive impact within ses-
treatment of some kind. Placebo is character-
sions, a client has to hold a belief that im-
ized as the therapist's efficacy in increasing
provement will occur, a belief in the therapist
the client's confidence in the therapist's ability
as the major source of help, or a belief in him-
to help them (Rosenthal & Frank, 1956). The
self/herself as the major source of change
placebo effect is an important component and
(Patterson & Watkins, 1996). In summary, pla-
the entire basis for the existence, popularity,
cebo, expectancy, and hope, which are contrib-
and effectiveness of therapy (Patterson &
uted by the client, the therapist and the therapy
Watkins, 1996).
itself in the process of counseling, are common
While both client and therapist interact
with each other during the counseling process,
the curative effects come from the client's and
factors across a variety of schools.
Counseling Techniques
the therapist's positive and hopeful expecta-
Some combinations of affective, experi-
tions that accompany the use and implementa-
ential, cognitive and behavioral regulations are
tion of the counseling method and in-session
recognized as common counseling techniques
techniques. The power of expectation is in-
of change. Common factors highlighted by
voked by the therapist's belief in the process,
Lambert and Bergin (1994) consist of three
in which human beings are capable of change
categories of counseling techniques: support
or of being changed. Every therapist believes
factors (e.g., reassurance, trust, empathy and
in or has confidence in the theory and method
catharsis), learning factors (e.g., cognitive
that he/she uses.
learning, advice, affective experiencing, and
It may be hypothesized that success bears
feedback), and action factors (e.g., behavioral
a strong relationship to the degree of confidence
regulations, cognitive mastery, reality testing,
that the therapist has in his/her approach within
and practicing new behaviors). These common
sessions (Patterson & Watkins, 1996). The
techniques result in a cooperative working en-
therapist's beliefs of and commitment to a par-
deavor in which the client's increased sense of
- 11 -
輔導與諮商學報
trust, security, and safety, along with decreases
in tension, threat, and anxiety, lead to changes
in conceptualizing his or her problems and ul-
solving problems (Frank, 1982).
Counseling Context
timately in acting differently by reframing
Four basic aspects of the treatment con-
fears, taking risks, and working through prob-
text are proposed by Beutler, Consoli & Wil-
lems in interpersonal relationships (Lambert &
liams (1995): the treatment setting (where),
Bergin, 1994). In summary, counseling tech-
the intensity of treatment (how much), the
niques common across schools share a certain
modality through which treatment is delivered
effect of outcome variance, such as corrective
(what kind), and the format in which this mo-
emotional
&
dality is transmitted (with whom). The healing
French, 1946; Arkowitz, 2000; Frank & Frank,
context and the meaning attributed to it by the
1991; Goldfried, 1980), cognitive insight (e.g.,
therapist and client are critical contextual
Frank
1996),
phenomena (Frank & Frank, 1991). A healing
Luborsky,
setting heightens the client's expectation of
1984), feedback for promoting awareness (e.g.,
help from a therapist and provides safety to
Lambert & Bergin, 1994), emotional catharsis
the client. During the process of psychother-
(Applebaum, 1982; Garfield, 1957), and emo-
apy, a provision of new learning experiences
tional arousal (Frank & Frank, 1991).
is not therapeutic unless the client views the
&
experiences
Frank,
self-understanding
(e.g.,
1991;
(Frank,
Alexander
Walborn,
1961;
Rituals
Rituals are a shared characteristic of
therapy to be taking place in a healing context.
Client changes can emerge from an empowering, collaborative interpersonal context.
healing procedures in most cultures (Frank &
In summary, this conceptual framework
Frank, 1991). The use of rituals in a therapeu-
of common factors is framed on a proc-
tic context inspires hope and a positive ex-
ess-based
pectation for change by conveying that the
commonly accepted ingredients in counseling
user possesses a special set of skills for heal-
addressed in previous literature. The counsel-
ing. In successful therapies both client and
ing process and its outcomes are first influ-
therapist believe in the restorative power of
enced by various preexisting characteristics
the treatment's procedures or rituals (Frank,
that the client and the therapist bring into the
1973). Clients change and grow in a context
therapeutic process (input variables). When
that mobilizes their growth through rituals.
client and therapist get involved in the process
Any technique from any model may be viewed
of change within the counseling context, ma-
as a healing ritual, rich in the possibility that
jor constructs of the counseling relationship;
hope and expectancy can inspire (Hubble,
counseling techniques; placebo, expectancy,
Duncan, & Miller, 1999). Therapists and cli-
and hope; and rituals closely interrelate. These
ents need a structured, concrete method of
factors are interactive and multivariate, and
ritual for mobilizing therapeutic factors. A
should be constructed within a holistic frame.
rational, conceptual scheme provides a plau-
This conceptual framework of common factors
sible explanation for the client's symptoms
revealing elements within four constructs is
and prescribes a ritual or procedure for re-
displayed in Figure 1.
- 12 -
perspective.
It
incorporates
the
Conceptualizing Common Factors in Counseling
- 13 -
輔導與諮商學報
various common factors reveals close rela-
Discussion
tionships and interdependence. The relationships among the common factors should be
further explored to trace the dynamics or
The conceptual framework of common
mechanisms of these factors.
factors not only stresses the important shared
general ingredients across many counseling
For example, rituals are embedded in
approaches, but also organizes these factors
therapeutic methods and/or techniques within
into a holistic, systematic, comprehensive and
the counseling context. The use of rituals in a
process-based framework. The provision of
therapeutic context inspires hope and a posi-
this conceptual framework responds the im-
tive expectation for change by conveying that
portance of common factors, and reflects the
the user possesses a special set of skills for
emphasis of counseling authorities that the
healing. Any counseling technique may be
proportion of variance contributed by common
viewed as a healing ritual, which inspires hope
factors is much greater than the variance
and expectancy (Hubble, Duncan, & Miller,
stemming from specific ingredients and ef-
1999). In other words, the therapist and the
fects (e.g., Lambert, Bergin, & Garfield, 2004;
client in a counseling session are motivated by
Messer & Wampold, 2002; Sexton et al., 1997).
hope, expectations, and confidence to commit
This conceptual framework of common factors
to therapy and to change through rituals in the
highlights the prominence of common factors;
counseling context. Therapists provide a ritual
the better the usage of common factors, the
or procedure for helping clients to resolve
more effective the outcome of counseling
problems
could be.
method for mobilizing therapeutic factors. In
through
a
structured,
concrete
Some major themes related to this con-
addition, the counseling context is related to
ceptual framework are delineated below. First,
the client's improvement, because healing
the four constructs interact mutually and can
takes place through the process of client trust
be understood from the perspective of process
in
within a holistic framework. This framework
Sprenkle, 2001) and a healing setting height-
reveals the interactive complexities of the in-
ens the client's expectation of help from a
terdependent, multivariate and multidimen-
healer and provides safety to the client (Frank,
sional nature of common factors through the
1982). In summary, therapeutic curative ef-
constructs of the client's and the therapist's
fects come from the client's and the therapist's
characteristics
relationship;
positive and hopeful expectations that ac-
techniques; placebo, expectancy, and hope;
company the use and implementation of the
and rituals (in-session), as well as the coun-
counseling method and in-session techniques
seling context. This interrelated and interac-
in the counseling context. Common factors are
tive nature of common factors responds to
closely interrelated and embedded in thera-
what
peutic activities within a holistic framework,
Duncan
commonalities
(pre-session),
(2002)
are
has
addressed,
conceptualized
that
into
a
therapeutic
relationship
(Blow
&
occurring in the therapeutic context.
Second, counseling professionals should
meaning system that cannot be broken down
into constituent parts. The interaction among
the
employ
- 14 -
common
factors
intensively
and
Conceptualizing Common Factors in Counseling
widely during the process of counseling due to
provide guiding structures and core principles
their significance and importance. In other
for practice and training and, at the same time,
words, common factors should be employed
must remain flexible to encourage therapist
significantly in the fields of clinical practice,
choice and the addition of new therapeutic
education/training, and research within coun-
systems and research developments.
seling. This conceptual framework of common
Conclusion
factors could be helpful for therapist education and training. Therapists should be familiar with the conceptual framework of common
The importance of common factors on the
factors in order to employ these common fac-
outcome of therapy has been confirmed. A
tors to enhance the effectiveness of the coun-
conceptual framework of these common fac-
seling outcome. Based on the importance of
tors has been proposed and delineated utiliz-
common factors, therapist educators might
ing four constructs within a process-based
incorporate these common factors into educa-
perspective: the client's characteristics; the
tion/training in order to enhance trainees'
therapist's characteristics (pre-counseling ses-
professional competence in the application of
sion); the counseling relationship, counseling
common factors.
technique, placebo, hope and expectancy, and
Third, this conceptual framework could
rituals (in session); and the counseling context
be examined and investigated thoroughly, and
within a holistic framework. The common
more proposals, hypotheses, and/or models
factors within these four constructs were in-
should be proposed and studied. Due to the
teractive and interdependent, and should not
importance of common factors, researchers
be thought of as separate constituents. This
should focus on exploration of level, type and
conceptual framework of common factors
specificity of common factors. Researchers
provides an effective reference for clinicians,
should not only explore and examine the level
researchers
and
and type of common factors, but also investi-
counseling
field.
gate the relationships and interactions among
could further explore and apply common fac-
common factors, and develop the mechanisms
tors through this conceptual framework, and
of dynamics within their major constructs. In
then examine them through empirical studies.
summary, this conceptual framework must
- 15 -
educators/trainers
Counseling
in
the
professionals
輔導與諮商學報
Oxford University Press.
References
Beutler, L. E., Crago, M., & Arizmendi, T. G.
(1986). Therapist variables in psychotherapy
Alexander, F., & French, T. M. (1946). Psycho-
process and outcome. In S. L. Garfield & A. E.
analytic therapy: Principles and application.
Bergin (Eds.), Handbook of psychotherapy
New York: Ronald Press.
and behavior change (3 rd ed., pp. 257-310).
New York: Wiley.
Applebaum, S. A. (1982). Challenges to traditional
Blow, A. J., & Sprenkle, D. H. (2001). Common
psychotherapy form the "new therapies."
factors across theories of marriage and family
American Psychologist, 37, 1002-1008.
therapy: A modified delphi study. Journal of
Arkowitz, H. (2000). Integrative theories of ther-
Marital and Family Therapy 27(3), 385-202.
apy. In P. L., Wachtell & S. B. Messer (Eds.),
Theories of psychotherapy: Origins and evo-
Bohart, A. (2000). The client is the most important
lution (pp. 227-288). Washington, D. C.:
common factor. Journal of Psychotherapy
American Psychological Association.
Integration, 10, 127-149.
Bohart, A., & Wugalter, S. (1991). Changes in
Assay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy:
experiential knowing as a common dimension
Quantitative findings. In B. L. Duncan, M. A.
in psychotherapy. Journal of integrative and
Hubble, & S. D. Miller (Eds.), The heart and
eclectic psychotherapy, 10, 14-37.
soul of change (pp. 23-55). Washington, D.C.:
Bordin, E. S. (1994). Theory and research on the
therapeutic alliance: New directions. In A. O.
American Psychological Association.
Bachelor & Horvath (1999)
Horvath & L. S. Greenberg (Eds.), The
Bergin, A. E., & Garfield, S. L. (1994). Overview,
working
alliance:
Theory,
research,
and
practice (pp. 13-37). New York: Wiley.
trends, and future issues. In A. E. Bergin & S.
L. Garfield (Eds.), Handbook of psychother-
Brady, J. P., Davison, G. C., Dewald, P. A. Egan,
apy and behavioral change: An empirical
G., Fadiman, J., Frank, J. D., Gull, M. M.,
analysis (pp. 783-817). New York: John
Hoffman, I., Kempler, W., Lazarus, A. A.,
Wiley.
Raimy, V., Rotter, J. B., & Strupp, H. H.
Berman, J. S., & Norton, N. C. (1985). Does pro-
(1980). Some views on effective principles of
fessional training make a therapist more ef-
psychotherapy. Cognitive therapy and re-
fective? Psychological Bulletin, 98, 401-407.
search, 4, 271-306.
Beutler, L. E., & Consoli, A. J. (1992). Systematic
Castonguay, L. G.., Goldfried, M. R., Wiser, S.,
eclectic psychotherapy. In J. C. Norcross & M.
Raue, P. J., & Hayes, A. M. (1996). Predict-
R. Goldfried (Eds.), Handbook of psycho-
ing the effect of cognitive therapy for de-
therapy integration (pp. 264-299). New York:
pression: A study of unique and common
Basic Books.
factors. Journal of Consulting and Clinical
Psychology, 64, 497-504.
Beutler, L. E., Consoli, A. J., & Williams, R. E.
Duncan, B. L. (2002). The founder of common
(1995). Integrative and eclectic therapies in
practice. In B. Bongar & L. E. Beutler (Eds.),
factors: A conversation with Saul Rosenzwieg.
Comprehensive textbook of psychotherapy:
Journal of psychotherapy Integration, 12(1),
Theory and practice (pp. 274-295). New York:
10-31.
- 16 -
Conceptualizing Common Factors in Counseling
therapeutic
Duncan, B., & Miller, S. (2000). The client's the-
change
principles.
American
Psychologist, 35, 991-999.
ory of change. Journal of Psychotherapy In-
Goldfried, M. R. (1982). On the history of thera-
tegration, 10, 169-187.
peutic integration. Behavior Therapy, 13,
Fiedler, F. E. (1950). The concept of the ideal
572-593.
therapeutic relationship. Journal of Consult-
Goldfried, M. R., & Norcross, J. C. (1995). Inte-
ing Psychology, 14, 239-245.
grative and eclectic therapies in historical
Fischer, A. R., Tokar, D. M., & Serna, G. S. (1998).
Reconceptualizing multicultural counseling:
perspective. In B. M. Bongar & L. E. Beulter
Universal healing conditions in a culturally
(Eds.), Comprehensive textbook of psycho-
specific context. Counseling Psychologist, 26,
therapy: Theory and practice (pp. 254-292).
525-588.
New York: Oxford University Press.
Frank, J. D. (1961). Persuasion and healing. Bal-
Greenberg, L., Rice, L., & Elliott, R. (1993). Facilitating
timore: Johns Hopkins Press.
emotional
change:
The
mo-
ment-by-moment process. New York: Guilford
Frank, J. D. (1973). Therapeutic components
Press.
shared by all psychotherapies. In J. H. Harvey
& M. M. Parks (Eds.), The master lecture se-
Grencavage, L. M., & Norcross, J. C. (1990).
ries. (Vol. 1). Psychotherapy research and
Where are the commonalities among the
behavior change (pp. 77-122). Washington,
therapeutic common factors? Professional
DC: American Psychological Association.
Psychology:
Research
and
Practice,
21,
372-378.
Frank, J. D. (1982). Therapeutic components
shared by all psychotherapies. In J. H. Harvey
Henry, W. P., & Strupp, H. H. (1994). The thera-
& M. M. Parks (Eds.), The master lecture se-
peutic alliance as interpersonal process. In
ries (Vol. 1). Psychotherapy research and
A.O. Horvath & L. S. Greenberg (Eds.), The
behavior change. (pp. 9-37). Washington, D.
working alliance: Theory, research and prac-
C.: American Psychological Association.
tice (pp. 51-84). New York: Wiley.
Frank, J. D., & Frank, J. (1991). Persuasion and
healing (3
rd
Hill, C. E., & Corbett, M. M. (1993). A perspective on the history of process and outcome
ed.). Baltimore: Jones Hopkins
research in counseling psychology. Journal of
University Press.
Counseling Psychology, 40(1), 3-24.
Garfield, S. L. (1957). Introductory clinical psychology. New York: Macmillan.
Horvath, A. O., & Greenberg, L. S. (1994). The
working alliance: Theory, research, and prac-
Garfield, S. L. (1973). Basic ingredients or com-
tice. New York: Wiley.
mon factors in psychotherapy? Journal of
Consulting and Clinical Psychology, 41,
Hovarth, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in
9-12.
psychotherapy: A meta-analysis. Journal of
Garfield, S. L. (1980). Psychotherapy: An eclectic
Counseling Psychology, 38, 139-149.
approach New York: Wiley.
Gelso, C. J., & Hayes, J A. (1998). The psycho-
Hubble, B. L., Duncan, M. A., & Miller, S. D.
therapy relationship: Theory, research, and
(1999). The heart and soul of change. Wash-
practice. New York: Wiley.
ington, D. C.: American Psychological Association.
Goldfried, M. R. (1980). Toward the delineation of
- 17 -
輔導與諮商學報
change (fifth edition) (pp. 139-193). New
Jones, E. E., Cumming, J. D., & Horowitz, M. J.
York: John Wiley.
(1988). Another look at the nonspecific hypothesis of therapeutic effectiveness. Journal
Lambert, M. J., Shapiro, D. A., & Bergin, A. E.
of Clinical and Consulting Psychology, 56,
(1986). The effectiveness of psychotherapy.
48-55.
In S. L. Garfield & A. E. Bergin (Eds.).
Krupnick, J. L., Sotsky, S. M., Simmens, S.,
Handbook of psychotherapy and behavior
Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P.
change (3 rd ed.: pp. 143-189). New York:
A. (1996) The role of the therapeutic alliance
Wiley.
in psychotherapy and pharmacotherapy out-
Luborsky, L. (1984). Principles of psychoanalytic
come: Findings in the National Institute of
psychotherapy:
Mental health Treatment of Depression Col-
tive-expressive treatment. New York: Basic
laborative Research Program. Journal of
Books.
Consulting and Clinical Psychology, 64,
A
manual
for
suppor-
Luborsky, L. (1994). Therapeutic alliance as pre-
532-539.
dictors of psychotherapy outcomes: Factors
Lambert, M. J. (1992). Psychotherapy outcome
explaining the predictive success. In A. O.
research: Implications for integrative and
Horvath & L. S. Greenberg (Eds.), The
eclectic therapists. In J. C. Norcross & M. R.
working
Goldfried (Eds.), Handbook of psychotherapy
practice (pp.38-50). New York: Wiley.
integration. New York, NY: Basic.
alliance:
Theory,
research,
and
Luborsky, L., Singer, B., & Luborsky, S. (1975).
Lambert, M. J., & Bergin, A. E. (1994). The ef-
Comparative studies of psychotherapies: Is it
fectiveness of psychotherapy. In A. E. Bergin
true that "Everyone has won and all must
& S. L. Garfield (Eds.), Handbook of psy-
have prizes"? Archives of General Psychiatry,
chotherapy and behavioral change: An em-
32, 995-1008.
pirical analysis (pp. 143-184). New York:
Menninger, K. A., & Holzman, P. S. (1973). Theory of psychoanalytic techniques (2 nd ed.).
John Wiley.
Lambert, M. J., Bergin, A. E., & Garfield, S. L.
New York: Basic Books.
(2004). Introduction and historical overview.
Messer, S. B, & Wampold, B. E. (2002). Let's face
In M. J. Lambert (Eds.), Bergin and Gar-
facts: Common factors are more potent than
field's Handbook of psychotherapy and be-
specific therapy ingredients. Clinical Psy-
havioral change (fifth edition) (pp. 3-15).
chology: Science and Practice, 9(1), 21-25.
New York: John Wiley.
Miller, J. B., Jordan, J. V., Kaplan, A. G., Stiver, I.
Lambert, M. J., & Cattani-Thompson, C. (1996).
P., & Surrey, J. L. (1997). Some misconcep-
Current findings regarding the effectiveness
tions and reconceptions of a relational ap-
of counseling: Implications for practice.
proach. In J. V. Jordan (Ed.), Women's growth
Journal of Counseling and Development, 74,
in diversity: More writings form the Stone
601-608.
Center (pp. 25-49). New York: Guilford
Lambert, M. J., & Ogles, B. M. (2004). The effi-
Press.
cacy and effectiveness of psychotherapy. In
Patterson , C. H., & Watkins, C. E. (1996). Theo-
M. J. Lambert (Eds.), Bergin and Garfield's
ries of psychotherapy. New York: Harper-
Handbook of psychotherapy and behavioral
Collins College Publishers.
- 18 -
Conceptualizing Common Factors in Counseling
havior change (2 nd ed., pp. 369-410). New
Pinsof, W. M. (1994). An integrative systems perspective on the therapeutic alliance: Theo-
York: Wiley.
retical, clinical, and research implications. In
Stevens, S. E., Hynan, M. T., & Allen, M. (2000).
A. O. Horvath & L. S. Greenberg (Eds.), The
A meta-analysis of common factors and spe-
working
cific treatment effects across the outcome
alliance:
Theory,
research,
and
practice (pp. 173-198). New York: Wiley.
domains of the phase model of psychotherapy.
Prochaska, J. O., & Norcross, J. C. (1999). Sys-
Clinical Psychology: Science and Practice,
tems of psychotherapy: A transtheoretical
analysis. New York, NY: Brooks/Cole Pub-
7(3), 273-290.
Strupp, H. H. (1973). On the basic ingredients of
lishing Company.
psychotherapy. Journal of Consulting and
Raue, P. J., & Goldfried, M. R. (1994). The thera-
Clinical Psychology, 41, 1-9.
peutic alliance in cognitive-behavior therapy.
Snyder, C. R., Michael, S. T., & Cheavens, J. S.
In A.O. Horvath & L.S. Greenberg (Eds.),
(1999). Hope as a psychotherapeutic founda-
The working alliance: Theory, research, and
tion of common factors, placebos, and ex-
practice (pp.133-152). New York: Wiley.
pectancies. In M. A. Hubble, B. L. Duncan, &
Rogers, C. R. (1957). The necessary and sufficient
S. C. Miller (Eds.), The heart and soul of
conditions of therapeutic personality changes.
change: What works in therapy (pp. 170-200).
Journals of Consulting and Clinical Psy-
Washington, DC: American Psychological
chology, 21, 95-103.
Association.
Rosenthal, D., & Frank, J. D. (1956). Psycho-
Tallman, K., & Bohart, A. C. (1999). The client as
therapy and the placebo effect. Psychological
a common factor: Clients as self-healers. In
Bulletin, 53, 294-302.
M. A. Hubble, B. L, Duncan, & S. C. Miller
Rosenzweig, S. (1936). Some implicit common
(Eds.), The heart ad soul of change: What
factors in diverse methods of psychotherapy.
works in therapy (pp. 91-131). Washington,
American Journal of Orthopsychiatry, 6,
DC: American Psychological Association.
412-415.
Torrey, E. F. (1986). Witchdoctors and psychia-
Sexton, T. L., Whiston, S. C., Bleuer, J. C., &
trists: The common roots of psychotherapy
Walz, G. R. (1997). Integrating outcome re-
and its future. Northvale, NJ: Jason Aronson
search into counseling practice and training.
Inc.
Alexandria, VA: American Counseling Asso-
Truax, C. B., & Carkhuff, R. R. (1967). Toward
ciation.
effective counseling and psychotherapy Chi-
Sexton, T. L., & Whiston, S. C. (1994). The status
cago: Basic Books.
of the counseling relationship: An empirical
Truax, C. B., & Mitchell, K. M. (1971). Research
review, theoretical implications, and research
on certain therapist interpersonal skills in re-
directions.
lation to process and outcome. In A. E. Ber-
The
Counseling
Psychologist,
22(1), 6-78.
gin & S. L. Garfield (Eds.), Handbook of
Shapiro, A. K., & Morris, L. A. (1978). The pla-
psychotherapy
cebo effect in medical and psychological
behavior
change
(1 st
ed.,
pp.299-344). New York: Wiley.
therapies. In S. L. Garfield & A. E. Bergin
Walborn, F. S (1996). Process variables: Four
(Eds.). Handbook of psychotherapy and be-
common elements of consulting psychother-
- 19 -
輔導與諮商學報
Clinical Psychology: Science and Practice, 2,
apy. Pacific Grove, CA: Brooks/Cole.
45-49.
Wampold, B. E. (2001). The great psychotherapy
debate:
Models,
methods,
and
findings.
Weinberger, J. (2002). Short paper, large impact:
Rosenzweig's influence on the common fac-
Mahwah, NJ: Erlbaum.
tors movement. Journal of Psychotherapy
Watson, J. C., & Greenberg, L. S. (1994). The al-
Integration, 12(1), 67-76.
liance in experiential therapy: Enacting the
relationship conditions. In A. O. Horvath &
Wiser, S., & Goldfried, M. R. (1993). Comparative
L.S. Greenberg (Eds.), The working alliance:
study of emotional experiencing in psycho-
Theory, research, and practice (pp. 153-172).
dynamic-interpersonal and cognitive-behav-
New York: Wiley.
ioral therapies. Journal of Consulting and
Clinical Psychology, 8, 264-276.
Weinberger, J. (1995). Common factors aren't so
common: The common factors dilemma.
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Conceptualizing Common Factors in Counseling
概念化諮商共通因子
林旖旎
國立清華大學
摘
要
本文目的為概念化不同心理諮商學派中所呈現的心理諮商共通因子。所提出的概念化架
構包含四個理論構化(construct)：個案特色、諮商員特色、諮商改變歷程（包括諮商關係；諮
商共通技術；安慰劑、希望、與期待；諮商儀式）
、與諮商情境。本文企圖整合前人文獻並 加
以系統化整理，所有諮商共通因子彼此相互影響並嵌合於一整合性的諮商歷程架構之中。作
者最後提出與此共通因子的概念化架構相關的臨床實務、教學訓練、與未來研究議題，以供
參考。
關鍵詞：共通因子、心理諮商、心理治療
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輔導與諮商學報
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