BulletPointsummary of Essential Research Findings in Counselling and Psychotherapy by Cooper - 1st edition

What is the importance of research? - BulletPoints 1

• Research refers to the systematic analysis process that leads to the development of new knowledge. Empirical means that something is based on experiences or observations (as in experiments) as opposed to theoretical assumptions. Qualitative research is research based on language, in which experiences, perceptions, observations, etc. are not reduced to a numerical form. Quantitative research is research based on numbers, usually using statistical analyzes.
• Results from studies can be helpful because:
  1. they can give counselors and psychotherapists (as well as clients) some very good ideas about where to start from in the absence of other information;
  2. they can tell us more about the probability of certain things happening;
  3. they can help therapists understand the therapy from the client's perspective
  4. they can be a means of communication about the work being carried out.

How do we know whether therapy works or not? - BulletPoints 2

• Thousands of studies have been conducted in the last half-century into whether therapy is successful. The results of these studies provide an unambiguous answer: yes. Among other things, the well-being of participants was compared before, and after therapy. However, pre- and post-test scores alone are not sufficient to conclude that psychotherapy is responsible for the observed changes in well-being. It could also be the case that the problems simply disappear over time, which is called spontaneous remission. Therefore, it is important to measure change using a control group. This means that the group of individuals who have undergone therapy (the experimental group) is compared to a comparable group of individuals who have not undergone therapy (the control group). In this way, the efficiency of therapy, the potential to produce the desired effect, can be determined with greater certainty.
• Studies using a control group show that therapy does indeed produce positive changes.
• The most commonly used effect measure is Cohens ' d'. A 'd ' of 0.2 is considered a small effect, of 0.5 as a medium effect and of 0.8 as a large effect. This standardized measure allows researchers to combine results from multiple studies, even when using different measurement instruments.
• Research shows that, on average, clients do not continue to improve after the therapy is finished (= sleeper effect), but do not deteriorate either.

What do therapeutic approaches look like? - BulletPoints 3

• Certain therapies are better (more suitable) for certain types of psychological stress. It is therefore important to identify the specific problem of an individual. Then, it is best to look for the most effective form of therapy. Empirically supported interventions are therapeutic applications, of which the effectiveness for certain client groups has been demonstrated by rigorous experimental studies.
• The dodo bird verdict is the claim that different bonafide therapies are approximately equivalent to each other when it comes to efficacy and effectiveness.
• The debate between differential effectiveness and the dodo bird verdict could go on forever. How do we determine which perspectives and research results are favorable for the therapist and the client and which are not? It is good to assume that both non-specific and specific factors can contribute to psychological change. Lambert's research shows that nonspecific factors account for about eighty-five percent of the variance of therapeutic outcomes. Thus, fifteen percent of the variance can be attributed to the therapist's specific techniques or model.

Which client factors influence the therapeutic process? - BulletPoints 4

• The level of active participation in the therapy is one of the best predictors of the outcome of the therapy. It is responsible for at least twenty percent of the improvement. Furthermore, clients who cooperate with the therapist do better during the therapy.
• The level of resistance is a good predictor of unwanted results. Resistance refers to the behavior of the client that shows that there is a reluctance to participate in the tasks of the therapy.
• Client openness to defensive behavior appears to be a good predictor of positive therapeutic outcomes. Furthermore, it has been found that intrinsic or autonomous motivation to participate in therapy is also a good predictor of this. This concerns the extent to which clients have voluntarily chosen to participate in therapy.
• Fifteen percent of the variance of the therapeutic result can be explained by the client's belief in the effectiveness of the therapy ('self- fulfilling prophecy'). The client's expectations are related to the outcome of the therapy. However, there is a difference between certain client groups. For example, clients with substance abuse or anxiety problems may do better when they have high expectations, but this is not true for clients with depression.
• Predilection refers to the client's belief about the origin of their stress and what will be helpful against this stress.
• Clients with a higher level of manifested overt stress have better clinical outcomes. People with higher levels of psychosocial functioning seem to benefit the least from therapy.
• Personality disorders are relatively long-lasting maladaptive (character) traits that can result in significant subjective stress and functional deterioration. Clients with psychological comorbidity (multiple mental disorders) appear to benefit less from therapy. It also appears that the more serious the personality disorder, the worse the therapeutic result. However, there appears to be a difference between various personality disorders. For example, clients with borderline or schizotypal personality disorder appear to have poorer therapeutic outcomes compared to clients with a dependent personality disorder.
• The attachment style refers to an individual's pattern of behavior, thoughts, and feelings in close relationships. There are three types of attachment styles: safe, preoccupied/ambivalent and avoidant. Clients with a secure attachment style benefit more from therapy compared to clients with an unsafe attachment style. Furthermore, people with interpersonal difficulties (non-assertive, hostile, social avoidance) also benefit less from therapy.
• Clients with a higher level of perfectionism show less improvement on a range of indicators compared to clients with a lower level of perfectionism.
• Psychological mindedness is the ability to understand people and their problems in psychological terms.
• Client factors are identifiable beyond what takes place during therapy and are relatively stable and solid. This means that these factors are not just about the client's direct feelings towards the therapist. A good example of client factors is the personal characteristics of the client. A distinction can be made here between implicit and observable client factors.
• The basic assumption behind the 'Stages of Change' model of Prochaska and DiClemente is that behavioral changes are not immediate events, but processes that take time:
  1. Precontemplation: No motivation or intention to change in the next six months.
  2. Contemplation: Ambivalence, with an intention to change at some point in the future.
  3. Preparation: An intention to change in the next six months.
  4. Action: Open (overt) behavioral change.
  5. Maintenance: A focus on preventing relapse.
  6. Termination: No further temptation and a sense of total self-control.

Which therapist-related factors influence the therapeutic process? - BulletPoints 5

• Research shows that the therapist's personality is one of the most important factors of the therapy for the client. However, there is no clear evidence for correlations between client outcomes and therapist personality traits. Some evidence has been found that therapists with unconscious dogmatic and controlling ideas and attitudes ('introjects') have worse therapy outcomes.
• Research shows that there is no direct relationship between the beliefs or values ​​of the therapist and the results of the client. However, it has been found that clients with strong and/or extreme values ​​or beliefs prefer therapists with corresponding values ​​or beliefs because they feel better understood.
• In general, the therapist's traits seem to be a less important predictor of therapeutic outcomes compared to the way therapists relate to their clients.

What role does the relationship between the therapist and the client play in therapy? - BulletPoints 6

• The therapeutic alliance is the quality and strength of the partnership between therapist and client.
• Bordin (1979) described this partnership on the basis of three components:
  1. The agreement between the therapist and client about the goals of the therapy
  2. The agreement between the therapist and client about the tasks of the therapy
  3. The existence of a positive affective bond between the therapist and the client
• Empathy is entering another person's personal world and with an accurate sense of understanding of the other person's experiences. The level of empathy is closely associated with therapeutic outcomes.
• Positive prestige is a warm acceptance of the other person and his or her experiences without conditions. The level of positive esteem is moderately related to therapeutic results.
• Congruence is being free and deeply self in a relationship while being aware of other people's experiences in an accurate manner. In some cases, the therapist's level of congruence appeared to be related to the results of the therapy.
• There are indications that the therapist's ability to control and manage countertransference responses is related to therapeutic outcomes. Countertransference refers to the therapist's response to the client based on unresolved therapist conflicts.
• Transfer is the process of communicating and repeating early patterns of behavior with current partners.
• Self-disclosure embraces the therapist's statements that reveal something personal about the therapist. Moderate amounts of self-disclosure can help the client better compared to the systematic absence of self-disclosure. This is certainly the case when it comes to positive statements regarding the self. Self-involving statements are a form of self-disclosure, in which the therapist gives a personal response to the client in the here and now.
• Feedback refers to information provided by an external source about the behavior or effects of that behavior of a particular individual. This information can certainly help the client, especially when it is positive feedback.
• Indirect evidence shows that the ability to repair alliance breaks is associated with positive outcomes of the therapy. Alliance breakdown is tension or a defect in the partnership between client and therapist.
• Interpretations are statements made by the therapist that go beyond public recognition. A new understanding of experiences is suggested. Transfer interpretations are interpretations that try to help the client understand the relationship between the interaction with the therapist and the interactions with others. Low concentrations of accurate interpretations appear to help the client in the therapeutic process. High frequencies of transfer interpretation must be avoided. This is particularly important as a means of dealing with alliance breaches. This is also important when a therapist is dealing with highly dysfunctional clients.

Which techniques are used in therapy? - BulletPoints 7

• Cognitive-behavioral techniques try to produce a change by influencing thoughts, behavior or both.
• Exposure is primarily used for anxiety disorders, especially in (social) phobias. This technique has proven to be very effective for many individuals. This technique can be described as: "Deliberately evoking fear through direct confrontation with situations that produce fear for the patient." The basic principle behind this is that if individuals are directly confronted with fear, they can learn that they are able to deal with it. There are different forms of exposure:
  1. In vivo exposure
  2. Imagined exposure
  3. Virtual reality exposure
  4. Interoceptive exposure
  5. Exposure and reaction prevention
  6. Exposure to stimuli related to substance abuse (cue –exposure)
  7. Systematic desensitization
• Cognitive-behavioral techniques are most strongly supported by evidence. These interventions yield especially good results for anxiety-related issues.
• Non-directivity is a therapeutic standpoint in which the practitioner tries to prevent his / her client from pointing in a certain direction. In many cases, directive therapies seem more effective than non-directive therapies.
• Humanistic techniques are based on deepening the level of experienced and emotional processing. Evidence shows that these techniques lead to positive therapeutic outcomes. The experience is the extent to which inner feelings and processes are the focus of attention.
• For many forms of psychological stress, interventions over the phone or over the internet appear to be as effective as face to face interventions.

What is already known and what is still unknown about therapy? - BulletPoints 8

• What do we know? In conclusion, we can say that it is the client who is largely responsible for the changes he or she wants to make in his or her life. When involving a therapist who feels comfortable with the client and who has sufficient techniques, this therapist can help the client to achieve his goals. The most essential predictor of therapeutic outcomes remains the extent to which the client is motivated to work with the techniques provided to him or her by the therapist.
• Of course you can also get started yourself. As a healthcare provider in practice, you can, for example, keep track of data yourself (for example, how many clients you see, what their demographic backgrounds are, and which clients seem to do best). You can then analyze your own data using SPSS, CORE-OM or R.
• What do we not know (thus, what should be studied)? It is important to study why certain therapeutic orientations or techniques work better for specific psychological problems than others. In addition, more independent studies must be conducted into the effect and validity of certain therapies. In addition, it is important to study which client/therapist/relational factors are important in specific patient groups. It is also important to study how clients can be most motivated to follow therapies.