Therapeutic technique of APA master therapists: Areas of difference and integration across theoretical orientations.

Abstract

This study utilized the American Psychological Association (APA) PsycTHERAPY digital video database of therapy masters working with participants on problems related to either anxiety or depression. Thirty-four APA master sessions were included. Therapist primary orientation included Cognitive–Behavioral (CB), Psychodynamic–Relational (P/R), and Person Centered-Experiential (PC/E), the last of which served as a comparison group to contrast the former 2 samples. All sessions were evaluated using the Comparative Psychotherapy Process Scale (CPPS) by 4 independent clinical raters who demonstrated excellent (>.75; Fleiss, 1981) reliability in the rating of these sessions. Results demonstrated significant differences on the CPPS Psychodynamic-Interpersonal (CPPS-PI) and Cognitive-Behavioral (CPPS-CB) subscales in the expected directions between the APA master CB and P/R sessions. APA master PC/E sessions did not rate as highly on either CPPS-PI or CPPS-CB subscales than therapists from the respective modalities. A subsample Integrative (IN) group was created using APA master therapist secondary orientation to further analyze the relationship between technique use and integration. Findings demonstrated that IN master therapists utilized significantly more CPPS-CB techniques than P/R therapists, and significantly more CPPS-PI techniques than CB therapists, supporting the IN orientation. Further, CB-3rd wave (Schema, ACT, Mindfulness) APA master therapist sessions demonstrated a significantly greater integration (i.e., use) of CPPS-PI items, particularly those related to participant emotional expression and exploration, identifying patterns of experience, and facilitating insight, than the traditional CB APA master therapist sessions. Clinical implications with regard to training and practice will be discussed.

An Italian validation of the Comparative Psychotherapy Process Scale: Reliability and validity

“…The mean scores of these items were from low to moderate, also when characteristic of a session. Similar data were evidenced by previous studies (Migdley et al, 2018;Pitman et al, 2017).…”

“…It should be noted that the interventions focused on affects, as alternative ways of understanding and recurring patterns were utilized without significant differences by both dynamic and cognitive therapists. These data seem to connect with the more integrative techniques adopted by the newer generation of cognitive practitioners (Pitman et al, 2017).…”

“…The therapists' adherence flexibility may also reflect the efforts to tailoring the techniques to patient's needs and to context of session (Owen & Hilsenroth, 2014), such as to patient's symptoms, diagnosis, and/or presence or absence of personality disorders (Pitman et al, 2017).…”

“…sample with or no personality disorders (Pitman et al, 2017). The measure has also been used to investigate therapeutic techniques with respect to other dimensions, such as insight (Lehmann et al, 2015), the therapeutic relationship (Kuutmann & Hilsenroth, 2012;Levy, Hilsenroth, & Owen, 2015;Siegel & Hilsenroth, 2013), the alliance and treatment outcome from the patients' and/or therapists' perspectives (DeFife, Hilsenroth, & Gold, 2008;Glock, Hilsenroth, & Curtis, 2018;Owen, Hilsenroth, & Rodolfa, 2013).…”

Understanding and misunderstanding randomized controlled trials

“…The difficulty of controlling for placebo effects can be especially acute in testing medical interventions (see Howick (2011), Chapter 7 for a critical review), as is the difficulty in controlling both for placebo effects and the effects of therapist variables in testing psychological therapies. For instance, Pitman, et al (2017) suggest how difficult it will be to identify just what a psychological therapy consists of; Kramer and Stiles (2015) treat the ‘responsiveness’ problem of categorizing therapist responses to emerging context; and there has been a lively debate about whether cognitive mechanisms of change are responsible for the effectiveness of cognitive therapy for depression based on data that shows the changes in symptoms occur mainly before the cognitive techniques are brought into play (Ilardi and Craighead (1999), Vittengl et al (2014)). …”