David E. Orlinsky

Towards an empirically grounded model of psychotherapy training: Four thousand therapists rate influences on their development

Various influences on their own development as therapists were rated by more than 4,000 psychotherapists who differed in terms of professional background, career level, theoretical orientation, and nationality. Despite these and other differences, considerable agreement was found concerning the factors that facilitate or impede professional development. Most important as positive influences were practice-related interpersonal situations, chiefly the experience of working directly with patients, as well as formal supervision and the therapists own personal therapy. Academic learning, whether by taking courses or reading books and journals, was accorded a significant but distinctly secondary role. Institutional conditions of practice were the only noteworthy negative influence. Implications of these findings for an empirically grounded model of psychotherapist training include proposals for an early start to direct patient contact and concurrent development of clinical skill through supportive supervisory relations and successful personal therapy or an equivalent experience, along with relevant didactic work.

The Therapeutic Bond Scales: Psychometric Characteristics and Relationship to Treatment Effectiveness

The Therapeutic Bond Scales assess the quality of the therapeutic relationship from the patients perspective. The therapeutic bond is composed of 3 aspects: working alliance, empathic resonance, and mutual affirmation. Scales were developed to measure these aspects and the therapeutic bond as a whole. The correlations between these scales and 2 measures of outcome (session quality assessed by the patient and termination outcome evaluated by nonparticipan t raters) were examined. All scales were significantly correlated with session quality. Therapeutic bond was significantly correlated with termination outcome in both a linear and a curvilinear fashion, suggesting that, at least in the initial phase of therapy, the therapeutic bond can be too high as well as too low. A substantial accumulation of empirical findings exists relating psychotherapy process variables to treatment outcome (cf. Orlinsky & Howard, 1986a). One of the most consistent findings in the psychotherapy research literature is that the quality of the relationship between the patient and the therapist is a major determinant of psychotherapeutic effectiveness (e.g., the therapeutic alliance literature: Alexander & Luborsky, 1986; Marmar, Horowitz, Weiss, & Marziali, 1986). Reviews (Gurman, 1977; Lambert, Shapiro, & Bergin, 1986; Orlinsky & Howard, 1986a; Patterson, 1984) consistently demonstrate that (a) a good therapeutic relationship is at least a major contributing factor, if not a necessary and sufficient condition (Rogers, 1957), for successful treatment, and (b) that the patients perception of the quality of the relationship is most consistently positively related to outcome. Yet most systems for measuring this aspect of the therapeutic relationship are based on the nonparticipant observer perspective. The primary goal of the present study was to develop a reliable measure of the quality of the therapeutic relationship, from the patients perspective, based on a theoretical model of the therapeutic bond. We also investigated the relationship between the quality of the bond, measured in this way in the early stage of therapy, and two measures of therapeutic effectiveness: an

Researchers' images of psychotherapy: Their origins and influence on research

Abstract In order to formulate research hypotheses, designs and procedures, researchers must rely on their prior conceptions of the phenomenon they study. The paradigmatic status of a science depends in part on researchers sharing a common basic image of the central phenomenon. However, psychotherapy researchers have been guided in formulating studies not by one but by four basic images, which represent psychotherapy alternatively (a) as mental health treatment, (b) as personal education, (c) as a reform or correctional process, and (d) as moral or spiritual redemption. The dominant image of therapy as treatment inclines researchers to define process in terms of technique, therapists as professionals trained in the application of techniques, patients as embodiments of psychiatrically diagnosable disorders, and outcome as the end result of a treatment episode. Other formulations of process, therapist, patient and outcome variables are suggested by less explicitly acknowledged images of therapy, engendering confusion among researchers. To repair this situation, the nature and origin of the four basic images of psychotherapy are discussed, their integration into a general research-based model is proposed, and the implications of this “generic” model for the design of future research are explored.

Rorschach test correlates of dreaming and dream recall.

Abstract Measures of frequency of dream recall for 47 Ss and of amount of dreaming for 18 Ss, as determined by the Dement-Kleitman method, were available as part of a larger investigation of the influence of personality factors on dream recall. Rorschach Test indices obtained from these Ss were intercorrelated among themselves and correlated with the appropriate dream variable in order to assess the presumed affinity of dream phenomena and Rorschach response processes. The results were: (1) indices of fantasy predominance correlated positively with both amount of dreaming and frequency of dream recall; (2) indices of associative productivity correlated positively with frequency of dream recall; (3) an index of introspective constriction correlated negatively with frequency of dream recall. Further exploration of this area seems promising.

The master therapist: Ideal character or clinical fiction? Comments and questions on Jennings and Skovholt's "The Cognitive, Emotional, and Relational Characteristics of Master Therapists."

L. Jennings and T. M. Skovholts (1999) study constitutes a useful step toward deepening scientific understanding of what therapists at their best are capable of offering to their clients. Both the studys strengths and limitations stimulate questions, which this commentary attempts to consider. These questions mainly concern the lack of a clear initial definition of master therapist, the lack of meaningful comparison groups needed to infer the distinctive characteristics of master therapists, the incomplete communication of data-analytic procedures, and the formulation of results as a uniform ideal-typical pattern that precludes recognition of individual differences. Despite this, the clinical richness of the findings is well appreciated, and the questions stimulated by the study indicate its high heuristic value.

Die nächsten 10 Jahre Psychotherapieforschung

The established paradigm in psychotherapy research is oriented to the dominant bio-medical research paradigm, which is too narrow and decontextualized to generate realistic (and thus truly scientific) studies in our field. The central assumptions of this paradigm are critically discussed and an expansion is suggested that can provide a more adequate conception of the human contexts of psychotherapy (biographical, sociocultural, political-economic). Researchers need to have a more specific theoretical conception of the contexts in which actual clinical practice occurs. When carried far enough, the concepts proposed here should lead to specifications of how operational measures can be constructed for use in psychotherapy studies.

Sources of influence on the professional development of psychologists and psychiatrists in Norway and Germany

Background: There are many professional psychotherapists, but no psychotherapy profession. The psychotherapists’ professions vary between countries, the most frequent being psychiatry and clinical psychology. Aim: As these professions have different basic training and also may be impacted differently by other factors, we wanted to study potential differences as to perceived influences on their development as psychotherapists across career level, theoretical orientation, and gender. Methods: More than 2500 Norwegian and German psychiatrists and psychologists reported data on their professional development in the DPCCQ/2000, a lengthy multi-part survey instrument developed within the ‘Collaborative Research Network’ of the Society for Psychotherapy Research. The four groups were compared for differences, and a series of multiple regression analyses were conducted to examine the impact of profession on a variety of aspects of therapist experiences. Results: Although a few therapist experiences (e.g. teaching, treating patients, institutional conditions) had a significantly different impact between the two professions, as a main effect, they only accounted for less than 1% or the variance. Conclusion: Profession seems to have little influence on perceived development as a psychotherapist, and it is reasonable to conclude that other therapist qualities, often personal qualities, are more important for therapeutic processes and outcomes.

Theoretical Orientations of Spanish Psychotherapists: Integration and Eclecticism as Modern and Postmodern Cultural Trends

In this article, we focus on the theoretical orientations of Spanish psychotherapists with reference to the concepts of integration and eclecticism associated respectively with the cultural patterns of modernity and postmodernity. Data are reported from 179 Spanish therapists who responded to the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). The results indicated that these Spanish therapists do not show a tendency toward postmodern eclecticism, suggesting that present clinical practice in Spain still needs high-profile theoretical constructs.

Ironies in the history of psychotherapy research : Rogers, Bordin, and the shape of things that came

This paper discusses Bordins (1948) contribution to this journal in the context of the historical period in which it was written, in relation to Bordins later contributions to the field of psychotherapy research, and in anticipation of issues that seem likely to emerge as critical in that field during the coming decades.

The Graying and Greening of SPR: A Personal Memoir on Forming the Society for Psychotherapy Research

Progress in research depends, to a great extent, on an adequate flow of information between investigators in each specific field of science. The flow of scientific communications, carried on simultaneously through formal and informal channels, creates the culture in which research grows best. If you were able to place a Petri dish under a microscope, containing a colony of scientists in a communications-rich culture, you would see those researchers stimulating, challenging, correcting, and ultimately supporting each other in pursuit of their common goals.