Kapitel 7

Cooper, M. (2010). Essential Research Findings in Counselling and psychotherapy.London: SAGE

Therapeutic techniques: a well defined procedure launched to solve a specific task or goal. Factors which are unique for a specific therapy approach. Techniques are important for therapy as they strengthens the therapeutic alliance as well as it’s directed influences in therapy. Techniques and orientation only has about 15 % importance for the outcome of therapy according to Lamberts Pie. Many non-orientated therapy approaches has as good results as for example CBT.

Studies show that clients with externalised coping strategies get more out of orientated-techniques than clients with internalised coping strategies.

There is no clear line between what is oriented-techniques and what is relational factors in what the therapist do.

 

Component study: investigates the effect of specific aspects of the therapeutic practice, either by adding components to the therapy or subtract components from therapy.

 

CBT: tries to produce change by influence thinking, behaviour or both.

– Exposure: are used to treat anxiety by expose the client for the anxiety-causing stimuli and help him learn how to cope.

• In vivo exposure: in life, actual exposure for fear-stimuli, the most effective exposure form.

• Imaginal exposure: visualising the fear-stimuli, effective in situations where in vivo is not possible.

• Virtual reality exposure: simulated fear-stimuli, as effective as in vivo and better than systematic desensitisation and controls.

• Interceptive exposure: generating bodily symptoms from anxiety. This is especially effective against panic, actually better than any other CBT-technique, but can also have an effect against claustrophobia, but in vivo works better for this disorder.

• Exposure and response prevention: encourages the client to refrain from doing ritual behaviours or compulsions. This technique are specially effective towards OCD.

• Cue exposure: exposes the client to a cue to their addiction and help them to avoid relapse. Especially good at treating alcohol addiction (better or equal to normal CBT), but are not better at treating opium addiction than controls.

• Systematic desensitisation: graded exposure to fear-stimuli while in a state of muscles relaxation. This technique has mixed clinical results.

– Paradoxical interventions: for example when the therapist ask a client with sleep deprivation to keep awake as long as possible. The idea that the more you try to do something the harder it is. It is associated with good therapeutic outcomes. But it raises some ethical dilemmas about when and how much to keep from doing.

– Activity scheduling: clients must plan and measure their everyday activities and challenge dysfunctional cognitions. Clients with depression has a good effect with this technique.

– Cognitive techniques: identifies and challenge dysfunctional thoughts through disputations and collecting evidence. This technique has good results for treating depression, but there is not a big difference from behavioural therapy. Reduction of dysfunctional thoughts does not give a better mood and better moods does not reduce dysfunctional thoughts, so there must be a third variable according to one study.

 

Psychodynamic techniques:

– Perceptions: the therapist’s perceptions that are beside what the client tells. Assessed by clients to be very helpful and it can strengthen the therapeutic alliance according to one study.

 

Humanistic and experiential techniques:

– Non-directivity: a therapeutic approach where the therapist refrain from direct his client in any specific direction. Studies have not found big difference between orientated-therapy and non-orientated therapy. Non-directivity gives mixed results. Some clients believes that the therapist is to passive, and therefore must the therapist be good at maintaining the therapeutic alliance. Clients who are against therapy get a lot out of non-directivity.

– Deepening levels of experience: the degree to which the inner felt sensation and processes are of focus for consciousness. The better felt focus the better outcome. Process-guiding interventions help people to go deeper in their work with consciousness.

Deepening levels of emotional processing: heighten emotional arousal and expression are related with heighten outcome of therapy. Catharsis is however an exception. Additionally accept of feelings are more effective than to suppress them.

– Two-chair and empty-chair dialogues: two-chair is when clients shares parts of their self in to two chairs and can get to the bottom of an inner conflict. This technique has showed significant greater attention and depth of experiences, good behavioural changes and self reported progress. Empty-chair is a technique where the client can go into an imagined dialogue with a significant other and solve unresolved emotional conflicts. This technique gives good results, but many clients refuse to use this technique.

– Focusing: this is a method which helps clients to lead their thoughts to their bodily felt experiences, it gives deeper experiences and is a part of 75 % of positive sessions.

– Generic techniques and practices:

• Contracting and boundaries: it is a good idea with a contract and clear limits but is it not related to outcome, but the fact that the therapist is ready to do something extra is an important predictor for positive outcome.

• Therapist ‘response model’:

o Listening: to be listen to are assessed to be one of the most important factors from therapy by clients as it strengthens the therapeutic alliance. Some clients finds it frustrating if there is to much silence, therefore must the therapist be active while listening.

o Paraphrasing: to repeat the meaning of what the other says. Is a frequently used technique and it is very helpful.

o Encouragement: To encourage hope in the client has a positive effect, it is valuable for the client and it strengthens the therapeutic alliance.

o Asking questions: to ask questions is frequently used but is not assessed to help much by clients.

o Guidance and advice: if the therapist comes with good advices it can be helpful, be experienced as sensitivity and accept and be a god predicator for positive outcome.

o Touch: can give many different outcome but can strengthens the therapeutic alliance and the feelings of accept and nurture.

• Homework assignments: the quality of homework is related with a better outcome, especially if the client understands why it can help. The causality between homework and outcome have not yet been shown. To write about emotional experiences decreases psychological distress and works as good as talking about it with the therapist.

• Feedback on client progress: a system of questionnaires that measures if the client is on-track and warns the therapist with a green, orange or red poster. The system can discover clients close to drop-out before it happens. It has most effect for vulnerable clients.

• Manualisation: to practice after a guided manual neither worsen or improve therapy.

• Telephone- and internet-based interventions: despite the fact that non-verbal communication is assessed to be the most important element in strengthening of the therapeutic alliance, telephone- and internet-based interventions have not a worse alliance and gives as good results as face-to-face therapy.

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