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Counseling: Common Factors

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Evidence-Based Practice
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Evidence-based practice is the integration of the best research evidence with clinical expertise and client values. ‘best research’ = ‘outcomes research’ or clinically relevant research into the accuracy,precision, and efficacy of diagnostic tests and treatments
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Clinical Expertise
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‘clinical expertise’ = the ability to use our best clinical skills and past experience to identify delay or disorder, appropriate intervention, and the client’s personal values and expectations
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Client Values
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‘client-values’ = the unique preferences, concerns and expectations each client brings to the clinical experience
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“Dodo Effect”
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Different therapy approaches use dissimilar strategies or processes to achieve the same outcome Research methods may not be sensitive enough to detect differences in therapeutic effectiveness among approaches OR differences are so subtle that they cannot be observed using conventional between-group designs
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four factors common to all forms of psychotherapy:
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1. Technique 2. Extratherapeutic Change 3. Therapeutic Relationship 4. Hope or Expectancy
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Extratherapeutic Change
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characteristics of the client and his/her environment (e.g. temperament, social support)
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Therapeutic Relationship
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characteristics of the clinician and client (and family) that facilitate change and are present regardless of clinician’s therapy orientation (i.e. ‘technique’). Components include shared goals, agreement on methods, means and tasks for treatment, and an emotional bond (Bordin, 1979).
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Expectancy
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Hope; sometimes thought of as “placebo”. Improvement that results from client (and clinician’s?) belief that treatment will help.
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THERAPEUTIC RELATIONSHIP
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Shared goals, agreement on methods, means and tasks for treatment, and an emotional bond (Bordin, 1979).
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Helping Develop Congruence
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Congruence helps clients & families to respond to a situation with both intellect (rational intelligence) and emotion. An idealized situation that is difficult to attain. As people, we all need to work continually to attain congruence; as clinicians, we want to help our clients to attain it.
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Different styles of internal organization
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High intellect: focus on facts; deny or repress emotions High affect: difficulty in processing information
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Pathways thinking
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developing one or two ways to accomplish change Inability to experience either pathways or agency thinking causes stress and difficulty in coping
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Agency thinking
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the ability to begin and persist in doing what is necessary to change. Inability to experience either pathways or agency thinking causes stress and difficulty in coping
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Expectancy Theory
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With hope for change comes expectancy that change can and will take place. An individual’s belief that a certain treatment will yield a certain effect either triggers or correlates to that effect. Expectancy Theory has long been used to explain the placebo effect in medicine.
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Characteristics of good therapists
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1. Interpersonal skill 2. Perseverance 3. Optimism
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EBP and Therapy
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1. The size of therapist effects is consistently greater than treatment effects 2. The therapeutic alliance is a critical factor 3. The manner in which treatment is chosen and delivered is central to the alliance