Factors in the scope of abnormal behavior therapy

2021-07-15 04:15 PM

Self-disclosure occurs when the therapist tells the client stories that correspond to the client's situation, such as similar experiences, thoughts, feelings, and reactions.

Regardless of the therapist's training or experience, the real issue in therapy is whether the therapist's behavior during the session causes its different outcomes. The answer here is clearly yes. Several factors within therapy have been shown to influence outcomes, including treatment acceptance, therapist proficiency, and established relationships between therapists and clients.

Acceptance of treatment

Acceptance of treatment is expressed in terms of the extent to which the client accepts and agrees to a particular technique or type of therapy. It is useless if the client shows no acceptance of the treatment process. This acceptance is influenced by the perception of the treatment and especially the client's likelihood of success: Is there a real outcome? Will therapy lead to great suffering...? The intervention proved to be effective for better acceptability clients (Reimer et al. 1992). Therefore, it is necessary if the therapist regularly consults with the client about therapy and makes reasonable adjustments to them.

Therapist's Abilities

A therapist's competence is clearly important, even in standardized therapies. Several measures of the therapist's ability are provided by O'Malley et al. (1988) introduced in the NIMH Depression Trial (Elkin et al. 1994: see chapter 9). These measures include the scoring of a therapy session tape, the therapist's report, and the supervisor's score for the report. The therapist's performance on this combined measure contributed 23% to the difference in therapeutic outcomes, whereas 34% of the difference was attributed to the client's personality. The NIMH trial used skilled therapists, so it's possible that this reduced the difference in outcomes.

Therapeutic Link

A more important factor in therapy is the strength of the therapeutic bond between the client and the therapist (Horvath and Luborsky 1993). This is determined through the extent to which the client agrees with the proposed intervention, through their short- or medium-term expectations of the treatment outcome, and ultimately the relationship between the client and the patient. therapist, based on the client's perception of the therapist as a likable, sensitive, helpful, and caring person. The meta-analysis by Horvath and Symonds (1991) showed that the therapeutic association contributed 26% of the difference in therapeutic outcomes. The strength of the bond in therapy is thought to be important early on and becomes less important later. This may be because clients become more independent from the therapist once they have made improvements, or it may be because the initial degree of association encourages a change of therapy without considering the relationship. the future relationship between therapist and client. An encouraging finding by Horvath and Luborsky (1993) is that positive therapeutic outcomes can be obtained even if the therapeutic relationship is broken, provided it is subsequently re-established.

How these links are made is a complex and still unexplained thing. Crits-Cristoph (1988) found that the accuracy or frequency of the therapist's analysis in psychotherapy was not related to the criterion for assessing the strength of the therapeutic association. In contrast, Piper et al. (1993) found an inverse relationship between the number of times of analysis and interpretation in therapy sessions and the client's assessment of the relational nature of therapy. Explaining too much is seen as a nuisance or just makes things confusing. People with poor communication skills will find it difficult to achieve high therapeutic effects with many accurate explanations; these people are more likely to keep the relationship in good shape.

In a similar examination of the therapist-client interaction, Beutler and Consoli (1993) found that counseling did not work with depressed clients, who did not even want to explore the problem. . More subtle impact studies suggest that improvement in therapy culminates when the therapist gradually responds to the client's interpersonal relationship patterns and psychological needs. Hardy et al. (1999) found that the most effective therapists are those who can make clients feel secure by meeting their fluctuating needs and allowing them to work within the proximal growth zone. Best. This is an area where clients can explore their fears and dangers but do not sink into them. This includes the therapist's decision-making as to whether a client can most benefit from interventions, they call a "prevention policy". Thereby, the therapist can create a sense of security in the client or, conversely, the interventions are challenging in some way.

Many studies have focused on therapy failure caused by client abandonment. Hill et al. (1996) pointed out that in all the cases they studied, the disengagement was due to a disagreement over strategy, the therapist's fault, and the negative feelings the client had towards the therapist. . And as a result, the therapeutic link is broken. The problem is that this is rarely the result of a medical accident, but more often from a disagreement that can be resolved during the session. When the therapist is able to anticipate the breakdown of the therapeutic relationship, the problem can be resolved, and can even lead to a stronger and stronger course of therapy. To do this thing,


Self-disclosure occurs when the therapist tells the client stories that correspond to the client's situation, such as similar experiences, thoughts, feelings, and reactions. Such a process is seen to strengthen the relationship between the therapist and the client. To date, these effects have not been fully evaluated. However, Barrett and Berman (2001) evaluated the effects of different levels of therapist sharing by systematically determining the therapist's level of self-concept. With therapist self-talk, clients will feel more like their therapist and will notice a reduction in stress symptoms.

Specific techniques

So far, we have not discussed the therapist's use of technique but have focused on the general characteristics of the therapist or the style of therapy. The use of more specialized strategies is also a factor in determining outcomes. Teasdale and Fennell (1982) compared the outcomes of therapy in clients with a cognitive-behavioral approach and those with a less focused and holistic approach to their problems. . The results showed that cognitive-behavioral therapy for depression worked better than the overall approach. The same, similar,

Bryant et al. (1999) examined both therapist and client characteristics in relation to homework completion in a cognitive-behavioral therapy program for depression. Common characteristics of therapists related to degree completion are: review, homework assignment during therapy; The combined assessment criteria for the therapist's competence include: items on cooperation, the effectiveness of interpersonal relationships, and the development of the corresponding cognitive intervention. That is the condition for the client to develop a good relationship with the therapist and see for themselves the value of the exercises that they do.

Finally, Wiser and Goldfried (1998) show that the nature of the therapist's control over the course of therapy strongly influences the client's emotional experience in therapy. When the therapist makes rebuttals and acknowledges without directly addressing the issues under consideration, the client clearly feels both negative and positive emotions in therapy. When therapists interrupt clients or increase their control over the issues discovered during the session, clients are more likely to redirect to reduce the emotional intensity, perhaps because they feel less connected. emotional relationships and may find it difficult to uncover outstanding emotional problems when they are interrupted and controlled by a therapist.

Factors beyond the therapeutic situation

Each treatment session usually lasts 1 hour with one or two sessions per week. That suggests clients have more time in real life than in a therapeutic situation. Factors outside of the therapeutic situation may therefore have a certain influence on the outcome of therapy. A model of therapeutic change that takes these factors into account is suggested by Teasdale (1993). According to Teasdale, cognitive change in therapy helps clients develop new beliefs and re-examine the world and themselves. However, these beliefs are initially very unstable and certain, the longer they persist, the more influence they have on the client's emotions and behavior, which is often seen through external events. outside the therapeutic setting. If these facts are consistent with the new cognitive map (then new beliefs will be corroborated), they will be fortified; otherwise, these events may simply be confirmation of the previous cognitive map and will be even more difficult to change in the future.