Training on context-responsive psychotherapy integration: An evidence-informed framework.

Abstract

D espite their dubious impact (see Chapters 3 and 4, this volume), the primary training models in psychotherapy have remained mostly unchanged. Specifically, the focus has largely been on training therapists to academically determined competency thresholds and then encouraging fidelity in applying such competencies across patients, contexts, and time. As one prominent version of this approach, therapists are trained to administer somewhat theory-narrow empirically supported treatments (ESTs) for specific disorders, with the replicable use of the theory-prescribed ingredients ostensibly signifying a clinician's competence. Although EST-centered training can be useful, as we know that many therapists become generally effective, we have little evidence that it is the training method itself that causes providers to become effective. Additionally, this approach is limiting in that it privileges treating the average patient rather than the individual, thereby neglecting those who may be less likely to respond to an EST when delivered in its standard form. Further, this EST-centric approach also implies that change will generally be linear-with few, if any, major bumps in the road that require therapists to shift their theoretical orientation during treatment.

Client-focused assessment and intervention: Tailoring the work to the client.

“…Much is unknown, however, about how feedback is used by therapists (Wampold, 2015). This area is receiving more attention (e.g., de Jong et al, 2012), as is the expansion of variables that should be considered for baseline and withintreatment assessment (Constantino et al, 2013).…”

Evidence-based psychotherapy: On what can we agree?

“…For instance, the empirical literature would suggest that when faced with markers of patient resistance, therapists should consider momentarily departing from their typical treatment approach and shifting into motivational interviewing strategies to reengage the patient in the collaborative work of therapy (Aviram et al, 2016). Indeed, there is a growing meta-analytic literature with specific clinical recommendations to help guide evidence-based therapist responsiveness to key clinical constructs in accordance with EBP (see Norcross & Wampold, 2019), which has led some to propose that practice be guided with such context responsivity in mind (e.g., Constantino et al, 2013; we discuss this interesting and important framework further at the end of this chapter). While psychotherapists across divides disagree about how (or how much) to be responsive, we feel many would concur that meeting patient needs in the moment is a core element of EBP.…”

“…Interest in responsiveness-focused psychotherapy training has been present in the literature for decades, such as with Strupp' s (1955Strupp' s ( , 1960 early work on therapist response to key in-session stimuli, Standal and Corsini' s (1959) scholarship on critical incidents in psychotherapy, and Lazarus and Messer' s (1988) work on clinical choice points. Based on increasing evidence for the utility of therapist within-and between-orientation flexibility in key clinical moments (e.g., Aviram et al, 2016;Owen & Hilsenroth, 2014), Constantino et al (2013) more recently published on an "if-then" context-responsive framework for training and practice that is informed by a consensual, transtheoretical evidence base. In this paradigm, adept therapists are those who draw on the right transtheoretical, evidence-based principle at the right time (Constantino & Bernecker, 2014).…”

Therapist responsivity during disagreement in psychotherapy

“…Psychotherapy process research emphasises the importance of therapist responsivity (Constantino et al, 2013;Moyers et al, 2009;Westra & Norouzian, 2018). Kramer and Stiles (2015) describe therapist responsivity as "therapist behaviour that is influenced by emerging context" (p. 277).…”

“…It includes a willingness to responsively shift their own behaviour as a result of the emerging context in therapy. In other words, therapist responsivity can be conceptualised as "if-then" thinking and behaviour: the prudent intervention (the then activity) is the one indicated by the moment or immediate process (the if context; Constantino et al, 2013;Stiles et al, 1998;Westra, 2012).…”