No abstract

Highly effective therapists are clinicians who systematically achieve excellent therapeutic outcomes. However, variables that could explain this performance still unknown. To identify these variables (i.e., definition, objective measurements; and the degree to which the independent variables measure what it claims) could help to know more about highly effective therapists’ performance. Therefore, a systematic review was conducted. Publications between 2000 and 2020 -from Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Scholar and ProQuest Research Library databases- were included. After analyzing 2784 empirical works, 31 studies have met the inclusion criteria. This systematic review allowed to identify, summarize, and define almost 50 variables that could predict therapists’ effects. The need to increase construct validity, to improve empirical designs, and to measure therapist-client interaction is discussed. Los terapeutas altamente eficaces son aquellos que logran sistemáticamente elevados niveles de éxito terapéutico. Sin embargo, aunque se contraste empíricamente dicha eficacia inter-terapeuta, todavía no se conocen cuáles son las conductas que explican este desempeño diferenciado. El objetivo de este trabajo es identificar las variables asociadas a estos terapeutas altamente eficaces, sus definiciones, los parámetros de medida de éxito y la precisión con la que se miden los constructos de interés. Para ello, se realizó una revisión sistemática (RS) con publicaciones entre los años 2000 y 2020 de las bases de datos Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Académico y ProQuest Research Library. Se seleccionaron 2784 artículos empíricos, de los cuales 31 cumplieron los criterios de inclusión. Los principales resultados muestran que hay casi 50 variables predictoras del efecto del terapeuta. Se resume y se define cada una de estas variables psicológicas, y se concluye que para lograr explicar el alto nivel de éxito inter-terapeuta es necesario incrementar la validez de constructo de las variables predictivas, adecuar el diseño de las investigaciones e incluir datos con respecto a la interacción entre el terapeuta y su cliente.

Psychological interventions have shown efficacy for the treatment of different psychological problems. Now, we need to know what processes make these results possible. The observational analysis of the verbal interaction of the therapist and the client has been used to analyze the learning processes that underlie the change in the client's behavior. However, previous coding systems have conceptual and methodological limitations. Therefore, the purpose of this article is to develop a functional coding system for the analysis of verbal interaction in clinical contexts. To this end, we developed and debugged a new functional description-based system. Also, we have analyzed 66 clinical sessions belonging to 23 different cases using the new coding system and the results have been compared with previous studies. The main result of this study is a system consisting of 5 functional categories with good reliability indices and methodological properties. The discriminant and cluster analysis have yielded similar results to those of previous studies. Finally, we discuss about conceptual and methodological advances of this new system, we list the main limitations, and we propose further studies in this line of research.

La proliferación de la investigación de resultados ha colocado al modelo cognitivo-conductual como la terapia de elección para la mayoría de problemas psicológicos. Este tipo de investigación deja a un lado el análisis de los procesos de cambio conductual que subyacen al éxito de las diferentes técnicas de  tratamiento, ya no sería importante saber qué es lo que hace que una técnica funcione siempre que ésta sea eficaz. Como consecuencia, el modelo cognitivo-conductual ha perdido la reflexión teórica y la fundamentación experimental que caracterizaba a la modificación de conducta sobre la cual se sustentaba en sus orígenes. Desde nuestra perspectiva, la investigación de procesos sería un paso previo necesario a la investigación de resultados de forma que los primeros puedan explicar cómo y por qué funcionan los tratamientos psicológicos, evitando así que el clínico se limite a aplicar procedimientos descritos en manuales protocolizados.

Recent developments in pattern analysis research have made this methodology suitable for the study of the processes that are set in motion in psychological interventions. Outcome research, based on the comparison between clinical results from treatment and control groups, has leveraged our empirical knowledge about the efficacy of psychological interventions. However, these methods of research are not precise enough for the analysis of these processes. On the contrary, pattern analysis could be a powerful tool to study moment-to-moment interactions typical of psychological interventions. This is methodology is relevant because clinical psychology is experiencing a paradigm shift from a protocol for syndrome perspective to a principle-based and person-centered intervention. This evidence-based, theory-grounded, and process-oriented paradigm of clinical intervention needs new research methods to thrive (i.e., pattern analysis). The analysis of the therapeutic relationship built into the verbal interaction between the clinician and the client is one of the cornerstones of this new era of research. So, the purpose of this article is three-fold: (1) to discuss the role of the verbal interaction pattern analysis in the clinical context to the development of the principle-based clinical psychology, (2) to analyze the patterns of verbal interaction in a clinical case, and (3) to compare the results using two different methods. To reach these purposes, using the observational methodology, we have coded the verbal interaction of 16 clinical sessions with a person diagnosed with a borderline personality disorder. We have analyzed the data using sequential analysis (GSEQ) and pattern recognition algorithms (i.e., T-Pattern detection). We have been able to detect typical patterns during different phases of psychological intervention (i.e., evaluation, explanation, treatment, and consolidation). Finally, the conceptual, methodological, and empirical implications of this study will be discussed within the realms of pattern analysis research and principle-based clinical psychology.