Expertise and Psychotherapy:
Core Tasks

Scott D. Miller, Ph.D.
International Center for Clinical Excellence
The Evolution of Psychotherapy:
So, what’s happened?

•Since the 1960’s:
•Number of treatment
approaches grown from 60 to
...
The Evolution of Psychotherapy:
Progress
•In most studies of treatment conducted over the
last 40 years, the average treat...
The Evolution of Psychotherapy:
Progress ?
“Decades of psychotherapy
research have failed to find
a scintilla of evidence ...
The Evolution of Psychotherapy:
Factor

# Studies

# Patients

Effect Size d

% of variability in
outcomes

Common Factors...
The Evolution of Psychotherapy:
What Does Make a Difference ?
Factor

# Studies

# Patients

Effect Size d

% of variabili...
The Evolution of Psychotherapy:
What Does Make a Difference ?
Factor

# Studies

# Patients

Effect Size d

% of variabili...
The Evolution of Psychotherapy:
•Baldwin et al. (2007):
•Study of 331 consumers, 81
clinicians.
•Therapist variability in ...
The Evolution of Psychotherapy:
•Despite the evidence:
•Training continues to emphasize
model and technique;
•Therapists f...
The Evolution of Psychotherapy:
What are the “Core Tasks” of Therapy?
The Evolution of Psychotherapy:
A New Question and Focus

•What is the core task
of psychotherapists?

Engagement

“…the m...
Engagement
Understand,
Affirm,
Be Congruent, Genuine, &
Collaborative,
Seek Consensus
Upcoming SlideShare
Loading in …5
×

What are the Core Tasks of Psychotherapy? A Presentation for the 2013 Evolution of Psychotherapy Conference

2,464 views
2,158 views

Published on

A summary of a presentation delivered by Scott D. Miller, Ph.D. at the 2013 Evolution of Psychotherapy conference in Anaheim, California. It contrasts traditional ideas with empirically supported practices.

1 Comment
5 Likes
Statistics
Notes
  • I haven't read all of the research but i do wonder whether the variable of whether the therapist has undergone their own therapy might make a difference to treatment outcomes….?
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
2,464
On SlideShare
0
From Embeds
0
Number of Embeds
54
Actions
Shares
0
Downloads
78
Comments
1
Likes
5
Embeds 0
No embeds

No notes for slide

What are the Core Tasks of Psychotherapy? A Presentation for the 2013 Evolution of Psychotherapy Conference

  1. 1. Expertise and Psychotherapy: Core Tasks Scott D. Miller, Ph.D. International Center for Clinical Excellence
  2. 2. The Evolution of Psychotherapy: So, what’s happened? •Since the 1960’s: •Number of treatment approaches grown from 60 to 400+; •10,000+ “how to” books published on psychotherapy; •145 manualized treatments for 51 of the 297 possible diagnostic groups in DSM. Duncan, B., Miller, S., Wampold, B., & Hubble, M. (eds.) (2009). The Heart and Soul of Change: Delivering What Works. Washington, D.C.: APA Miller, S.D., Hubble, M.A., Chow, D.L., & Seidel, J.A. (2013). The outcome of psychotherapy: yesterday, today, and tomorrow. Psychotherapy, 50, 88-97. Wampold, B.L. (2001). The great psychotherapy debate. Mahwah, NJ: LEAPress.
  3. 3. The Evolution of Psychotherapy: Progress •In most studies of treatment conducted over the last 40 years, the average treated person is better off than 80% of the untreated sample. •No difference in outcome between treatment approaches; •Taken together, comparative, component (dismantling), mediating variable, & aptitude-bytreatment studies all show that specific ingredients are NOT needed to achieve a good outcome. Duncan, B., Miller, S., Wampold, B., & Hubble, M. (eds.) (2009). The Heart and Soul of Change: Delivering What Works. Washington, D.C.: APA Press.
  4. 4. The Evolution of Psychotherapy: Progress ? “Decades of psychotherapy research have failed to find a scintilla of evidence that any specific ingredient is necessary for therapeutic change.” Ahn, H., & Wampold, B. (2001). Where oh where are the specific ingredients: A meta-analysis of component studies in counseling and psychotherapy. Journal of Counseling Psychology, 48(3), 251-257. Duncan, B., Miller, S.D., Wampold, B., & Hubble, M. (2009). The Heart and Soul of Change: Delivering What Works in Therapy. APA: Washington, D.C. Wampold, B. (2001). The Great Psychotherapy Debate. Mahwah, N.J.: LEA, 204.
  5. 5. The Evolution of Psychotherapy: Factor # Studies # Patients Effect Size d % of variability in outcomes Common Factors Alliancea 190 2630 .57 .075 Empathya 59 3599 .63 .090 Goal Consensus/collaborationa 15 1302 .72 .115 Positive Regard/Affirmationa 18 1067 .56 .073 Congruence/Genuinessa 16 863 .49 .057 Specific Ingredients Differences between treatmentsb >5900 <.20 <.010 Adherence to protocolc 28 1334 .04 <.001 Rated competence in delivering particular treatment aNorcross, 295 18 633 .14 .005 J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48(1), 4-8. doi: 10.1037/a0022180 bWampold, B. E. (2001b). The great psychotherapy debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates. cWebb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S. (2011). Two aspects of the therapeutic alliance: Differential relations with depressive symptom change. Journal of Consulting and Clinical Psychology, 79(3), 279-283. doi: 10.1037/a0023252
  6. 6. The Evolution of Psychotherapy: What Does Make a Difference ? Factor # Studies # Patients Effect Size d % of variability in outcomes Common Factors Alliancea 190 2630 .57 .075 Empathya 59 3599 .63 .090 Goal Consensus/collaborationa 15 1302 .72 .115 Positive Regard/Affirmationa 18 1067 .56 .073 Congruence/Genuinessa 16 863 .49 .057 Specific Ingredients Differences between treatmentsb >5900 <.20 <.010 Adherence to protocolc 28 1334 .04 <.001 Rated competence in delivering particular treatment aNorcross, 295 18 633 .14 .005 J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48(1), 4-8. doi: 10.1037/a0022180 bWampold, B. E. (2001b). The great psychotherapy debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates. cWebb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S. (2011). Two aspects of the therapeutic alliance: Differential relations with depressive symptom change. Journal of Consulting and Clinical Psychology, 79(3), 279-283. doi: 10.1037/a0023252
  7. 7. The Evolution of Psychotherapy: What Does Make a Difference ? Factor # Studies # Patients Effect Size d % of variability in outcomes Common Factors Alliancea 190 2630 .57 .075 Empathya 59 3599 .63 .090 Goal Consensus/collaborationa 15 1302 .72 .115 Positive Regard/Affirmationa 18 1067 .56 .073 Congruence/Genuinessa 16 863 .49 .057 Specific Ingredients Differences between treatmentsb >5900 <.20 <.010 Adherence to protocolc 28 1334 .04 <.001 Rated competence in delivering particular treatment aNorcross, 295 18 633 .14 .005 J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48(1), 4-8. doi: 10.1037/a0022180 bWampold, B. E. (2001b). The great psychotherapy debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates. cWebb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S. (2011). Two aspects of the therapeutic alliance: Differential relations with depressive symptom change. Journal of Consulting and Clinical Psychology, 79(3), 279-283. doi: 10.1037/a0023252
  8. 8. The Evolution of Psychotherapy: •Baldwin et al. (2007): •Study of 331 consumers, 81 clinicians. •Therapist variability in the alliance predicted outcome. •Consumer variability in the alliance unrelated to outcome. Baldwin, S., Wampold, B., & Imel, Z. (2007). Untangling the AllianceOutcome Correlation. Journal of Consulting and Clinical Psychology, 75(6), 842-852.
  9. 9. The Evolution of Psychotherapy: •Despite the evidence: •Training continues to emphasize model and technique; •Therapists firmly believe that the expertness of their techniques leads to successful outcomes; •The field as a whole is continuing to embrace the medical model. •Emphasis on so-called, “empirically supported treatments” or “evidence based practice.” •Embracing the notion of diagnostic groups, treatment specificity. Eugster, S.L. & Wampold, B. (1996). Systematic effects of participants role on the evaluation of the psychotherapy session. Journal of Consulting and Clinical Psychology, 64, 1020-1028.
  10. 10. The Evolution of Psychotherapy: What are the “Core Tasks” of Therapy?
  11. 11. The Evolution of Psychotherapy: A New Question and Focus •What is the core task of psychotherapists? Engagement “…the most important determinant of outcome…[this] can be considered fact established by 40plus years of research on psychotherapy.” Miller, S.D., Hubble, M.A., Chow, D.L., & Seidel, J.A. (2013). The outcome of psychotherapy: yesterday, today, and tomorrow. Psychotherapy, 50, 88-97. Orlinsky et al. (2005). Process and outcome in psychotherapy. In M.J. Lambert (ed). The Handbook of Psychotherapy and Behavior Change (5th ed.). New York: Wiley.
  12. 12. Engagement Understand, Affirm, Be Congruent, Genuine, & Collaborative, Seek Consensus

×