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This study sought to investigate the extent to which therapists endorse techniques outside of their self-identified orientation and which techniques are endorsed across orientations. A survey consisting of 127 techniques from 8 major theories of psychotherapy was administered via U.S. mail to a national random sample of doctoral-level psychotherapy...
Contexts in source publication
Context 1
... regarding the therapists' self- identified theoretical orientation is presented in Table 1. Participants were asked to identify their primary orientation from 14 choices: behavioral, client-centered, cognitive, cognitive-behavioral, constructivist, existential, gestalt, humanistic, integrative/eclectic, interpersonal, psychoana- lytic, psychodynamic, systems, and other (spec- ify). ...
Context 2
... left six main therapist groups: cognitive-behavioral, humanistic, eclectic, psychodynamic, systems, and other. The num- bers of therapists included in each of the larger broadband orientations is shown in Table 1. Henceforth in this paper orientation will be used to refer to broadband orientation. ...
Context 3
... in this paper orientation will be used to refer to broadband orientation. As seen in Table 1, the categories systems and other each make up less than 3.0% of the thera- pists in this sample and are also small in absolute numbers, at six and two therapists, respectively. These two orientation categories were dropped from further analysis. ...
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Citations
... respect to the techniques that they teach their trainees or employ in their day-to-day work (e.g., Beidas et al., 2015;Castonguay et al., 2023;Thoma & Cecero, 2009). Such techniques are also the key ingredients defining and discriminating treatment protocols that are investigated in research trials (Perepletchikova et al., 2007). ...
... Another critique was that Robins' analysis neglected clinical journals (Martens, 2000). An interesting study by Kiselica et al. later undertook this exercise, finding that all three major sub-disciplines of psychotherapy-psychodynamic, cognitive-behavioral, and humanistic (Thoma & Cecero, 2009)-are working in relative isolation from each other, with less than 1% of the references in two of the leading journals per sub-discipline citing journals from the other subdisciplines (Kiselica & Ruscio, 2014). They also found that references to other clinical psychology journals were considerably more frequent in the cognitive-behavioral journals (36%) than they were in the humanistic (7%) and psychodynamic ones (4%). ...
... Moreover, academic psychology is not the same as psychology as it is applied in clinical practice, a setting in which several theoretical backgrounds are used in the administration of psychotherapy (Altmann et al., 2016;Alvarez, 2020;Singer et al., 2017;Thoma & Cecero, 2009), and the variety of sub-disciplines in this field has been found to be both sensible and necessary (Leichsenring et al., 2019). ...
At the end of the last century, there was a debate about whether cognitive psychology had superseded behavioral psychology and psychoanalysis, and the question was raised of whether the latter two might even be dead. The aim of this study was to investigate how these sub-disciplines have developed since then. The citation count, Journal Impact Factor (JIF), and Immediacy Index of four leading journals from each sub-discipline were abstracted for the years 1998, 2008, and 2018. Trends were analyzed using joinpoint regression analysis. The average number of times each sub-discipline’s journals were cited increased between 1988 and 2018. The cognitive journals’ JIF increased slightly, the behavioral journals’ doubled, and the psychoanalytic journals’ remained at the same level. The average annual percentage change for citations to the International Journal of Psychoanalysis showed that the number of citations statistically significantly increased over the years. This was also the case for the Journal of Applied Behavior Analysis. Its JIF trend changed at one point: it decreased up through 2006, after which it increased. Citations to Cognitive Psychology also increased over time, while there was no evidence that its JIF changed. This shows that all three sub-disciplines are still alive and relevant.
... The demands of addressing the myriad of problems encountered with diverse clients pushes therapists away from a purist mentality and into a practical approach of finding out what works for each client [43]. A survey by Thoma and Cecero [44] found that even therapists espousing to be pure-form clinicians (following cognitive-behavioral, psychodynamic, or humanistic orientations) reported using more techniques from outside their orientations than from within their orientation. ...
Background
Psychotherapists must choose from an overwhelming number of theoretical models and empirically supported treatments to guide their work. Meta-analytic studies show there is comparable efficacy among the choices, making the decision about which approach to use difficult. Research indicates there are pantheoretical elements found in all effective models, called the common factors, which can offer psychotherapists a focusing point to maximize their effectiveness regardless of their chosen approach. Most psychotherapists begin practicing from a traditional theoretical orientation, but then their approach evolves over time toward an unintentional eclecticism, derived primarily from their practice experience with clients.
Methods
This exploratory qualitative study conducted in-depth interviews with six experienced clinical social workers about their evolution as psychotherapists and what they believe creates change in psychotherapy. The interviews were conducted using standardized prompts and then coded and analyzed utilizing thematic analysis based on a six-phase framework.
Results
The analysis suggests the psychotherapists had evolved to conducting therapy via an implicit and unique approach based on an unintentional heavy use of common factors. Five prominent themes emerged as central components of change in psychotherapy: the therapeutic relationship as a primary change agent, the importance of the therapist genuineness, the need to acknowledge and act upon a poor therapist—client match, the client bearing the primary responsibility for change, and the therapists’ development of unintended eclecticism in response to client interactions.
Conclusions
In practice, most psychotherapists start practicing from a traditional theoretical orientation only to find their approach evolves over time toward an informal eclecticism featuring common factors. This common factors-based eclecticism emerges primarily from practice experience with clients. These findings suggest an avenue for further inquiry—if psychotherapists are going to gradually evolve in an unplanned eclectic direction guided by their client interactions, are they also concurrently and inherently drawn to the common factors? If the answer proves to be yes, what are the implications for early training? Should the gradual emphasis toward common factors be supplanted with a more intentional and efficient focus on them in the training of students and early career clinicians?
... Given the prevalence of comparative research in both psychodynamic-interpersonal and cognitive-behavioural treatment modalities, the accompanying increase in integration of theory, practice, and research is understandable. Currently, psychotherapy integration appears to be in widespread use, with research demonstrating that a majority of therapists report regularly utilizing techniques outside of their identified orientation (Thoma & Cecero, 2009). Researchers have further proposed that thoughtful integration may better suit the specific needs of each in-dividual patient (Ablon & Jones, 1998). ...
This study examines the relationship between patient personality characteristics and therapeutic integration. Within a sample of patients (N = 93) receiving outpatient psychodynamically- oriented psychotherapy, we assessed patient Borderline and Emotionally Dysregulated personality features through the Shedler-Westen Assessment Procedure (SWAP-200), and therapeutic technique using the Comparative Psychotherapy Process Scale (CPPS) during an early treatment session. We examined personality dimensionally, psychotherapy interventions across different theoretical orientations, as well as psychotherapy integration. These analyses revealed an overlap between the Borderline Clinical Prototype and the Emotionally Dysregulated-Dysphoric Q-factor, with the former associated with higher use of integration and the latter associated with higher use of either psychodynamic- interpersonal or cognitive-behavioral interventions. Secondary analyses also indicated the greater presence of interventions oriented towards emotional exploration and to the didactic instruction of effective symptom coping techniques across both of these personality subtypes early in treatment. The key differences between these personality types, as well as the theoretical, empirical, and clinical implications of these findings are discussed.
... It is not uncommon for therapists to incorporate techniques and perspectives outside of their own psychotherapy orientation (Thoma & Cecero, 2009) and there is some evidence that therapists who hold a flexible stance and are open to greater integration produce better treatment alliance and outcomes for clients (Boswell et al., 2019;Goldman et al., 2013Goldman et al., , 2018. In other words, clients who present with symptomatology for which several ESTs exist (e.g., cognitivebehavioral therapy and short-term dynamic therapy for Anxiety disorders) might benefit from techniques from these different modalities in facilitating the change process (Glock et al., 2018). ...
Many clinicians hold misperceptions about evidence-based practice (EBP), and evidence-based psychodynamic therapy (PDT) in particular. It is important to address these beliefs and attitudes in graduate training and help students to consider evidence-based interventions from a range of theoretical orientations. This study reports on a required 15-week course in evidence-based PDT within two graduate psychology doctoral programs. Eighty-five students completed measures of attitudes toward EBP and PDT prior to the first class and after the final class. Students who identified with different theoretical orientations—integrative, CBT, or PDT—did not differ in attitudes toward EBP, and student attitudes toward EBP remained stable. Students with a precourse CBT orientation viewed PDT less favorably than those with a psychodynamic orientation. Attitudes toward PDT improved significantly across all orientations, but CBT-oriented students reported the largest gains in positive attitudes toward PDT as compared to students with a PDT or integrative orientation. The results support the use of graduate training in evidence-based PDT to improve attitudes toward specific aspects of EBP and PDT. Findings also highlight the mutability of student attitudes and the potential for fostering an integrative approach to EBP that includes PDT. Further research is warranted to examine whether graduate courses in EBP can lead to use of a wider range of therapy interventions with clients.
... Much of the research with the CPQ has shown psychodynamic clinicians and treatments to be more integrative than expected (Gastaud et al., 2015;Goodman, 2015;Ramires et al., 2017). In general practice, therapists across a wide range of treatment modalities indicate that they use techniques from theoretical orientations outside of their primary orientation (Thoma & Cecero, 2009). Even in controlled, laboratory settings, with the use of a standardized treatment manual, psychotherapy often includes elements of psychotherapy process from multiple theoretical approaches (Ablon et al., 2006). ...
Proceso de psicoterapia en la psicoterapia enfocada en la regulación para niños
Comprender el proceso de la psicoterapia proporciona un camino hacia la comprensión de los mecanismos de cambio y factores terapéuticos en psicoterapia psicodinámica. Este estudio examina el proceso de psicoterapia en la Psicoterapia Focalizada en la Regulación para Niños (RFP-C), un tratamiento psicodinámico manualizado y de tiempo limitado diseñado para niños con trastornos de conducta disruptiva. Sesenta sesiones de psicoterapia infantil, de 20 niños (13 varones, siete hembras; edad media = 8) diagnosticados con trastorno de oposición desafiante, fueron codificados usando el Q-Set de Psicoterapia Infantil. Los resultados indican que factores comunes caracterizaron las sesiones reales de RFP-C en mayor grado que lo esperado, con sesiones adhiriéndose significativamente al RFP-C, Terapia Psicodinámica, Terapia Cognitivo-Conductual, Terapia de juego centrada en el niño y prototipos de función reflexiva. Los resultados del model multinivel sugirieron una amplia gama de variabilidad en términos de los efectos del paciente y del terapeuta a través de los procesos de psicoterapia en esta modalidad de terapia infantil. Los terapeutas se adhirieron más al prototipo cognitivo-conductual cuando en tratamiento de niños con problemas comórbidos de atención. La fidelidad al prototipo RFP-C aumentó con el tiempo y los análisis de regresión múltiple indicaron que la adherencia al prototipo de PDT (b = ,85, p = 0,024) fue predictiva de una reducción de síntomas mayor. En general, las sesiones de RFP-C en este estudio fueron menos fiel al prototipo de lo previsto y la adherencia al proceso de psicoterapia psicodinámica fue predictiva de mejoras en síntomas. Se comentan las limitaciones, las direcciones para futura investigación y las implicancias clínicas.
... This tendency perhaps represents a shift that has taken place in a broader context, i.e.,, psychotherapy. The majority of psychotherapists, among them psychoanalytic psychotherapists, have been found to borrow and utilize interventions from other orientations when they find their self-identified modality to be insufficient in assisting the client's development (Thoma & Cecero, 2009). ...
This study explored psychoanalytic supervisees’ conceptualization of good supervision. Fourteen registered psychoanalytic psychotherapists recognized by the Irish Council for Psychotherapy were interviewed. Using Interpretative Phenomenological Analysis, interviews were analysed, and this process yielded two superordinate themes encompassing five subordinate themes. The superordinate theme providing illumination encapsulated the participants’ experiences of illuminating the self and illuminating the client. The superordinate theme helping with emotional management referred to the participants’ conceptualization of supervision as containing participants’ difficult emotions, normalizing clinical difficulties and feeling accompanied. The findings are discussed in light of their implications for practice and theory. Of particular interest is the relief that participants felt when their fears and anxieties were addressed and worked through in supervision. In addition, the study builds a foundation for future research studies to explore the supervisee insight and identify more specific types of insight.
... Researchers have conducted several studies to assess how frequently therapists use certain strategies with their patients. Although strategies that enhance the therapeutic relationship are typically the most frequently endorsed (e.g., empathizing with patients; communicating unconditional positive regard), the next most common strategies therapists use include cognitive restructuring; planning healthy, fun, or more effective behaviors; and promoting greater awareness of the patient's behaviors, emotions, and thoughts (Cook et al., 2010;Mussell et al., 2000;Thoma & Cecero, 2009). Thus, although there seems to be some consensus in the findings from both basic research and reports of in-session behaviors that cognitive restructuring and reappraisal are important strategies, less is known about points of agreement regarding other strategies. ...
... Further, not all therapists rate strategies similarly. For instance, therapists with a primary cognitive-behavioral or eclectic theoretical orientation reported using cognitive, behavioral, and constructivist strategies more frequently than therapists with a primary psychodynamic or humanistic orientation (Thoma & Cecero, 2009). Given that different theoretical orientations are associated with different mechanisms of change in treatment, they will likely emphasize certain emotion regulation strategies over others. ...
Objective
To develop more unified, process‐based, and disseminable psychotherapy treatments, it is important to determine whether there is consensus among therapists regarding intervention strategies.
Design
Because emotion regulation is a cornerstone of modern treatments and a thriving area of clinical research, we assessed therapists’ ratings of the effectiveness of commonly studied emotion regulation strategies.
Methods
Therapists (n = 582) read eleven vignettes describing stressful scenarios and rated the effectiveness of ten emotion regulation strategies in each scenario.
Results
Across therapists, we found general consensus regarding the most (i.e., problem‐solving) and least (i.e., concealing emotions) effective strategies. Cognitive/behavioural/third‐wave therapists rated acceptance and distraction as more effective, and emotional expression and gathering information as less effective, than other therapists, Fs> 4.20, ps < .05, whereas hours of clinical experience were generally unrelated to strategy effectiveness ratings.
Conclusions
We discuss what these points of agreement and relative disagreement among therapists reveal about a more unified, process‐based treatment approach and how these results can guide emotion regulation research.
Practitioner points
• There is general consensus among practising therapists that problem‐solving is the most effective emotion regulation strategy and expressive suppression is the least effective.
• However, CBT‐oriented therapists rated acceptance and distraction as more effective than non‐CBT‐oriented therapists.
• Non‐CBT‐oriented therapists rated emotional expression and gathering information as more effective than CBT‐oriented therapists.
• Years of experience were unrelated to ratings of emotion regulation strategy effectiveness.
... Moreover, the threecomponent structure can provide a framework for the integration of multiple psychotherapeutic theories and methods at the middle level of abstraction, emphasizing the practical use of change principles without creating a new theoretical orientation. Given the popularity of psychotherapy integration among training directors (Lampropoulos & Dixon, 2007), as well as psychotherapy and counselling practitioners (e.g., Hollanders & McLeod, 1999;Jensen, Bergin, & Greaves, 1990; Thoma & Cecero, 2009), there is a need for such trans-theoretical frameworks that help organize the multitude of psychotherapy approaches into a coherent system (e.g., Consoli & Jester, 2005). Our study offers an easy-to-use working model that is based on the practical use of change principles in counsellors' and psychotherapists' daily practice. ...
Many authors have proposed the existence of common principles of counselling and psychotherapeutic change. However, little is known about how practitioners use these change principles. A sample of N = 373 Czech psychotherapists and counsellors participated in an online survey and rated their use of ten psychotherapy change principles in their practice over the last year. The frequency of the use of the ten change principles is reported. Furthermore, three principal components of the change principles were identified: Exploration, acceptance, and understanding of clients’ experience, Attending to clients’ own resources, and Furnishing clients with new skills and advice. The use of these components was mainly associated with the practitioner's theoretical orientation. The implications of the component structure for psychotherapist and counsellor training and practice are discussed.
... Researchers have conducted several studies to assess how frequently therapists use certain strategies with their patients. Although strategies that enhance the therapeutic relationship are typically the most frequently endorsed (e.g., empathizing with patients; communicating unconditional positive regard), the next most common strategies therapists use include cognitive restructuring; planning healthy, fun, or more effective behaviours; and promoting greater awareness of the patient's behaviours, emotions, and thoughts (Cook et al., 2010;Mussell et al., 2000;Thoma & Cecero, 2009). Thus, although there seems to be some consensus in the findings from both basic research and reports of in-session behaviours that cognitive restructuring and reappraisal are important strategies, less is known about points of agreement regarding other strategies. ...
... Further, not all therapists rate strategies similarly. For instance, therapists with a primary cognitive-behavioural or eclectic theoretical orientation reported using cognitive, behavioural, and constructivist strategies more frequently than therapists with a primary psychodynamic or humanistic orientation (Thoma & Cecero, 2009). Given that different theoretical orientations are associated with different mechanisms of change in treatment, they will likely emphasize certain emotion regulation strategies over others. ...
Objective: To develop more unified, process-based, and disseminable psychotherapy treatments, it is important to determine if there is consensus among therapists regarding intervention strategies. Design: Because emotion regulation is a cornerstone of modern treatments and a thriving area of clinical research, we assessed therapists’ ratings of the effectiveness of commonly studied emotion regulation strategies. Methods: Therapists (n = 582) read eleven vignettes describing stressful scenarios and rated the effectiveness of ten emotion regulation strategies in each scenario. Results: Across therapists, we found general consensus regarding the most (i.e., problem-solving) and least (i.e., concealing emotions) effective strategies. Cognitive/behavioral/third-wave therapists rated acceptance and distraction as more effective, and emotional expression and gathering information as less effective, than other therapists, Fs > 4.20, ps < .05, whereas hours of clinical experience were generally unrelated to strategy effectiveness ratings. Conclusions: We discuss what these points of agreement and relative disagreement among therapists reveal about a more unified, process-based treatment approach and how these results can guide emotion regulation research.
