1. Common Factors Approach
to Counselling and Psychotherapy
2007
Forrest James and Chris Lobsinger

2. We are fundamentally the same
but culturally influenced.

3. Common Factors Approach to
Psychotherapy
 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. Warm Up Exercise
 In small groups
 Two stories each
 One about a time when cultural information was
helpful to you in your work.
 One where cultural information was unhelpful to you
in your work.
 Discuss in the large group

5. Etic vs. Emic debate
 Etic: approaches to counselling and
psychology cultural generalisable or
universal.
 Emic: Approaches to counselling and
psychology are designed to be culturally
specific relative.

6. The Old Presumption
 That the efficacy of a particular approach to therapy
is due to the unique aspects of that therapy.
 Psychoanalytic - Interpretations
 CBT – Modifications of cognitions
 EMDR- Eye movements
 Narrative therapy- Externalization
 Gestalt- Empty chair

7. The New Assumption
The common factors found in
conventional psychotherapy
and in healing across cultures
can serve as a framework for
multicultural counselling.

8. The New Rationale
The curative properties of a
given psychotherapy lie not in
its unique components but in
common components shared
by all psychotherapies.

9. Fishers Common Components in
Multicultural Counselling Fisher et al
 1. The Therapeutic Relationship
 2. Shared World View
 3. Client Expectations
 4. Ritual or Intervention
Ann R. Fisher, LaRae M. Jome Reconceptualizing Multicultural Counseling: Universal Healing
conditions in a culturally Specific Context The counselling psychologist,Vol.26 No4,July 1998 525-588 .

10. Common factors in culturally specific
context
 Combining the extremes of universalism and
relativism by explaining behavior both in
terms of culture and in terms of universals.
 Body Metaphor: The skeleton is ‘common
factors’ and the flesh is ‘cultural knowledge’.

11. Lamberts Common Factors
Lambert,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:
Wiley
LAMBERT’S FACTORS

12. Relationship
 Therapeutic relationship refers to a range of
variables that are found in therapy that are evident
irrespective of practice orientation. Empathy,
unconditional positive regard, encouragement…
30%

13. Extra Therapeutic Change
 Are brought to the therapy and aid recovery
regardless of intervention.
E.g. Social, Environmental , Community, and other
factors.
40%

14. Technique
 Factors that are unique to the practice
approach employed.
15%

15. Placebo or Expectancy
 Refers to the change that may be attributed
to the client knowledge that they are to be
treated by a credible techniques and rational.
15%

16. Lambert vs. Fisher
 Therapeutic relationship
 Extra-therapeutic
change
 Expectancy Placebo
 Techniques
 The therapeutic
relationship
 Shared world view
 Client expectations
 Ritual or intervention

17. Heuristic
(Pertaining to how something is discovered)
How can each of the common
factors be addressed given this
person’s culture and context?

18. The Therapeutic Relationship
Ethnically match clients (where possible)
The client needs to have confidence in the
therapist’s competence (own your expertise and that of
your culture/training?)
Client must feel that the therapist
genuinely cares
Giving the client a ‘gift’? ( symbolic, educative,)
Use of disclosure?

19. Shared Worldview
 Clients prefer counsellor who share their
views.
 Client's assumption about the world
 Explanatory model

20. Client Expectations
Increase expectation that
counseling will bring relief.
Expertise and credibility?
‘Gift giving’ (symbolic or educative)

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 be
helpful?

22. Working Alliance (3 Dimensions)
1. Bond – the relational aspect of the alliance; sense of
connection, understanding, respect, caring and trust.
– Absolutely necessary but not sufficient
2. Goals – overall purpose direction and specific
changes sought.
3. Tasks – the respective roles and responsibilities of
the 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 in
counselling”

23. Alliance Ruptures
 Ruptures are inevitable
 ‘Tear and Repair’ rule:
– Capacity to negotiate and repair ruptures is an
essential therapeutic task – some would say the
primary therapeutic task
(Safran and Muran 2000)
 Identifying rupture markers is indispensable
for this task.

24. Alliance Ruptures
 Ruptures are marked by subtle shifts in the client’s
affect and behavior and can be divided into:
1. Withdrawal markers – characterized by indirect
communication of negative feelings, surface
compliance, distancing, and avoidance because the
client is partially disengaging with from the therapist,
one’s feelings, or part of the therapy process.
– Withdrawals may be more difficult to identify than
confrontations due to the indirect nature of the
communication from the client and because they may not
evoke a strong reaction in the therapist.

25. Alliance Ruptures
2. Confrontation markers – characterized by
overt expressions of negative feelings toward
the therapist and overt expression of
disagreements about the goals and tasks of
therapy.
NB – Specific training on Alliance Ruptures will
be part of next quarterly training.

26. Points to Consider
 Use of culturally specific information can be helpful
or harmful.
 Stereotypes are natural but inadequate
 Culture is not always right.
 Behavior is meaningless outside of cultural context

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 of
counselling only a more aware approach which takes
less for granted.

28. EXCERCISE
 In group of three take turns discussing.
 Each person consider a case where one of
fishers factors could have been used to
better effect? And How you might have done
this.

29. References
Ann R. Fisher, LaRae M. Jome Reconceptualizing Multicultural
Counseling: Universal Healing
conditions in a culturally Specific Context The counselling
psychologist,Vol.26 No4,July 1998 525-588
Lambert,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: Wiley
Mark A. Hubble Barry L. Duncan Scott D. Miller, The Heart and Soul of
Change, What works in
Therapy Copywright 1999