The search for common factors in psychotherapy. Two theoretical models, with different empirical implications

The difficulties of demonstrating that any specific form of psychotherapy is more effective than any other has led to the formulation of the so-called Dodo Bird Verdict (that all forms of therapy are equally effective) and to the suggestion that what really matters for therapeutic efficiency are factors that are common to different forms of therapy. The term “common factors”, however, is seldom defined in an unambiguous way. In this paper, two different models of “common factors” are differentiated, and their implications are compared. The first model is referred to as the Relational-Procedural Persuasion (RPP) model and is primarily based on the writings of Frank and Wampold; according to this model effective psychotherapy requires a good therapeutic relationship, a specified therapeutic procedure, and a rhetorically skilful psychotherapist who persuades the client of a new explanation that provides new perspectives and meanings in life. The contents of these procedures and perspectives, however, are less important – according to this model, the treatment procedures are beneficial to the client because of the meaning attributed to these procedures rather than because of the specific nature of the procedures. The other model, the Methodological Principles and Skills (MPS) model, is based on the assumption that effective psychotherapy relies on common methodological principles that are instantiated in various ways in different forms of psychotherapy, and on the therapist’s capacity of applying these principles in a skillful way. According to this model, method matters, and it is possible to improve existing methods. Whereas the MPS model carries a hope for the improvement of psychotherapy, the RPP model implies a more pessimistic view of psychotherapy as forever bound by the limits of the Dodo Bird Verdict. It is concluded that psychotherapy research may benefit from using the MPS model as a working hypothesis, but that a comprehensive model of common factors in psychotherapy also needs to integrate important insights from the RPP model, as well as an understanding of the structural characteristics that psychotherapy shares with other kinds of social interaction

Combining Holism and Interactionism. Towards a Conceptual Clarification

The terms “holism” and “interactionism” are central to the person-oriented approach, especially as formulated in Magnusson’s (2001) holistic-interactionistic paradigm. However, Nilsson (2015) has recently argued that at least some forms of holism and interactionism need to be disentangled. This raises some general questions about what is meant by “holism” and “interactionism” and whether there are problems with combining them in one paradigm. The purpose of the present paper is to make a contribution to an increased conceptual clarity in this area. For this purpose a brief review is first made of how various writers have conceptualized holism and interactionism. On the basis of this review, a preliminary definition and differentiation of holism and interactionism is proposed, which suggests that holism and interactionism refer to different kinds of questions: Whereas holism involves assumptions about the relations between a whole and its parts (e.g., non-reducibility of the whole to its parts, and non-separability of the parts from the whole), interactionism refers to assumptions about causality. It is argued that both kinds of questions are relevant to all fields of study, and that questions about holism (e.g., whether a certain system is holistic or not) and interactionism (e.g., whether the interactions that occur are unidirectional or bidirectional) therefore need to be asked in any field of study. This reasoning is then illustrated by applying it to some questions concerning the nature of the organism-environment system. Finally, there is a brief discussion of the relevance of all this for a person-oriented approach to psychological science

Behandling vid icke-suicidalt självskadebeteende kräver tydlig struktur

Self-harm, particularly in the form of non-suicidal self-injury, has been identified as an increasing problem among adolescents and young adults. Treatment effects on self-harm have been studied in a number of RCTs, although only some treatments show consistently positive effects. Dialectical Behaviour Therapy (DBT) is the most empirically studied treatment so far. A comparison with other treatments (including mentalization-based treatment, schema-focused therapy, and some others) suggest the following common factors as being probably important for the efficient treatment of self-harm: 1) a clear treatment structure; 2) an empathically-validating therapeutic relationship; 3) a methodological focus on increased emotional awareness and improved emotion regulation; and 4) explicit strategies to decrease the risk for iatrogenic effects of treatment, which for several reasons seem to be especially pronounced with this group of patients

In memoriam: David Magnusson 1925-2017

This article has no abstract

Direct and indirect aggression and victimization in adolescents - Associations with the development of psychological difficulties.

Background Previous research has established that direct and indirect forms of aggression differ in their association with gender and type of psychological difficulties. One purpose of the present study was to test if the same applies to direct and indirect victimization. A second purpose was to study these associations not only cross-sectionally (as in most previous research) but also longitudinally. A third purpose was to test the hypotheses that there are prospective bidirectional associations not only between victimization and psychological difficulties (which has been shown in previous research), but also between aggression and psychological difficulties, and that direct and indirect forms of aggression and victimization show different associations with different types of psychological difficulties. Methods The participants were a community sample of all students in two grades of regular school in a Swedish municipality who answered questionnaires as part of a two-wave longitudinal study with a one-year interval. The participants were 13-15 years old, and there were longitudinal data on 893 students, which represented 85 % of all students. The cross-sectional associations were primarily tested by semi-partial correlations, and the longitudinal associations by hierarchical multiple regression. Results The results corroborated the meaningfulness of differentiating not only between direct and indirect aggression but also between direct and indirect victimization. Boys reported being more victim to direct aggression, whereas girls reported being more victim to indirect aggression. Direct aggression predicted increased conduct problems in boys, whereas indirect aggression predicted increased conduct problems in girls, and conduct problems reciprocally predicted increased direct and indirect aggression. Indirect victimization showed prospective bidirectional associations with emotional symptoms and conduct problems, suggesting the potential development of vicious cycles of escalating problems in these areas. Conclusions The present results indicate that direct and indirect aggression, as well as direct and indirect victimization, may have different roles in the development of psychological difficulties in young adolescents. Further, the demonstration of prospective bidirectional associations points to a possible mechanism for the development of psychological difficulties, that may be described in terms of dynamical systems theory. This has potential relevance both for the prevention and the treatment of psychopathology

The neglect of treatment-construct validity in psychotherapy research: A systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder

Background: Randomized controlled trials (RCTs) are considered the best methodology for studying the efficacy of psychotherapy. Optimally an RCT design makes it possible to conclude that if one treatment has a better outcomethan another, this is due to the treatment package (TP) as it was implemented in this particular context, rather than other factors beyond the treatment (= high internal validity). Strong internal validity does not, however, provide evidence for the treatment model (TM) that provides the theoretical basis of the TP, because the TP that is tested may differ from the comparison condition in a number of other ways that suggest alternative explanations for the effects. These alternative treatment contrasts represent threats to construct validity of the conclusions. Maximal construct validity requires (1) that the treatments are clearly contrasted on the experimental factors (treatment integrity), and (2) that alternative treatment contrasts can be eliminated. The analysis of alternative explanations is a neglected topic in psychotherapy research. To approach this problem, a methodology for the analysis of treatment contrasts is suggested and tested.Methods: Two indexes were defined: (1) a Treatment Integrity Index (TII) and (2) an Alternative Treatment Contrast Index (ATCI). This methodological approach was applied to eight comparative RCTs of treatments for BorderlinePersonality Disorder (BPD), which were coded for a set of treatment contrasts independently by three coders.Results: The analysis of the RCTs of treatments for BPD showed that construct validity differed widely between the different studies but was generally low (low TII and ATCI), and that it is therefore difficult to draw causal conclusions from this research. The publication policies of scientific journals in this area seldom require the systematic data relevant to an analysis of alternative explanations of the effects, which is needed to provide evidence for a particular TM.Conclusions: Research on psychotherapy needs to be refocused from treatment packages (TP) to treatment models (TM). This requires an improved conceptualization of the methodological principles and skills involved,and the development of valid measures of these, but also improved reporting standards concerning treatment-construct validity in scientific journals

Depressive Symptoms and Deliberate Self-Harm in a Community Sample of Adolescents: A Prospective Study

The associations between depressive symptoms and deliberate self-harm were studied by means of a 2-wave longitudinal design in a community sample of 1052 young adolescents, with longitudinal data for 83.6% of the sample. Evidence was found for a bidirectional relationship in girls, with depressive symptoms being a risk factor for increased self-harm one year later and self-harm a risk factor for increased depressive symptoms. Cluster analysis of profiles of depressive symptoms led to the identification of two clusters with clear depressive profiles (one severe, the other mild/moderate) which were both characterized by an overrepresentation of girls and elevated levels of self-harm. Clusters with more circumscribed problems were also identified; of these, significantly increased levels of self-harm were found in a cluster characterized by negative self-image and in a cluster characterized by dysphoric relations to parents. It is suggested that self-harm serves more to regulate negative self-related feelings than sadness

Compassion fatigue and compassion satisfaction among psychologists: Can supervision and a reflective stance be of help?

The pleasure derived from helping others is referred to as compassion satisfaction (CS). When a psychologist feels a too heavy demand to be compassionate and effective in helping, however, this may result in compassion fatigue (CF). CF may take the form of burnout or secondary traumatic stress (STS). The present paper focuses on two factors that may possibly protect against the development of CF, and facilitate the development of CS: (1) access to supervision and (2) a reflective stance. An online survey was distributed to two closed Swedish Facebook groups of psychologists, and complete data were obtained from 374 psychologists (320 women and 63 men). Both variable-oriented and person-oriented analyses were carried out. Correlational analysis showed that both supervision and reflection was associated with more CS, whereas only supervision but not reflection was significantly associated with less CF. Cluster analysis gave a more nuanced picture, suggesting a non-linear and multi-faceted association between reflection and CF. Some clusters of psychologists showed the expected association between level of reflection and level of CF. This was balanced, however, by other clusters that showed an association in the opposite direction, indicating high levels of reflection in clinicians with high levels of CF, and low levels in clinicians with low levels of CF. The results are discussed in terms of these differences in associative patterns possibly being due to different patient populations being involved. Among the limitations of the present study are its cross-sectional design, absence of data on patient characteristics, and a crude measure of supervision and reflection