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Lecture 9 common factors



Common factors approach

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Common factors approach

  1. 1. Common Factors Approachto Counselling and Psychotherapy2007Forrest James and Chris Lobsinger
  2. 2. We are fundamentally the samebut culturally influenced.
  3. 3. Common Factors Approach toPsychotherapy Warm up Exercise Etic vs. Emic debate, Presumption. Assumptions Rationale for common factors approach Fishers Common factors in Therapy Lambert common Factors Working Alliance and Alliance Ruptures Points to consider
  4. 4. Warm Up Exercise In small groups Two stories each One about a time when cultural information washelpful to you in your work. One where cultural information was unhelpful to youin your work. Discuss in the large group
  5. 5. Etic vs. Emic debate Etic: approaches to counselling andpsychology cultural generalisable oruniversal. Emic: Approaches to counselling andpsychology are designed to be culturallyspecific relative.
  6. 6. The Old Presumption That the efficacy of a particular approach to therapyis due to the unique aspects of that therapy. Psychoanalytic - Interpretations CBT – Modifications of cognitions EMDR- Eye movements Narrative therapy- Externalization Gestalt- Empty chair
  7. 7. The New AssumptionThe common factors found inconventional psychotherapyand in healing across culturescan serve as a framework formulticultural counselling.
  8. 8. The New RationaleThe curative properties of agiven psychotherapy lie not inits unique components but incommon components sharedby all psychotherapies.
  9. 9. Fishers Common Components inMulticultural Counselling Fisher et al 1. The Therapeutic Relationship 2. Shared World View 3. Client Expectations 4. Ritual or InterventionAnn R. Fisher, LaRae M. Jome Reconceptualizing Multicultural Counseling: Universal Healingconditions in a culturally Specific Context The counselling psychologist,Vol.26 No4,July 1998 525-588 .
  10. 10. Common factors in culturally specificcontext Combining the extremes of universalism andrelativism by explaining behavior both interms of culture and in terms of universals. Body Metaphor: The skeleton is ‘commonfactors’ and the flesh is ‘cultural knowledge’.
  11. 11. Lamberts Common FactorsLambert,M.J.&Bergan,A.E.1994 The effectiveness of psychotherapy. In A.E.Bergin & S.L.Garfield (eds) Handbook of psychotherapy and behavior change (pp.143-189)new York:WileyLAMBERT’S FACTORS
  12. 12. Relationship Therapeutic relationship refers to a range ofvariables that are found in therapy that are evidentirrespective of practice orientation. Empathy,unconditional positive regard, encouragement…30%
  13. 13. Extra Therapeutic Change Are brought to the therapy and aid recoveryregardless of intervention.E.g. Social, Environmental , Community, and otherfactors.40%
  14. 14. Technique Factors that are unique to the practiceapproach employed.15%
  15. 15. Placebo or Expectancy Refers to the change that may be attributedto the client knowledge that they are to betreated by a credible techniques and rational.15%
  16. 16. Lambert vs. Fisher Therapeutic relationship Extra-therapeuticchange Expectancy Placebo Techniques The therapeuticrelationship Shared world view Client expectations Ritual or intervention
  17. 17. Heuristic(Pertaining to how something is discovered)How can each of the commonfactors be addressed given thisperson’s culture and context?
  18. 18. The Therapeutic RelationshipEthnically match clients (where possible)The client needs to have confidence in thetherapist’s competence (own your expertise and that ofyour culture/training?)Client must feel that the therapistgenuinely caresGiving the client a ‘gift’? ( symbolic, educative,)Use of disclosure?
  19. 19. Shared Worldview Clients prefer counsellor who share theirviews. Clients assumption about the world Explanatory model
  20. 20. Client ExpectationsIncrease expectation thatcounseling will bring relief.Expertise and credibility?‘Gift giving’ (symbolic or educative)
  21. 21. Ritual or Intervention Healing systems reflect the values,assumptions, and themes of the culture. Spirituality, e.g. Bible reading Negotiating the ritual or intervention Directive vs. non-directive Culturally specific interventions may behelpful?
  22. 22. Working Alliance (3 Dimensions)1. Bond – the relational aspect of the alliance; sense ofconnection, understanding, respect, caring and trust.– Absolutely necessary but not sufficient2. Goals – overall purpose direction and specificchanges sought.3. Tasks – the respective roles and responsibilities ofthe client and therapist in working toward these goals(within and outside the session) Bordin 1979“Good working alliance is the best indictor of positive outcome incounselling”
  23. 23. Alliance Ruptures Ruptures are inevitable ‘Tear and Repair’ rule:– Capacity to negotiate and repair ruptures is anessential therapeutic task – some would say theprimary therapeutic task(Safran and Muran 2000) Identifying rupture markers is indispensablefor this task.
  24. 24. Alliance Ruptures Ruptures are marked by subtle shifts in the client’saffect and behavior and can be divided into:1. Withdrawal markers – characterized by indirectcommunication of negative feelings, surfacecompliance, distancing, and avoidance because theclient is partially disengaging with from the therapist,one’s feelings, or part of the therapy process.– Withdrawals may be more difficult to identify thanconfrontations due to the indirect nature of thecommunication from the client and because they may notevoke a strong reaction in the therapist.
  25. 25. Alliance Ruptures2. Confrontation markers – characterized byovert expressions of negative feelings towardthe therapist and overt expression ofdisagreements about the goals and tasks oftherapy.NB – Specific training on Alliance Ruptures willbe part of next quarterly training.
  26. 26. Points to Consider Use of culturally specific information can be helpfulor harmful. Stereotypes are natural but inadequate Culture is not always right. Behavior is meaningless outside of cultural context
  27. 27. Points to consider Expert insider vs. Interested outsider Uncertainty is the hallmark of cross-cultural work Cross-cultural work is not a special branch ofcounselling only a more aware approach which takesless for granted.
  28. 28. EXCERCISE In group of three take turns discussing. Each person consider a case where one offishers factors could have been used tobetter effect? And How you might have donethis.
  29. 29. ReferencesAnn R. Fisher, LaRae M. Jome Reconceptualizing MulticulturalCounseling: Universal Healingconditions in a culturally Specific Context The counsellingpsychologist,Vol.26 No4,July 1998 525-588Lambert,M.J.&Bergan,A.E.1994 The effectiveness of psychotherapy. InA.E.Bergin & S.L. Garfield (eds) Handbook of psychotherapy andbehavior change (pp.143-189)new York: WileyMark A. Hubble Barry L. Duncan Scott D. Miller, The Heart and Soul ofChange, What works inTherapy Copywright 1999
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