Abstract
While it is accepted that therapeutic relationship is a necessary condition for cognitive behavior therapy (CBT), the way a therapist adapts to that relationship based on the case formulation has not been clearly articulated. In addition, the direct effects of the therapeutic relationship and its elements require further empirical study. Achieving expert consensus on the roles and function for the therapeutic relationship is important for training, supervision, accreditation, as well as the next generation of research examining whether treatment processes are wholly or partially dependent upon in-session processes. This article summarizes the findings, conclusions, and recommendations of an expert panel on these features of the therapeutic relationship in order to identify potentially fruitful avenues for future research.
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References
American Psychological Association, Task Force on Evidence-Based Therapy Relationships. (2011). Conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. Retrieved from http://www.divisionofpsychotherapy.org/continuing-education/task-force-on-evidence-based-therapy-relationships/.
Asnaani, A., & Hofmann, S. G. (2012). Collaboration in multicultural therapy: Establishing a strong therapeutic alliance across cultural lines. Journal of Clinical Psychology, 68(2), 187–197.
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., Ametaj, A., Carl, J. R., Boettcher, H. T., & Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 74(9), 875–884. https://doi.org/10.1001/jamapsychiatry.2017.2164.
Beck, A. T., Rush, A. J., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Brady, J. P., Davison, G. C., Dewald, P. A., Egan, G., Fadiman, J., Frank, J. D., et al. (1980). Some views on effective principles of psychotherapy. Cognitive Therapy and Research, 4, 271–306.
Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour Research and Therapy, 70, 32–37.
Cameron, S. K., Rodgers, J., & Dagnan, D. (2018). The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression: a meta-analytic review. Clinical Psychology & Psychotherapy. https://doi.org/10.1002/cpp.2180.
Castonguay, L. G. (1993). “Common factors” and “non-specific variables:” clarification of the two concepts and recommendations for future research. Journal of Psychotherapy Integration, 3, 267–286.
Clark, D. A. (2013). Collaborative empiricism: a cognitive response to exposure reluctance and low distress tolerance. Cognitive and Behavioral Practice, 20(4), 445–454.
Clark, D. M., Canvin, L., Green, J., Layard, R., Pilling, S., & Janecka, M. (2017). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet. https://doi.org/10.1016/S0140-6736(17)32133-5.
Dattilio, F. M., & Hanna, M. A. (2012). Collaboration in cognitive-behavioral therapy. Journal of Clinical Psychology, 68(2), 146–158.
DeRubeis, R. J., Brotman, M. A., & Gibbons, C. J. (2005). A conceptual and methodological analysis of the nonspecifics argument. Clinical Psychology: Science and Practice, 12, 174–183.
Felder, J. N., Dimidjian, S., & Segal, Z. (2012). Collaboration in mindfulness-based cognitive therapy. Journal of Clinical Psychology, 68(2), 179–186.
Friedberg, R. D., & Gorman, A. A. (2007). Integrating psychotherapeutic processes with cognitive behavioral procedures. Journal of Contemporary Psychotherapy, 37, 185–193.
Froján-Parga, M. X., Calero-Elvira, A., & Montaño-Fidalgo, M. (2011). Study of the Socratic method during cognitive restructuring. Clinical Psychology & Psychotherapy, 18, 110–123.
Gilbert, P., & Leahy, R. L. (Eds.). (2007). The therapeutic relationship in the cognitive behavioral psychotherapies. New York: Routledge.
Goldfried, M. R., & Davison, G. C. (1976). Clinical behavior therapy. New York: Holt, Rinehart, & Winston.
Greenberg, L. S., & Warwar, S. H. (2006). Homework in an emotion-focused approach to experiential therapy. Journal of Psychotherapy Integration, 16(2), 178–200.
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of CBT and the rise of process-based care. World Psychiatry, 16, 245–246. https://doi.org/10.1002/wps.20442.
Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: the science and core clinical competencies of cognitive behavioral therapy. New Harbinger: Oakland CA.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford.
Heiniger, L. E., Clark, G. I., & Egan, S. J. (2018). Perceptions of Socratic and non-Socratic presentation of information in cognitive behaviour therapy. Journal of Behavior Therapy and Experimental Psychiatry, 58, 106–113. https://doi.org/10.1016/j.jbtep.2017.09.004.
Heyes, M. E., Schnitzen, L., et al. (2018). Recertification and reentry to practice for nurse anesthetists: determining core competencies and evaluating performance via high-fidelity simulation technology. Journal of Nursing Regulation, 8(4), 43–55. https://doi.org/10.1016/S2155-8256(17)30181-3.
Hofmann, S. G., & Barlow, D. H. (2014). Evidence-based psychological interventions and the common factors approach: the beginnings of a rapprochement? Psychotherapy, 51(4), 510–513. https://doi.org/10.1037/a0037045.
Holmes, E. A., Ghaderi, A., Harmer, C. J., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., Roiser, J. P., Bockting, C. L. J., O'Connor, R. C., Shafran, R., Moulds, M. L., & Craske, M. G. (2018). The lancet psychiatry commission on psychological treatments research in tomorrow’s science. The Lancet Psychiatry, 5(3).
Horvath, A., Del Re, A., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16. https://doi.org/10.1037/a0022186.
Huppert, J. D., Roth Ledley, D., & Foa, E. B. (2006). The use of homework in behavior therapy for anxiety disorders. Journal of Psychotherapy Integration, 16(2), 128–139.
Hutton, P., & Morrison, A. P. (2013). Collaborative empiricism in cognitive therapy for psychosis: a practical guide. Cognitive and Behavioral Practice, 20(4), 429–444.
Kazantzis, N. (2018). Introduction to the special issue on processes of cognitive behavioral therapy: does “necessary, but not sufficient” still capture it? Cognitive Therapy and Research, 42(2), 115–120. https://doi.org/10.1007/s10608-018-9891-z.
Kazantzis, N., & Kellis, E. (2012). A special feature on collaboration in psychotherapy. Journal of Psychotherapy Integration, 68(2), 133–135.
Kazantzis, N., & Ronan, K. R. (2006). Can between-session (homework) activities be considered a common factor in psychotherapy? Journal of Psychotherapy Integration, 16(2), 115–127.
Kazantzis, N., Cronin, T. J., Dattilio, F. M., & Dobson, K. S. (2013). Introduction: using techniques via the therapeutic relationship. Cognitive and Behavioral Practice, 20(4), 385–389.
Kazantzis, N., Cronin, T. J., Norton, P. J., Lai, J., & Hofmann, S. G. (2015). Reservations about the conclusions of the interdivisional (APA divisions 12 & 29) task force on evidence-based therapy relationships: what do we know, what don’t we know? Journal of Clinical Psychology, 71, 423–427. https://doi.org/10.1002/jclp.22178.
Kazantzis, N., Dattilio, F. M., & Dobson, K. S. (2017). The therapeutic relationship in cognitive behavior therapy: a clinician’s guide. New York: Guilford.
Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy: a guide for creating intense and curative therapeutic relationships. New York: Plenum.
Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective. Psychotherapy, 51, 467–481. https://doi.org/10.1037/a0034332.
Lorenzo-Luaces, L., & DeRubeis, R. J. (2018). Miles to go before we sleep: advancing the understanding of psychotherapy by modeling complex processes. Cognitive Therapy and Research, 42(2), 212–217.
Muran, J. C., Safran, J. D., Eubanks, C. F., & Gorman, B. S. (2017). The effect of alliance-focused training on a cognitive-behavioral therapy for personality disorders. Journal of Consulting and Clinical Psychology.
Newman, C. F. (2012). Core competencies in cognitive-behavioral therapy: becoming a highly effective and competent cognitive-behavioral therapist. New York: Routledge.
Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York: Guilford.
Persons, J. B., Beckner, V. L., & Tompkins, M. A. (2013). Testing case formulation hypotheses in psychotherapy: two case examples. Cognitive and Behavioral Practice, 20(4), 399–409.
Petersen, R. C., Lopez, O., et al. (2018). Practice guideline update summary: mild cognitive impairment. Report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of neurology. Neurology, 90(3), 126–135. https://doi.org/10.1212/WNL.0000000000004826.
Rogers, C. (1951). Client-centered therapy: its current practice, implications, and theory. Boston: Houghton Mifflin.
Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting and Clinical Psychology, 22, 95–103.
Sauer-Zavala, S., Boswell, J. F., Bentley, K. H., Thompson-Hollands, J., Farchione, T. J., & Barlowa, D. H. (2018). Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: an investigation of mediation. Cognitive Therapy and Research, 42(2), 135–145. https://doi.org/10.1007/s10608-017-9855-8.
Simos, G. (2012). Collaboration in psychopharmacotherapy. Journal of Clinical Psychology, 68(2), 198–208.
Sloane, R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J., & Whipple, K. (1975). Psychotherapy versus behavior therapy. Cambridge: Harvard University.
Stricker, G. (2006). Using homework in psychodynamic psychotherapy. Journal of Psychotherapy Integration, 16(2), 219–237.
Tee, J., & Kazantzis, N. (2011). Collaborative empiricism in cognitive therapy: a definition and theory for the relationship construct. Clinical Psychology: Science and Practice, 18, 48–62.
Thase, M. E., & Callan, J. A. (2006). The role of homework in cognitive behavior therapy of depression. Journal of Psychotherapy Integration, 16(2), 162–177.
Wiseman, H., Tishby, O., & Barber, J. P. (2012). Collaboration in psychodynamic psychotherapy. Journal of Clinical Psychology, 68(2), 136–145.
Wolpe, J. (1958). Reciprocal inhibition therapy. Stanford: Stanford University.
Wolpe, J., & Lazarus, A. (1966). Behavior therapy techniques. New York: Pergamon.
Young, J. E. (1999). Cognitive therapy for personality disorders: a schema-focused approach (3rd ed.). Sarasota: Professional Resource.
Zilcha-Mano, S., Muran, J. C., Eubanks, C. F., Safran, J. D., & Winston, A. (2018). Not just a non-specific factor: moderators of the effect of within- and between-clients alliance on outcome in CBT. Cognitive Therapy and Research, 42(2), 146–158. https://doi.org/10.1007/s10608-017-9866-5.
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Mathew E. Stuckey is acknowledged for comments on a previous version of this manuscript.
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The authors acknowledge the scientific committee of the 8th International Congress of Cognitive Psychotherapy held in Hong Kong, 24–27 June 2014, who supported this expert panel
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Kazantzis, N., Dattilio, F.M., McGinn, L.K. et al. Defining the Role and Function of the Therapeutic Relationship in Cognitive Behavioral Therapy: a Modified Delphi Panel. J Cogn Ther 11, 158–183 (2018). https://doi.org/10.1007/s41811-018-0014-0
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DOI: https://doi.org/10.1007/s41811-018-0014-0