Previous results have demonstrated that psychotherapists working in a practice setting have a relatively low treatment adherence, regardless of the therapy school to which they were affiliated. The objective of this study was to investigate whether the therapist’s attitudes in therapeutic matters are a better predictor of interventions employed than the therapeutic method in which the therapist was trained. The relationships between various types of psychotherapeutic intervention and both predictors were tested by means of Markov Chain Monte Carlo simulations. A total of 162 therapy sessions conducted by 18 therapists affiliated to 6 different therapeutic methods were analyzed. The interventions were classified according to the criteria of essentiality and commonality. The analysis showed that 40% of the examined intervention types were significantly associated with at least one of the nine attitude scales considered, whereas only 14% exhibited a significant association with the completed type of therapy training. The latter predictor was only associated with interventions of the kind essential/not common, whereas the attitude scales were related with both essential and common interventions. The rather weak association between the type of completed training and preferred therapeutic intervention types means that many essential intervention techniques acquired during training assume a subordinate role in a practice setting. Choice of therapeutic action is conditioned to a greater extent by nuances in individual attitudes, which may change throughout a professional career. The reciprocal influence of a psychotherapist’s attitude and his or her professional development is discussed.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Berglar, J., Crameri, A., von Wyl, A., Koemeda-Lutz, M., Koehler, M., Staczan, P., … Tschuschke, V. (2016). Therapist effects on treatment outcome in psychotherapy: A multilevel modelling analysis. International Journal of Psychotherapy, 20(2), 61–80.
Berne, E. (1964). Games people play. London: Penguin Books.
Beutler, L. E., & Clarkin, J. F. (2014). Systematic treatment selection: Toward targeted therapeutic interventions. New York: Routledge.
Cook, J. M., Biyanova, T., Elhai, J., Schnurr, P. P., & Coyne, J. C. (2010). What do psychotherapists really do in practice? An Internet study of over 2,000 practitioners. Psychotherapy: Theory, Research, Practice, Training, 47(2), 260.
Crameri, A., von Wyl, A., Koemeda, M., Schulthess, P., & Tschuschke, V. (2015). Sensitivity analysis in multiple imputation in effectiveness studies of psychotherapy. Frontiers in psychology, 6, 1042.
DeVellis, R. F. (2003). Scale development: Theory and applications (2nd ed.). Newbury Park: Sage.
Duncan, B. L. (2002). The legacy of Saul Rosenzweig: The profundity of the dodo bird. Journal of Psychotherapy Integration, 12(1), 32–57.
Fenner, P., Abdelazim, R. S., Bräuninger, I., Strehlow, G., & Seifert, K. (2017). Provision of arts therapies for people with severe mental illness. Current Opinion in Psychiatry, 30(4), 306–311.
Gelman, A., & Hill, J. (2006). Data analysis using regression and multilevel hierarchical models. New York: Cambridge University Press.
Goldfried, M. R., Castonguay, L. G., Hayes, A. M., Drozd, J. F., & Shapiro, D. A. (1997). A comparative analysis of the therapeutic focus in cognitive–behavioral and psychodynamic–interpersonal sessions. Journal of Consulting and Clinical Psychology, 65(5), 740–748.
Goldfried, M. R., Raue, P. J., & Castonguay, L. G. (1998). The therapeutic focus in significant sessions of master therapists: A comparison of cognitive-behavioral and psychodynamic-interpersonal interventions. Journal of Consulting and Clinical Psychology, 66(5), 803–810.
Hollanders, H. (2000). Eclecticism/integration: Some key issues and research. In S. Palmer & R. Woolfe (Eds.), Integrative and eclectic counselling and psychotherapy (pp. 31–55). London: Sage.
Klug, G., Henrich, G., Kächele, H., Sandell, R., & Huber, D. (2008). Die therapeutenvariable [the therapist variable]. Psychotherapeut, 53(2), 83–91.
Knill, P. J., Nienhaus Barba, H., & Fuchs, M. (1995). Minstrels of soul: Intermodal expressive therapy. Toronto: EGS-Press.
Koemeda-Lutz, M., Crameri, A., Schulthess, P., Wyl, A. V., & Tschuschke, V. (2016a). Specificity and pace variability of therapists’ interventions under naturalistic conditions. International Journal of Psychotherapy, 20(1), 19–50.
Koemeda-Lutz, M., Crameri, A., Tschuschke, V., Schulthess, P., & von Wyl, A. (2016b). Therapists’ interventions in different psychotherapy approaches: Category and temporal aspects. International Body Psychotherapy Journal, 15(2), 37–57.
Larsson, B. P., Kaldo, V., & Broberg, A. G. (2009). Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists. Journal of Psychotherapy Integration, 19(1), 34–66.
Lowen, A. (1971). The language of the body. New York: Prentice Hall.
Lunn, D., Jackson, C., Best, N., Thomas, A., & Spiegelhalter, D. (2013). The BUGS book: A practical introduction to Bayesian analysis. Boca Raton: CRC Press.
Mindell, A. (1982). Dreambody: The body’s role in revealing the self. Santa Monica, CA: Sigo Press.
Najavits, L. M. (1997). Psychotherapists’ implicit theories of therapy. Journal of Psychotherapy Integration, 7(1), 1–16.
Orlinsky, D., Ambühl, H., Rønnestad, M., Davis, J., Gerin, P., Davis, M., … Branco Vasco, A. (1999). Development of psychotherapists: Concepts, questions, and methods of a collaborative international study. Psychotherapy Research, 9(2), 127–153.
Perls, F. S., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. New York: Julian Press.
Plummer, M. (2017). JAGS version 4.2.0 user manual. Lyon: International Agency for Research on Cancer.
Poznanski, J. J., & McLennan, J. (1995). Conceptualizing and measuring counselors’ theoretical orientation. Journal of Counseling Psychology, 42(4), 411–422.
Poznanski, J. J., & McLennan, J. (2003). Becoming a psychologist with a particular theoretical orientation to counselling practice. Australian Psychologist, 38(3), 223–226.
Rihacek, T., & Roubal, J. (2017). The proportion of integrationists among Czech psychotherapists and counselors: A comparison of multiple criteria. Journal of Psychotherapy Integration, 27(1), 13–22.
Röhricht, F. (2014). Body psychotherapy for the treatment of severe mental disorders—An overview. Body, Movement and Dance in Psychotherapy, 10(1), 51–67.
Rosenberg, J. L., & Rand, M. (1989). Body self & soul: Sustaining integration. Atlanta: Humanics Limited.
Salter, M., & Rhodes, P. (2018). On becoming a therapist: A narrative inquiry of personal–professional development and the training of clinical psychologists. Australian Psychologist, 53, 486–492.
Sandell, R., Carlsson, J., Schubert, J., Broberg, J., Lazar, A., & Grant, J. (2004). Therapist attitudes and patient outcomes: I. Development and validation of the therapeutic attitudes scales (TASC-2). Psychotherapy Research, 14(4), 469–484.
Suszek, H., Grzesiuk, L., Styła, R., & Krawczyk, K. (2016). General overview of psychotherapeutic practice in Poland. Results from a nationwide survey. Psychiatric Quarterly. https://doi.org/10.1007/s11126-016-9480-9.
Thoma, N. C., & Cecero, J. J. (2009). Is integrative use of techniques in psychotherapy the exception or the rule? Results of a national survey of doctoral-level practitioners. Psychotherapy: Theory, Research, Practice, Training, 46(4), 405–417.
Topolinski, S., & Hertel, G. (2007). The role of personality in psychotherapists’ careers: Relationships between personality traits, therapeutic schools, and job satisfaction. Psychotherapy Research, 17(3), 365–375.
Toska, G. A., Neimeyer, G. J., Taylor, J. M., Kavas, A. B., & Rice, K. G. (2010). Epistemology and allegiance: Exploring the role of therapists’ epistemic commitments on psychotherapy outcomes. European Journal of Psychotherapy & Counselling, 12(1), 65–75.
Tschuschke, V., Crameri, A., Koehler, M., Berglar, J., Muth, K., Staczan, P., … Koemeda-Lutz, M. (2015). The role of therapists’ treatment adherence, professional experience, therapeutic alliance, and clients’ severity of psychological problems: Prediction of treatment outcome in eight different psychotherapy approaches. Preliminary results of a naturalistic study. Psychotherapy Research, 25(4), 420–434.
Tschuschke, V., Koemeda, M., & Schlegel, M. (2014). PAP-S rating manual (PAP-S RM): Rating manual for the objective evaluation of therapeutic interventions of psychotherapists using various theoretical concepts. Swiss Charter for Psychotherapy.
van Lith, T. (2016). Art therapy in mental health: A systematic review of approaches and practices. The Arts in Psychotherapy, 47, 9–22.
Vasco, A. B., & Dryden, W. (1997). Does development do the deed?: clinical experience and epistemological development together account for similarities in therapeutic style. Psychotherapy: Theory, Research, Practice, Training, 34(3), 262–271.
von Wyl, A., Crameri, A., Koemeda, M., Tschuschke, V., & Schulthess, P. (2016). Practice study outpatient psychotherapy-Switzerland (PAP-S): Study design and feasibility (revised edition). ZHAW Zurich University of Applied Science. https://doi.org/10.21256/zhaw-1100.
Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620–630.
Wittchen, H. U., Zaudig, M., & Fydrich, T. (1997). Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. [Structured clinical interview for DSM-IV. Axis I and II]. Göttingen: Hogrefe.
This work was supported by a grant from an anonymous spender arranged by the Department of Health of the Canton Zurich.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A research application was submitted to the ethics committees of each of the Swiss cantons in which the project was carried out; all of the applications were approved.
Written informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Crameri, A., Tschuschke, V., Koemeda, M. et al. The Therapists’ Training and Their Attitudes Towards Therapy as Predictors of Therapeutic Interventions. J Contemp Psychother 50, 67–76 (2020). https://doi.org/10.1007/s10879-019-09421-y
- Therapy training
- Therapeutic techniques
- Theoretical orientation
- Bayesian analysis
- Psychotherapy integration