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May 8, 2018

The Components of Psychotherapy

Cover of Journal of Psychotherapy Integration (small)Therapists use different types of techniques during a psychotherapy session. These can be divided into "specific and "non-specific" psychotherapy components.

Specific components are unique techniques based on the theoretical orientation of a particular treatment — for example, weighing the evidence for and against automatic thoughts in cognitive behavior therapy.

Non-specific components are techniques that are shared across many psychotherapies — for example, developing a therapeutic alliance and providing opportunity for emotional catharsis.

In their recently published article in the Journal of Psychotherapy Integration, authors Marlissa Amole, Jill Cyranowski, Laren Conklin, John Markowitz, Stacy Martin, and Holly Swartz (2017) demonstrated the successful use of an established measure, the Collaborative Study Psychotherapy Rating Scale (CSPRS), to evaluate therapists' use of specific and non-specific components in two affect-focused treatments for depression — interpersonal psychotherapy (IPT) and brief supportive psychotherapy (BSP).

IPT is a structured, time-limited treatment focused on the reciprocal relationship between mood states and interpersonal problems that commonly trigger or exacerbate depressive episodes. BSP is also time-limited and affect-focused; however, it is non-directive except to explore patients' affective responses. BSP rests primarily on non-specific components and has often been used as an active psychotherapy comparator condition to control for common non-specific components in psychotherapy trials.

Raters who were blind to the type of treatment delivered listened to 180 audio-recorded psychotherapy sessions. Using the CSPRS, raters discriminated between therapies with 97% accuracy.

Ratings on component subscales showed that both IPT and BSP therapists used similarly high levels of non-specific components, such as warmth and empathy. As expected, IPT therapists were more directive and used more IPT-specific strategies, while BSP therapists utilized more non-directive, supportive strategies.

BSP therapists displayed a greater focus on feelings (i.e., encouraging the identification, acceptance, and exploration of affect) than IPT therapists. This likely reflects the fact that BSP therapists had a limited number of alternative techniques available, whereas IPT therapists have at their disposal multiple specific interpersonal strategies that vie for session time.

Amole and colleagues were interested in the relative use of specific vs non-specific components over the course of treatment.

In exploratory analyses, the authors found that therapists typically use more specific strategies earlier in treatment and more non-specific strategies toward the end of treatment. They also found that a greater focus on feelings, a non-specific strategy, during early sessions (i.e., sessions 2–4) was associated with greater depressive symptom reduction in the first eight weeks of treatment.

Greater use of specific strategies was unrelated to symptom change. This suggests that identification and exploration of emotions are crucial to any successful therapy, especially early in treatment. Premature introduction of directive techniques, which is common among early therapists who are less comfortable with patient negative affect, may not allow enough time to build an alliance or experience relevant emotions.

The results of this study highlight the possibility of using measures like the CSPRS to assess the components of psychotherapy and their effect on outcomes within empirically supported treatments without the need for dismantling the treatments.

Future research should examine the reciprocal relationship between therapist use of strategies and patient symptom change over time and explore the optimal balance of specific vs non-specific components.

The authors believe that therapy is as much an art as it is a science and that an important part of successful treatment is the therapist's ability to balance and creatively weave together the component parts.

Citation

  • Amole, M. C., Cyranowski, J. M., Conklin, L. R., Markowitz, J. C., Martin, S. E., & Swartz, H. A. (2017). Therapist use of specific and nonspecific strategies across two affect-focused psychotherapies for depression: Role of adherence monitoring. Journal of Psychotherapy Integration, 27(3), 381–394. http://dx.doi.org/10.1037/int0000039

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Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.

About the Author

Marlissa Amole is a doctoral candidate in the clinical psychology program at the University of Pittsburgh.

She is interested in interpersonal dynamics in close relationships such as parent-child, romantic, and therapist-client.

You can reach Ms. Amole via email.