Skip to main content
SpringerLink
Log in

How to Use Research to Become More Effective Therapists

  • Chapter
  • First Online:
Routine Outcome Monitoring in Couple and Family Therapy

Part of the book series: European Family Therapy Association Series ((EFTAS))

Abstract

To improve therapists, they need feedback about their performance, which typically involves routine outcome monitoring . However, such feedback is not sufficient because a model of how psychotherapy works is also needed so that feedback can be focused on key therapeutic actions. In this chapter, the contextual model is presented. After formation of the initial bond between the therapist and the client, the contextual model demonstrates how three pathways lead to client change: (a) the real relationship , (b) creation of expectation through explanation and treatment actions, and (c) enactment of healthy activity through specific therapeutic actions. Effective therapists utilize all three pathways to help clients change. The characteristics and actions of effective therapists are discussed. Effective therapists are able to form a strong working alliance across a range of clients, use effectively the facilitative interpersonal skills (viz., verbal fluency, emotional expression, persuasiveness, hopefulness, warmth, empathy, and problem focus), express professional self-doubt, and practice deliberately to improve.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    There are limitations to the continuity of therapy, as would be the case of danger to self or others, for example.

References

  • Anderson, T., McClintock, A. S., Himawan, L., Song, X., & Patterson, C. L. (2016). A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome. Journal of Consulting and Clinical Psychology, 84(1), 57–66. doi:10.1037/ccp0000060.

    Article  PubMed  Google Scholar 

  • Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755–768. doi:10.1002/jclp.20583.

    Article  PubMed  Google Scholar 

  • Baldwin, S. A., & Imel, Z. E. (2013). Therapist effects: Finding and methods. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 258–297). New York: Wiley.

    Google Scholar 

  • Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842–852.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1999). Self-efficacy: Toward a unifying theory of behavioral change. In R. F. Baumeister (Ed.), The self in social psychology (pp. 285–298). New York, NY, US: Psychology Press.

    Google Scholar 

  • Baumeister, R. F. (2005). The cultural animal: Human nature, meaning, and social life. New York: Oxford University Press.

    Book  Google Scholar 

  • Benedetti, F. (2009). Placebo effects: Understanding the mechanisms in health and disease. New York: Oxford University Press.

    Google Scholar 

  • Benedetti, F. (2011). The patient’s brain: The neuroscience behind the doctor-patient relationship. New York: Oxford University Press.

    Google Scholar 

  • Benedetti, F. (2014). Placebo effects: Understanding the mechanisms in health and disease (2nd ed.). New York: Oxford University Press.

    Book  Google Scholar 

  • Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., et al. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). New York: Wiley.

    Google Scholar 

  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. doi:10.1037/h0085885.

  • Boswell, J. F., Gallagher, M. W., Sauer-Zavala, S. E., Bullis, J., Gorman, J. M., Shear, M. K., et al. (2013). Patient characteristics and variability in adherence and competence in cognitive-behavioral therapy for panic disorder. Journal of Consulting and Clinical Psychology, 81(3), 443–454. doi:10.1037/a0031437.

    Article  PubMed  Google Scholar 

  • Bowlby, J. (1980). Attachment and loss. New York, NY, US: Basic Books.

    Google Scholar 

  • Branson, A., Shafran, R., & Myles, P. (2015). Investigating the relationship between competence and patient outcome with CBT. Behaviour Research and Therapy, 68, 19–26. doi:10.1016/j.brat.2015.03.002.

    Article  PubMed  Google Scholar 

  • Boyer, P., & Barrett, H. C. (2005). Domain specificity and intuitive ontologies. In D. M. Buss (Ed.), The handbook of evolutionary psychology (pp. 96–118). Hoboken, NJ: Wiley.

    Google Scholar 

  • Budge, S. L., & Wampold, B. E. (2015). The relationship: How it works. In O. C. G. Gelo, A. Pritz, B. Rieken, O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: Foundations, process, and outcome (pp. 213–228). New York, NY, US: Springer.

    Google Scholar 

  • Cacioppo, S., & Cacioppo, J. T. (2012). Decoding the invisible forces of social connections. Frontiers in Integrative Neuroscience, 6. doi:10.3389/fnint.2012.00051.

  • Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337–345. doi:10.1037/pst0000015.

    Article  PubMed  Google Scholar 

  • Clement, P. W. (1994). Quantitative evaluation of 26 years of private practice. Professional Psychology: Research and Practice, 25(2), 173–176. doi:10.1037/0735-7028.25.2.173.

    Article  Google Scholar 

  • Clement, P. W. (1996). Evaluation in private practice. Clinical Psychology: Science and Practice, 3(2), 146–159. doi:10.1111/j.1468-2850.1996.tb00064.x.

    Google Scholar 

  • Connell, J., Grant, S., & Mullin, T. (2006). Client initiated termination of therapy at NHS primary care counselling services. Counselling & Psychotherapy Research, 6(1), 60–67. doi:10.1080/14733140600581507.

    Article  Google Scholar 

  • Constantino, M. J., Arnkoff, D. B., Glass, C. R., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. Journal of Clinical Psychology, 67(2), 184–192. doi:10.1002/jclp.20754.

    Article  PubMed  Google Scholar 

  • Crum, A. J., & Langer, E. J. (2007). Mind-set matters: Exercise and the Placebo effect. Psychological Science, 18(2), 165–171. doi:10.1111/j.1467-9280.2007.01867.x.

    Article  PubMed  Google Scholar 

  • Decety, J., & Fotopoulou, A. (2015). Why empathy has a beneficial impact on others in medicine: Unifying theories. Frontiers in Behavioral Neuroscience, 8. doi:10.3389/fnbeh.2014.00457.

  • Del Re, A. C., Flückiger, C., Horvath, A. O., Symonds, D., & Wampold, B. E. (2012). Therapist effects in the therapeutic alliance–outcome relationship: A restricted-maximum likelihood meta-analysis. Clinical Psychology Review, 32(7), 642–649. doi:10.1016/j.cpr.2012.07.002.

    Article  PubMed  Google Scholar 

  • Ericsson, K. A., & Lehmann, A. C. (1996). Expert and exceptional performance: Evidence of maximal adaptation to task constraints. Annual Review of Psychology, 47, 273–305.

    Article  PubMed  Google Scholar 

  • Flückiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59(1), 10–17. doi:10.1037/a0025749.

    Article  PubMed  Google Scholar 

  • Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Gelso, C. (2014). A tripartite model of the therapeutic relationship: Theory, research, and practice. Psychotherapy Research, 24(2), 117–131.

    Article  PubMed  Google Scholar 

  • Gelso, C. J. (2009). The real relationship in a postmodern world: Theoretical and empirical explorations. Psychotherapy Research, 19(3), 253–264. doi:10.1080/10503300802389242.

    Article  PubMed  Google Scholar 

  • Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 41(3), 296–306. doi:10.1037/0022-0167.41.3.296.

    Article  Google Scholar 

  • Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., et al. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11. doi:10.1037/cou0000131.

    Article  PubMed  Google Scholar 

  • Hatcher, R. L., & Barends, A. W. (2006). How a return to theory could help alliance research. Psychotherapy: Theory, Research, Practice, Training, 43(3), 292–299.

    Article  Google Scholar 

  • Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. doi:10.1177/1745691614568352.

    Article  PubMed  Google Scholar 

  • Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. Plos Medicine, 7(7), e1000316.

    Article  PubMed  PubMed Central  Google Scholar 

  • Horvath, A. O. (2006). The alliance in context: Accomplishments, challenges, and future directions. Psychotherapy: Theory, Research, Practice, Training, 43(3), 258–263. doi:10.1037/0033-3204.43.3.258.

    Article  Google Scholar 

  • Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16. doi:10.1037/a0022186.

    Article  PubMed  Google Scholar 

  • Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561–573.

    Article  PubMed  Google Scholar 

  • Kaptchuk, T. J., Kelley, J. M., Conboy, L. A., Davis, R. B., Kerr, C. E., Jacobson, E. E., et al. (2008). Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome. BMJ. British Medical Journal, 336(7651), 999–1003. doi:10.1136/bmj.39524.439618.25.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kirsch, I. (1985). Response expectancy as a determinant of experience and behavior. American Psychologist, 40, 1189–1202.

    Article  Google Scholar 

  • Kirsch, I. (1999). How expectancies shape experience. Washington DC: American Psychological Association.

    Book  Google Scholar 

  • Kirsch, I. (2010). The emperor’s new drugs: Exploding the antidepressant myth. New York: Basic Books.

    Google Scholar 

  • Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48(1), 72–79. doi:10.1037/a0022238.

    Article  PubMed  Google Scholar 

  • Liberman, B. L. (1978). The role of mastery in psychotherapy: Maintenance of improvement and prescriptive change. In J. D. Frank, R. Hoehn-Saric, S. D. Imber, B. L. Liberman, & A. R. Stone (Eds.), Effective ingredients of successful psychotherapy (pp. 35–72). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Lieberman, M. D. (2013). Social: Why our brains are wired to connect. New York: Crown Publishing Group.

    Google Scholar 

  • Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social Science and Medicine, 74(6), 907–914. doi:10.1016/j.socscimed.2011.11.028.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nissen-Lie, H. A., Monsen, J. T., & Rønnestad, M. H. (2010). Therapist predictors of early patient-rated working alliance: A multilevel approach. Psychotherapy Research, 20(6), 627–646. doi:10.1080/10503307.2010.497633.

    Article  PubMed  Google Scholar 

  • Nissen-Lie, H. A., Monsen, J. T., Ulleberg, P., & Rønnestad, M. H. (2013). Psychotherapists’ self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research, 23(1), 86–104. doi:10.1080/10503307.2012.735775.

    Article  PubMed  Google Scholar 

  • Nissen-Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., et al. (2015). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy. doi:10.1002/cpp.1977.

    Google Scholar 

  • Orlinsky, D. E., & Howard, K. I. (1986). Process and outcome in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (3rd ed., pp. 311–381). New York: Wiley.

    Google Scholar 

  • Owen, J., & Hilsenroth, M. J. (2014). Treatment adherence: The importance of therapist flexibility in relation to therapy outcomes. Journal of Counseling Psychology, 61(2), 280–288.

    Article  PubMed  Google Scholar 

  • Powers, M. B., Smits, J. A. J., Whitley, D., Bystritsky, A., & Telch, M. J. (2008). The effect of attributional processes concerning medication taking on return of fear. Journal of Consulting and Clinical Psychology, 76(3), 478–490.

    Article  PubMed  Google Scholar 

  • Price, D. P., Finniss, D. G., & Benedetti, F. (2008). A comprehensive review of the placebo effect: Recent advances and current thought. Annual Review of Psychology, 59, 565–590.

    Article  PubMed  Google Scholar 

  • Schöttke, H., Flückiger, C., Goldberg, S. B., Eversmann, J., & Lange, J. (in press). Predicting psychotherapy outcome based on therapist interpersonal skills: A five-year longitudinal study of a therapist assessment protocol. Psychotherapy Research.

    Google Scholar 

  • Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78(3), 298–311. doi:10.1037/a0019247.

    Article  PubMed  Google Scholar 

  • Simon, G. E., & Ludman, E. J. (2010). Predictors of early dropout from psychotherapy for depression in community practice. Psychiatric Services, 61(7), 684–689. doi:10.1176/appi.ps.61.7.684.

    Article  PubMed  Google Scholar 

  • Simpson, S. H., Eurich, D. T., Majumdar, S. R., Padwal, R. S., Tsuyuki, S. T., Varney, J., et al. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. doi:10.1136/bmj.38875.675486.55.

    Google Scholar 

  • Thoma, N. C., & McKay, D. (2015). Working with emotion in cognitive-behavioral therapy: Techniques for clinical practice. New York, NY, US: Guilford Press.

    Google Scholar 

  • Thomas, R. M. (2001). Folk psychologies across cultures. Thousand Oaks, CA: Sage. Guilford Press.

    Google Scholar 

  • Tracey, T. J. G., Wampold, B. E., Lichtenberg, J. W., & Goodyear, R. K. (2014). Expertise in psychotherapy: An elusive goal? American Psychologist. doi:10.1037/a0035099.

    PubMed  Google Scholar 

  • Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110(2), 639–644. doi:10.2466/02.07.17.pr0.110.2.639-644.

    Article  PubMed  Google Scholar 

  • Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579–592. doi:10.1037/a0021769.

    Article  PubMed  Google Scholar 

  • Wampold, B. E., & Budge, S. L. (2012). The 2011 Leona Tyler award address: The relationship–and its relationship to the common and specific factors of psychotherapy. The Counseling Psychologist, 40(4), 601–623. doi:10.1177/0011000011432709.

    Article  Google Scholar 

  • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The research evidence for what works in psychotherapy (2nd ed.). New York: Routledge.

    Google Scholar 

  • Wampold, B. E., Imel, Z. E., Bhati, K. S., & Johnson Jennings, M. D. (2006). Insight as a common factor. In L. G. Castonguay & C. E. Hill (Eds.), Insight in psychotherapy (pp. 119–137). Washington, DC: American Psychological Association.

    Google Scholar 

  • Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 200–211. doi:10.1037/a0018912.

    Article  PubMed  PubMed Central  Google Scholar 

  • Willis, J., & Todorov, A. (2006). First impressions: Making up your mind after a 100-Ms exposure to a face. Psychological Science, 17(7), 592–598. doi:10.1111/j.1467-9280.2006.01750.x.

    Article  PubMed  Google Scholar 

  • Wilson, E. O. (2012). The social conquest of earth. New York: Liveright Publishing.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Modum Bad Research Institute, Badeveien 287, 3370, Vikersund, Norway

    Bruce E. Wampold

Authors
  1. Bruce E. Wampold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce E. Wampold .

Editor information

Editors and Affiliations

  1. Modum Bad, Vikersund, Norway

    Terje Tilden

  2. University of Wisconsin, Madison, Wisconsin, USA

    Bruce E. Wampold

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Wampold, B.E. (2017). How to Use Research to Become More Effective Therapists. In: Tilden, T., Wampold, B. (eds) Routine Outcome Monitoring in Couple and Family Therapy. European Family Therapy Association Series. Springer, Cham. https://doi.org/10.1007/978-3-319-50675-3_14

Download citation

Publish with us

Policies and ethics

Search

Navigation