Researchon updating computer systems in hospitals
—Charles Dickens, A Tale of Two Cities Dickens, starting his celebrated novel, used the rhetorical device called anaphora: the repetition of a word or words at the beginning of two or more successive clauses or sentences. Indeed, as the next section discusses, the research evidence has shown convincingly that the particular tteatment is relatively unimportant and the combination of thetapist, the client, and their work together is critical to the success of psychotherapy. In other words, clients are the common factor across varying forms of psychotherapy. On the other hand, many master's programs do emphasize interpersonal skills in admissions decisions, yet are forced to accept the vast majority of applicants for economic survival. To enhance client engagement in setvices, Duncan, Spatks, Millet, Bohanske, and Claud (2006) emphasized the impoitance of giving youths and theii categivets a voice about both the outcome and fit of provided services in their Partners for Change Outcome Management System (PCOMS). A tecent investigation of Parent Management Training, the Oregon Model (PMTO) futthet illustrates. Journal 0/Consulting and Clinical Psychology, 71, 973-979. WAMPOLD It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity. As presented here, however, the status of superiority of treatment method, above all else, may well indeed be a consequence of history rather than of science. Their effort, involvement, intelligence, and creativity enable them to accommodate and metabolize different therapeutic approaches and achieve positive outcomes. Fitst, we must select students for graduate training who are both academically qualified and inteipeisonally skilled. On the one hand, Ph D and MD/DOs programs are very competitive in admissions, but favor entrance examination scores, undergraduate grades, and research experiences over interpersonal skills. Categivets or other adults typically initiate or maintain mental health services for youth (Yeh & Weisz, 2001). When therapists were drawn from the same pool, the supetiotity of EBT was nonsignificant. Establishing specificity in psychotherapy: A meta-analysis of stmctural equivalence of placebo controls.
Over the past decade, advances in knowledge and social changes congenial to the practice of psychotherapy are contrasted to instability, monetary anxieties, and a crisis of confidence. Briefly, the research evidence related to several critical questions is reviewed in this section. Healing practices, which have existed since the origins of the human species and which are indigenous to every culture, past and present, have only recently been subjected to scientific scrutiny to determine whether or not they are effective. As soon as this was established, productive work on the patient's problems was more likely" (p. Strength-based approaches are increasingly becoming a part of many psychotherapies. Responsiveness tefeis to behavioi that is affected by emetging context and occuts on many levels—including choice of an overall treatment, case formulation, strategic use ofthe self and method—and then adjusting those to meet the emetging, evolving needs ofthe client in any given moment (Stiles, Honos-Webb, & Suiko, 1998). A significant limitation of this study is the small sample size, which reduces the possibility of finding the most powerful effects of feedback, namely fot clients who are eithei not improving oi deteiiotating. Finally, the dose of treatment favored PMTO (work with parents; 40 vs. The meager results, no findings on 12 of 16 measutes, and no effects favoring PMTO for children 8 years of age and over, combined with the confounds ofthe differential training and support of the two thetapist gioups and unequal doses of tieatment, cast significant doubt on this study's conclusions. We are at the point that knowing what works in therapy is not enough. The result has been to establish the effectiveness of many medical drugs and procedures. Therapists can note and then share such discoveries with clients. Successful responsiveness can confound attempts to find naturalistically observed lineal relations of outcome with theiapist behaviors (e.g., self-disclosures, positive regard). Motivation to change and commitment to the target goal ate necessaty but not sufficient foi therapist change to occur. Ttainees are taught to collect, score, and use btief, valid measuies of progress and relationship (ORS, SRS, CORS; see at each session to enhance thetapist flexibility, evaluate outcome, and improve overall effectiveness. The empirical case for the common factors in therapy: Quantitative findings. Delivering what works, the subtitle of this edition, is the next revolutionary step. The only other healing practice that has been subject to scientific scrutiny that approaches the rigor of modem medicine is psychotherapy, although the journey to scientific establishment has not been without some tortured tums. A n aspect of this work is finding strength in seemingly dysfunctional behaviors (Honos-Webb, 2005,2006; Mosher, Hendrix, & Fort, 2004) and recognizing that clients' identities and innate abilities transcend descriptions of pathology (Duncan et al., 2004). Because of such problems, the statistical relations between the relationship and outcome cannot always be trusted. The clinician must also believe that the goal is yet to be accomplished. Additionally, our program uses a softwate system that allows automated data entty from the ORS, SRS, and CORS and teal-time warnings to theiapists when client tatings of eithet the alliance ot outcome fall significantly outside of established nouns. The University of Chicago's David Orlinsky has provided insight into the teasons for a downturn in model development. Finally, clinicians treating depression in a managed care environment achieve outcomes comparable with the outcomes attained in clinical trials of established and evidence-based treatments fot depression (Minami et al., 2008). Journal of Consulting and Clinical Psychology, 69, 159-172. Therapists should promote client involvement: Psychotherapy is a collaborative endeavor. Who (or what) can do psychotherapy: The status and challenge of nonprofessional therapies. An analysis of psychiatric survivor oral histories. Crits-Christoph, P., Siqueland, L., Blaine, J., Frank, A., Luborsky, L, Onken, L. CFIT has promising implications foi guiding both supeivision and tiaining fot clinicians by providing an evidence-directed approach. In addition to wanting measutes to be btief, to be easy to integrate, and to have face validity, therapists want measures that ate clinically useful. Citing Thomas Kuhn, author of The Structure o/Scienti/ic Revolutions (1970), Orlinsky (2006) suggested that psychotherapy has moved from the earliest stage of science, termed preparodigmatic, to the next, termed normal science. The answer to the question "Does psychotherapy work? As Orlinsky et al.'s (2004) review makes clear, psychotherapy is most effective when it nurtures and supports maximum client involvement and participation. Psychological Science, 5, 8-14- CLIENTS: THE NEGLECTED COMMON FACTOR 105 Cohen, O. It has been suggested that client-level feedback brings the voice of the client and categivets directly into the supeivisoiy session, a valuable addition to the clinician's petceptions in the discussion of individual clients (Duncan & Miller, 2000; Worthen & Lambert, 2007). Is the measure intended to improve the effectiveness of rendered services or merely monitot them?