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INTRODUCTION
Psychotherapy research has settled the question of the
efcacy of psychotherapy to the positive since several years.
Numerous studies and meta-analyses have demonstrated
that psychotherapy works for most forms of psychopathology. The eld has arrived at a consensus that psychotherapy is more effective than no treatment and than
placebo controls (Lambert & Ogles, 2004). Yet sources
83
In addition, a dichotomy of common versus specic
factors has not received empirical support. For both,
signicant relations to outcome have been shown: A series
of meta-analyses demonstrated that several aspects of the
common factor therapeutic alliance, such as empathy or
goal consensus, are clearly related to positive outcome
(Lambert & Cattani, 2012; Norcross & Wampold, 2011a).
At the same time, also techniques such as exposure,
empty-chair technique, paradoxical intention and particular forms of interpretations were (. . .) found to be consistently and strongly associated with positive therapeutic
outcome (Orlinsky et al., 2004, p. 341). Thus, the question
is less which of both, techniques or common factors, are
more important but how each relate to the other so that
they can be successfully tailored to a specic patient
(Norcross & Wampold, 2011b).
Clear terminology and accurate conception of process
variables is of paramount importance in this context. Currently, several projects aim at creating a common language
for techniques, such as the development of a Comprehensive Psychotherapeutic Interventions Rating Scale by
Trijsburg et al. (2002), the Multitheoretical List of Therapeutic Interventions by McCarthy and Barber (2008) and
the web-based project Common Language for Psychotherapy by Marks (2010). The Taxonomy Project presented here
is an attempt to empirically arrive at a more precise
language for, and conception of, common factors in psychotherapy. The Taxonomy Project deviates from the either-or
mentality prominent in the camp of school-specic and
disorder-specic factors (medical model) and the camp
of the proponents of common factors (contextual model;
Wampold et al., 2001). Rather than mutually exclusive
causes of change, we consider specic techniques and common factors as associated components of psychotherapy
process.
For the present study, we decided to analyze the
relationships between specic techniques and common
factors through the use of expert opinion. We collected
assessments of psychotherapy experts in the framework
of an extensive survey, to which researchers of psychotherapy were invited. Techniques were treated as given
anchor points (i.e. as independent variables) because techniques are operationalized and dened in the manuals
and textbooks of different psychotherapy schools. In other
words, we used techniques as the entities that allow
describing the dependent variables in our study: the
common factors of psychotherapy. Doing this, the goal
of the Taxonomy Project was to contribute to a clearer
denition and conception of common factors. Thereby, we
also wished to introduce a novel understanding of specicity in the common versus specic debate: common factors
may be considered specic insofar as they may be generated by specic subsets of techniques and possibly inhibited
by other subsets of techniques. We hypothesized that
common factors would markedly differ with respect to
Clin. Psychol. Psychother. 21, 8296 (2014)
W. Tschacher et al.
84
their relations to specic techniques. This would then
allow a precise operational denition of each common
factor: a common factor is that which is implemented by
a specic pattern of techniques. Therefore, the primary
goal of this study was the description of all common
factors by their idiosyncratic associations with techniques.
In this, we relied on the consensual knowledge of psychotherapy experts acting as referees who assessed these
associations step by step. Accordingly, we hypothesized in
second line that rater variables (gender, age, profession,
allegiance to a psychotherapy approach) would inuence
the assessments to a limited degree only.
METHODS
Selection of Common Factors and Specic Techniques
A recent comprehensive literature search identied all
constructs discussed as non-specic or common factors of
therapeutic change in psychotherapy research literature.
Pfammatter and Tschacher (2012) included all factors that
were described by at least two authors. For the present
study, we adopted this list of 22 common factors, which
are dened in Table 1.
Simultaneously, based on textbooks of the four major
approaches of psychotherapy (cognitive behavioural therapy, psychodynamic therapy, humanistic therapy and
systemic therapy), we selected 22 standard techniques
(Table 2) of these approaches (numbers of factors and
techniques are equal by coincidence). Our selection of
techniques was subjective. We selected techniques that
represent the most characteristic procedures of the major
psychotherapy approaches, particularly those techniques
that a group of experienced psychotherapy researchers
would supposedly be familiar with, even if a technique
originated from a different psychotherapy approach than
the researchers own.
Survey
An internet-based survey consisting of the 22 common
factors and 22 specic techniques was developed. After
logging into the system, a participant was briefed on the
objectives of the study: to investigate the relationship
between techniques and common factors, with the ultimate
goal of arriving at a taxonomy of common factors. On
the next page, as an initial common factor, Therapeutic
Alliance1 was introduced and dened (Table 1). The
instruction was: Please assess how much, in your opinion,
1
In the following text, common factors will be printed bold, techniques in italics
Participants
Experienced researchers of psychotherapy, most of whom
were also active psychotherapists, were contacted via
personal e-mails and invited to participate as expert raters
in an internet-based survey (using the platform SurveyMonkey). We contacted, in rst line, German-speaking
members of the Society for Psychotherapy Research, and
in second line, further psychotherapy researchers with a
psychiatric afliation. Most addressees had an academic
background. Of 140 researchers addressed, 68 nally
participated in the survey (mean age 50.2 years, standard
deviation (SD) = 11.1; 47 (69%) men). Non-responders did
not signicantly differ from participants with respect to
gender, yet mean age of non-responders was higher:
54.6 years; t(138) = 2.47, p < 0.05. Participants mean professional experience in psychotherapy research (independent
variable Experience) was 18 years (SD = 11.0), and current
active psychotherapeutic work was 9 h/week (SD = 8.8).
As for their professional and scientic backgrounds (independent variable Profession), 54 participants (79.4%) were
psychologists, nine (13.2%) were psychiatrists, four (5.9%)
were both psychologists and psychiatrists and one (1.5%)
was trained in another profession. Professions of nonresponders were not signicantly different (chi2(3) = 2.37,
p = 0.50). Participants (variable Rater) noted their predominant psychotherapeutic orientations (independent variable
Allegiance) as cognitivebehavioural (n = 29, 42.6%),
psychodynamic (n = 19, 27.9%), eclectic (n = 14, 20.6%),
systemic (n = 4, 5.9%) and client-centred (n = 2, 2.9%).
Statistical Procedures
Each participating rater assessed the associations between
22 techniques and 22 common factors, i.e. he or she
responded to a maximum of 22 22 = 484 items. With
Clin. Psychol. Psychother. 21, 8296 (2014)
85
Table 1. List of common factors with denition given in the survey; Relevance, intercepts of all ratings of a common factor (test against
zero: * p < 0.05; ** p < 0.01; *** p < 0.001; **** p < 0.0001); Explanation, % variance of a common factor explained by all techniques (cf. text)
Common factor
Therapeutic alliance
Mitigation of social
isolation
Provision of an
explanatory scheme
Instillation of hope
Readiness to change
Patient engagement
Resource activation
Affective experiencing
Affective catharsis
Problem
confrontation
Desensitization
Corrective emotional
experience
Mindfulness
Emotion regulation
Denition
Relevance
0.17
Explanation
16.90
0.26**
24.72
0.03
22.04
0.05
24.39
0.04
19.91
0.22**
23.71
0.04
27.90
0.17*
29.81
0.14
29.44
0.14*
35.75
0.39****
25.98
0.10
20.98
0.43****
17.00
0.15*
22.75
(Continues)
W. Tschacher et al.
86
Table 1.
0. (Continued)
Common factor
Insight
Assimilating
problematic
experiences
Cognitive
restructuring
Mentalization
Behaviour regulation
Mastery experiences
Self-efcacy
expectation
New narrative about
self
Denition
Relevance
Explanation
0.03
31.51
0.22**
20.64
0.16
26.78
0.24**
31.25
0.24**
35.12
0.25**
33.25
0.22**
34.27
0.21**
25.64
for each common factor and served as the basis for all
subsequent analyses in approaches a and b.
Approach a: in an initial modelling approach, we
described each common factor by dening two separate
dimensions, Relevance and Explanation (Table 1). These
dimensions were operationalized as follows: The dimension
Relevance was computed, in each common factor as the
dependent variable, by the intercept of a model with only
the variable Rater entered as a random effect (approach a.1).
The single ratings constituted level 1, Rater identied
level 2 of the data. The intercepts operationalize the overall
relevance of a common factor. These intercepts were very
similar in value to the mean of response (r = 0.99), i.e. the
mean of all single ratings a common factor received (ratings
ranging between 2 and 2). In the column Relevance of
Table 1, we listed these intercepts. The intercepts were tested
against zero, the midpoint of the scales.
Clin. Psychol. Psychother. 21, 8296 (2014)
87
Technique
Positive reinforcement technique
Exposure with response prevention
Role play technique
Problem-solving training
Reality testing
Free association technique
Therapeutic abstinence
Transference interpretation
Resistance interpretation
Verbalization of emotional
reactions
Focusing
Empty-chair and two-chair
technique
Creative expression technique
Circular questions technique
Sculpture work
Paradoxical intention technique
Prescription of rituals
Reecting team technique
Progressive muscle relaxation
Hypnosis
Biofeedback training
Counselling
Denition
Therapist praises/rewards desired, adequate patient behaviour.
Therapist confronts patient in imagination or in vivo, gradually or by ooding,
massed or in intervals with a problematic situation and prevents escape.
Therapist simulates difcult social interactions in a play with patient as
participant, and instructs, models and corrects the performance.
Therapist teaches patient to identify and dene the problem, to systematically
generate and evaluate alternative problem solutions, to implement and verify
selected problem solution.
Therapist encourages patient to test the evidence for the validity of
dysfunctional thoughts and beliefs, runs behavioural experiments and
provides alternative explanations.
Therapist encourages patient to talk about whatever comes to her or his mind.
Therapist deliberately does not comment statements, disclosures or behaviour
of patient.
Therapist links patienttherapist relationship to other interactions of patient to
point out recurring problematic themes in her or his relationships.
Therapist draws attention to the patients opposition to or avoidance of certain
topics, experiences or feelings by pointing out evasions, sudden thematic shifts
or behavioural inconsistencies.
Therapist listens carefully to what patient is saying, uses empathic statements,
repeats back (paraphrases), explores its personal meaning and reects the
internal frame of reference (mirroring).
Therapist draws attention to unexpressed feelings, promotes deeper
experiencing, encourages patient to explore and express feelings.
Therapist guides patient to speak to an empty chair for unnished business, or
engages patient in a two-chair dialogue for analyzing and resolving inner
conicts.
Therapist encourages patient to use creative media to actualize experiences and
express feelings.
Therapist explores the meaning of a problematic behaviour of a family member
for another family member with a third family member.
Therapist asks the family to spatially illustrate the familial relationships
(afnity, distance, hierarchical structure) by building a sculpture.
Therapist offers a new interpretative framework (reframing), assigns a positive
meaning to the problem (positive connotation), invites patient to deliberately
show the problem behaviour (symptom prescription) or offers lots of problem
solutions (confusion technique).
Therapist prescribes formalized and symbolic actions that disrupt problematic
behaviour.
A team of experts monitors therapy and discusses the observations with
participants.
Therapist guides patient to rhythmically and sequentially contract and relax
different groups of muscles.
Therapist asks patient to bring up pictures or scenes, or induces hypnotic trance
by verbal suggestions and motoric procedures.
Therapist guides patient to deliberately inuence and control physiological
processes by feedback signals, discriminative learning and relaxation techniques.
Therapist gives advice.
Therapeutic alliance
Negatively associated
techniques
- Biofeedback training
(t = 6.35)
- Reecting team technique
(t = 4.51)
- Progressive muscle
relaxation (t = 3.4)
- Resistance interpretation
(t = 2.2)
- Sculpture work (t = 2.2)
Observations (n)
1338
% of variance explained
52.01
by model
% of variance explained
28.29
by rater (random effect)
% of variance explained
23.72
by xed effects
Fixed effect tests
Technique
F = 10.69
Allegiance
F = 2.26
Technique Allegiance
F = 1.76
Profession
F = 0.51
Experience
F = 0.14
Age
F = 0.33
Gender
F = 2.02
Positively associated
- Verbalization of emotional
techniques
reactions (t = 7.19)
- Positive reinforcement
technique (t = 6.4)
- Focusing (t = 5.62)
Model
- Free association
technique (t = 5.12)
- Therapeutic
abstinence
(t = 5.07)
- Resistance
interpretation
(t = 4.33)
- Transference
interpretation
(t = 3.49)
- Sculpture work
(t = 3.07)
- Progressive muscle
relaxation (t = 2.59)
- Circular questions
technique (t = 2.38)
- Biofeedback training
(t = 6.43)
- Progressive muscle
relaxation (t = 6.09)
- Therapeutic
abstinence (t = 4.43)
- Free association
technique (t = 4.25)
- Resistance
interpretation
(t = 2.71)
- Hypnosis (t = 2.11)
29.26
31.86
F = 12.24
F = 0.72
F = 1.16
F = 1.48
F = 0.02
F = 0.19
F = 2.8
- Problem-solving
training (t = 7.51)
- Positive
reinforcement
technique (t = 7.10)
- Reality testing
(t = 4.4)
- Exposure with
response
prevention (t = 3.48)
- Role play technique
(t = 3.32)
25.37
25.08
F = 11.19
F = 1.18
F = 1.08
F = 1.75
F = 0.75
F = 0.13
F = 3.51
- Positive reinforcement
technique (t = 6.07)
- Role play technique
(t = 5.09)
- Problem-solving
training (t = 3.31)
- Verbalization of
emotional reactions
(t = 3.09)
- Circular questions
technique (t = 2.89)
- Focusing (t = 2.46)
1110
54.63
F = 11.02
F = 1.29
F = 1.35
F = 1.24
F = 0.22
F = 0.03
F = 4.83
- Problem-solving
training (t = 6.57)
- Positive reinforcement
technique (t = 6.53)
- Role play technique
(t= 5.29)
- Reality testing
(t= 3.52)
- Exposure with
response prevention
(t = 2.72)
27.8
25.14
1113
52.94
Readiness to
change
31.9
23.41
1092
55.31
Patient engagement
(Continues)
F = 14.3
F = 0.68
F = 1.5
F = 2.29
F = 2.9
F = 1.66
F = 3.68
- Role play technique
(t = 5.82)
- Positive
reinforcement
technique (t = 4.28)
- Empty/two-chair
technique (t = 4.23)
- Problem-solving
training (t = 4.12)
- Exposure with
response prevention
(t = 3.8)
- Sculpture work
(t = 3.63)
- Creative expression
technique (t = 3.62)
- Reality testing
(t = 3.51)
- Progressive
- Free association
- Resistanceinterpretation
muscle relaxation
technique (t = 5.04) (t= 5.94)
- Transference
(t = 6.22)
- Progressive
interpretation
- Therapeutic abstinence muscle relaxation
(t = 5.72)
(t = 5.38)
(t = 4.47)
- Therapeutic
- Hypnosis (t = 3.99)
- Therapeutic
abstinence (t = 5.62)
- Biofeedback training abstinence
-Reectingteamtechnique
(t = 3.44)
(t = 4.04)
(t = 4.42)
- Free association
- Resistance
- Hypnosis (t = 3.75)
technique (t = 2.93)
interpretation
- Paradoxical
- Prescription of rituals (t = 3.15)
intention technique
(t = 2.67)
- Biofeedback
(t = 3.32)
training
- Biofeedback training
(t = 3.08)
(t = 3.00)
- Transference
- Progressive muscle
interpretation
relaxation (t = 2.19)
(t = 2.75)
- Hypnosis
(t = 2.15)
30.03
17.37
Provision of an
explanatory
scheme
1111
47.40
F = 9.68
F = 1.15
F = 1.27
F = 1.76
F = 0.32
F = 0.53
F = 1.16
- Reality testing
(t = 5.13)
- Verbalization of
emotional
reactions (t = 3.84)
- Focusing (t = 3.35)
- Transference
interpretation (t = 2.65)
- Resistance
interpretation (t = 2.58)
- Empty/two-chair
technique (t = 2.36)
- Reecting
team technique (t = 2.34)
- Circular questions
technique (t = 2.12)
Common factors
Instillation of hope
1045
56.94
Mitigation of social
isolation
Table 3. ad. Results of mixed-effects modelling of each common factor. Common factor, dependent variable; techniques and rater characteristics, xed effects: * p < .05; ** p < .01; *** p < .001; ****
p < .0001, bold print in cases of Bonferroni-signicance. Only signicantly predictive techniques are listed
88
W. Tschacher et al.
Resource activation
Negatively associated
techniques
- Resistance interpretation
(t = 5.85)
- Transference interpretation
(t = 5.59)
- Therapeutic abstinence
(t = 4.6)
- Free association technique
(t = 3.97)
- Progressive muscle
relaxation (t = 2.05)
- Reecting team technique
(t = 2.05)
Observations (n)
1089
% of variance explained
57.42
by model
% of variance explained
25.56
by rater (random effect)
% of variance explained
31.86
by xed effects
Fixed effect tests
Technique
F = 12.96
Allegiance
F = 0.33
Technique Allegiance
F = 1.39
Profession
F = 1.03
Experience
F = 0.44
Age
F=0
Gender
F = 1.21
Positively associated
- Positive reinforcement
techniques
technique (t = 7.66)
- Problem-solving training
(t = 6.33)
- Creative expression
technique (t = 5.6)
- Role play technique
(t = 4.17)
- Verbalization of emotional
reactions (t = 2.92)
Model
Table 3. (Continued)
34.52
24.68
1137
59.2
Catharsis
F = 17.17
F = 1.78
F = 1.31
F = 0.16
F = 0.13
F = 0.37
F = 2.25
- Empty/two-chair
technique (t = 7.3)
- Focusing (t = 7.04)
- Verbalization
of emotional
reactions (t = 6.07)
- Creative expression
technique (t = 5.24)
- Role play technique
(t = 4.72)
- Exposure with
response prevention
(t = 4.48)
- Sculpture work
(t = 2.37)
- Progressive muscle
- Progressive muscle - Progressive muscle
relaxation (t = 7.6)
relaxation (t = 8.25) relaxation (t = 6.05)
- Biofeedback training
- Biofeedback
- Biofeedback
(t = 5.19)
training (t = 7.02)
training (t = 7.78)
- Problem-solving
- Therapeutic
- Therapeutic
abstinence (t = 5.36) abstinence (t = 6.36) training (t = 4.22)
- Reality testing
- Positive
- Reecting
(t = 3.75)
reinforcement
team technique
- Positive reinforcement
technique (t = 3.6)
(t = 5.72)
technique (t = 3.51)
- Free association
- Prescription of
- Reecting team
technique (t = 2.11)
rituals (t = 4.02)
technique t = 3.18)
- Paradoxical
- Circular questions
intention technique
technique (t = 2.36)
(t = 2.93)
- Prescription of rituals
- Problem-solving
(t = 2.22)
training (t = 2.77)
- Circular questions - Therapeutic abstinence
technique (t = 2.72) (t = 2.17)
39.25
42.75
F = 14.16
F = 2.41
F = 1.69
F = 1.57
F = 1.72
F = 1.81
F = 2.05
- Focusing (t = 6.95)
- Empty/two-chair
technique (t = 6.21)
- Verbalization of
emotional reactions
(t = 5.97)
- Role play
technique (t = 5.77)
- Exposure with
response prevention
(t = 4.98)
- Creative expression
technique (t = 2.76)
17.88
14.91
F = 14.44
F = 1.96
F = 1.23
F = 0.74
F = 2.51
F = 1.61
F = 4.39
- Exposure with
response prevention
(t = 6.65)
- Role play
technique (t = 6.42)
- Empty/two-chair
technique (t = 5.17)
- Focusing (t = 3.97)
- Verbalization of
emotional reactions
(t = 2.69)
- Problem-solving
training (t = 2.14)
1115
57.13
Common factors
Affective experiencing
1159
57.66
Problem confrontation
F = 12.8
F = 2.27
F = 1.1
F = 0.17
F = 2.33
F = 0.99
F = 0.73
- Exposure with
response
prevention
(t = 10.21)
- Role play technique
(t = 5.38)
- Problem-solving
training (t = 3.54)
- Hypnosis
(t = 3.48)
- Empty/two-chair
technique
(t = 3.12)
- Reality testing
(t = 2.71)
- Therapeutic
abstinence
(t = 4.68)
- Free association
technique
(t = 4.36)
- Circular questions
technique
(t = 3.68)
- Resistance
interpretation
(t = 3.62)
- Reecting team
technique (t = 3.24)
- Transference
interpretation
(t = 3.2)
- Creative expression
technique (t = 2.32)
32.18
22.35
1159
54.53
Desensitization
(Continues)
- Progressive muscle
relaxation (t = 3.68)
- Biofeedback
training
(t = 3.44)
- Therapeutic
abstinence (t = 3.23)
- Free association
technique (t = 3.14)
- Circular questions
technique (t = 2.99)
- Resistance
interpretation
(t = 2.68)
- Reecting team
technique (t = 2.4)
F = 8.56
F = 1.71
F = 1.38
F = 1.57
F = 0.42
F = 0.02
F = 1.5
- Exposure with
response
prevention (t = 5.67)
- Role play technique
(t = 5.38)
- Positive
reinforcement
technique (t = 3.98)
- Empty/two-chair
technique (t = 3.55)
- Verbalization of
emotional reactions
(t = 3.23)
- Focusing (t = 2.2)
28.93
18.72
Corrective emotional
experiences
1157
47.65
Emotion regulation
Negatively associated
techniques
- Therapeutic abstinence
(t = 4.46)
- Transference
interpretation (t = 3.24)
- Resistance interpretation
(t = 3.19)
- Free association technique
(t = 3.05)
- Reecting team technique
(t = 2.99)
- Circular questions
technique (t = 2.90)
Observations (n)
1075
% of variance explained
50.52
by model
% of variance explained by
18.45
rater (random effect)
% of variance explained by
32.07
xed effects
Fixed effect tests
Technique
F = 9.5
Allegiance
F = 1.4
Technique Allegiance
F = 1.6
Profession
F=2
Experience
F = 0.33
Age
F = 1.33
F = 3.08
Gender
Positively associated
- Exposure with response
techniques
prevention (t = 5.88)
- Role play technique (t = 5.54)
- Verbalization of emotional
reactions (t = 5.28)
- Focusing (t = 4.77)
Model
Table 3. (Continued)
- Prescription of rituals
(t = 3.11)
- Transference
interpretation (t = 2.8)
- Resistance
interpretation
(t = 2.63)
- Problem-solving
training (t = 2.39)
- Paradoxical intention
technique (t = 2.33)
- Progressive muscle
relaxation (t = 6.84)
- Biofeedback
training (t = 5.32)
- Therapeutic
abstinence (t = 3.72)
- Hypnosis (t = 2.11)
F = 7.14
F = 0.94
F = 1.35
F = 1.36
F = 0.4
F = 0.15
F = 7.73
- Verbalization of
emotional
reactions (t = 4.08)
- Reality testing
(t = 3.33)
- Focusing (t = 3.11)
- Sculpture work
(t = 2.07)
32.46
24.86
F = 6.11
F = 1.51
F = 1.47
F = 0.22
F=0
F = 0.02
F = 2.32
- Focusing (t = 4.82)
- Verbalization of
emotional reactions
(t = 4.46)
- Free association
technique (t = 3.35)
- Progressive muscle
relaxation (t = 2.99)
- Hypnosis (t = 2.7)
- Biofeedback training
(t = 2.09)
18.08
39.58
13.84
1054
53.42
Insight
- Progressive muscle
relaxation (t = 7.52)
- Biofeedback training
(t = 6.83)
- Therapeutic
abstinence (t = 4.7)
- Hypnosis (t = 3.62)
- Positive reinforcement
technique (t = 2.31)
- Prescription of rituals
(t = 2.27)
- Exposure (t = 2.22)
F = 12.23
F = 1.49
F = 1.2
F = 1.9
F = 0.44
F=0
F = 5.87
- Reality testing
(t = 5.23)
- Transference
interpretation (t = 4.03)
- Verbalization of
emotional
reactions (t = 3.83)
- Resistance
interpretation (t = 3.63)
- Focusing (t = 3.44)
- Empty/two-chair
technique (t = 2.9)
- Reecting team
technique (t = 2.46)
- Role play technique
(t = 2.09)
Common factors
Assimilating
problematic experiences
967
50.54
29.91
1074
54.77
Mindfulness
F = 12.36
F = 0.25
F = 1.43
F = 1.22
F = 0.65
F = 0.45
F = 0.66
- Reality testing
(t = 5.61)
- Problem-solving
training (t = 4.68)
- Exposure with
response
prevention
(t = 3.54)
- Paradoxical
intention technique
(t = 3.24)
- Role play
technique (t = 2.51)
- Transference
interpretation
(t = 2.26)
- Resistance
interpretation
(t = 2.06)
- Focusing (t = 2.01)
- Empty/two-chair
technique (t = 2)
- Progressive
muscle relaxation
(t = 6.93)
- Biofeedback
training (t = 6.51)
- Therapeutic
abstinence
(t = 5.44)
- Free association
technique
(t = 4.18)
- Creative
expression
technique (t = 4)
- Hypnosis (t = 2.97)
32.28
28.28
Cognitive
restructuring
943
60.56
(Continues)
F = 15.11
F = 0.61
F = 1.89
F = 1.34
F = 1.16
F = 0.53
F = 1.75
- Role play technique
(t = 6.26)
- Circular questions
technique (t = 5.13)
- Empty/two-chair
technique (t = 4.92)
- Reality testing
(t = 4.65)
- Verbalization of
emotional reactions
(t = 4.24)
- Focusing (t = 2.61)
- Reecting team
technique (t = 2.51)
- Sculpture work
(t = 2.35)
- Transference
interpretation
(t = 2.31)
- Resistance
interpretation
(t = 2.08)
- Progressive muscle
relaxation (t = 7.19)
- Biofeedback
training (t = 6.64)
- Therapeutic
abstinence (t = 4.15)
- Hypnosis (t = 3.83)
- Exposure (t = 3.45)
- Prescription of
rituals (t = 3.38)
- Creative expression
technique (t = 2.97)
39.98
21.54
920
61.52
Mentalization
90
W. Tschacher et al.
Negatively associated
techniques
46.45
43.27
F = 12.46
F = 0.87
F = 1.44
F = 2.93
F=0
F = 0.03
F = 4.52
- Problem-solving
training (t = 6.19)
- Role play technique
(t = 5.97)
- Exposure with
response
prevention (t = 5.84)
- Positive
reinforcement
technique (t = 5.77)
- Reality testing
(t = 4.69)
- Empty/two-chair
technique (t = 2.15)
- Therapeutic
abstinence (t = 5.07)
- Free association
technique (t = 4.91)
- Reecting team
technique (t = 3.78)
- Transference
interpretation
(t = 3.35)
- Resistance
interpretation
(t = 3.24)
- Circular questions
technique (t = 3.13)
12.43
20.82
F = 14.29
F = 0.91
F = 1.22
F = 3.26
F = 0.7
F = 0.04
F = 1.74
- Exposure with
response prevention
(t = 3.44)
- Problem-solving
training (t = 2.62)
- Role play technique
(t = 2.53)
- Positive reinforcement
technique (t = 2.05)
d
Common Factors
Mastery experiences Self-efcacy expectation
922
924
64.09
58.88
Behaviour regulation
Observations (n)
922
% of variance explained
62.8
by model
% of variance explained by
19.72
rater (random effect)
% of variance explained by
43.08
xed effects
Fixed effect tests
Technique
F = 16.4
Allegiance
F = 1.07
Technique Allegiance
F = 1.22
Profession
F = 2.01
Experience
F=0
Age
F = 0.58
Gender
F = 4.85
Positively associated
- Problem-solving training
techniques
(t = 7.82)
- Role play technique
(t = 7.58)
- Positive reinforcement
technique (t = 6.2)
- Exposure with response
prevention (t = 5.85)
- Reality testing (t = 2.48)
Model
Table 3. (Continued)
- Progressive muscle
relaxation (t = 6.51)
- Biofeedback training
(t = 6.01)
- Therapeutic abstinence
(t = 3.27)
- Prescription of rituals
(t = 2.85)
F = 8.6
F = 0.44
F = 1.34
F = 2.08
F = 1.41
F = 0.4
F = 1.74
- Verbalization of
emotional reactions
(t = 4.88)
- Role play technique
(t = 3.08)
- Reality testing (t = 2.75)
- Sculpture work (t = 2.54)
- Transference
interpretation (t = 2.41)
- Empty/two-chair
technique (t = 2.15)
- Focusing (t = 2.03)
35.97
17.1
92
by the following xed effects (predictors): Technique (as in
approach a.2), Allegiance, Technique Allegiance, Profession, Experience, Age, Gender. In all models, Rater
was again entered as a random effect (Table 3). The random
effect operationalizes the variance components: how much
variance (% of total variance) is attributable to the person
of the rater. The xed effects are assigned an F-value each;
the F-value designates how strongly the respective xed
effect is regressed on the common factor. The higher the
F-value of the xed effect Technique, the better can a common factor be differentially (positively or negatively)
described by the single techniques. In other words, this
F-value operationalizes how well a common factor is
explained by the whole set of 22 different techniques
(cf. the degree of explanation due to Technique in approach a.2). Some single techniques may signicantly implement the common factor (they have positive t-values
in the parameter estimates of single techniques), whereas
other techniques are negatively associated to the common
factor (indicated by negative t-values). These signicant
positive (negative) parameter estimates are therefore
valid descriptors of a common factor since they show by
which psychotherapeutic procedures a common factor
can (not) be realized. The technique Counselling is not
listed since it is used as a reference value in the analysis.
We computed Akaikes Information Criterion (AIC), a
criterion of model accuracy and parsimony. The single
AIC values are not reported for reasons of brevity; it
was found that according to AIC, all 22 models in Table 3
were superior to the respective models where Technique
was the only xed effect (approach a.2). In Table 3, we therefore report all models with the full set of xed effects.
RESULTS
The two dimensions Relevance and Explanation describe
how strongly the common factors were implemented by the
set of techniques, in the view of the expert raters. The rst
dimension Relevance, denoted by the intercept, indicates
how close a common factor is related to (implemented by)
the complete set of techniques, irrespective of the differential contribution of the single techniques. The second
dimension Explanation is given by the variance of each
common factor when explicitly and differentially explained
by the techniques. These two dimensions (see respective
columns in Table 1) were almost orthogonal (correlation
r = 0.02) descriptors of the common factors (for a graphical
depiction, see Figure 1). All common factors were highly
signicantly, yet to varying degrees, described by techniques (Explanation in Table 1), the highest explanation
was found for the factors Problem confrontation, Behaviour regulation and Self-efcacy expectation. The most
relevant factors (see approach a.1, Relevance in Table 1),
however, were Patient engagement, Therapeutic alliance
Copyright 2012 John Wiley & Sons, Ltd.
W. Tschacher et al.
and Affective experiencing, which produced the highest
intercepts on the scales. Some common factors were both
well explained and relevant, notably Patient engagement, Affective experiencing, Therapeutic alliance and
Problem confrontation (positive ratios in Figure 1). Other
factors were assessed as having very low overall relevance
but were still well explained by techniques, especially
Desensitization and Mindfulness (negative ratios).
Approach b provides a detailed picture of how each common factor is described by an ensemble of predictors which
included, additional to techniques, characteristics of the
expert raters themselves such as their allegiance to a therapeutic school, their professional background, their years of
therapeutic experience, their age and gender. All results of
22 mixed effects models are portrayed in Table 3ad; here,
we will focus on Bonferroni-signicant ndings with a
probability < 0.001 in order to correct for alpha ination
due to repeated testing (0.05/22 0.002); Bonferronisignicant predictors are printed bold in Table 3ad.
The variance explained by the whole models ranged
between 47.4% (Provision of an explanatory scheme)
and 64.1% (Mastery experiences). The variance that
goes back explicitly to the raters, with the mentioned
predictors of rater characteristics accounted for, varied
between 12% and 30%: Self-efcacy expectation, Insight
and Problem confrontation had low rater variances, hence
high inter-rater agreement, whereas Mindfulness, Therapeutic alliance and Cognitive restructuring received more
heterogeneous assessments, i.e. showed elevated rater
variance. None of the characteristics of raters were predictors
at the level of Bonferroni-corrected signicance. Raters
allegiance, age and experience were statistically unrelated to the assessments (p > 0.05) throughout. Their gender was a signicant predictor of some common factors
(p < 0.05: Assimilating problematic experiences, Insight,
Behaviour regulation, Readiness to change, Self-efcacy
expectation, Problem confrontation, all of which were
rated lower by male raters), but these effects did not survive
Bonferroni-correction. Raters profession played a role in the
assessments of Mastery experiences and Self-efcacy expectation, but again these effects were not Bonferroni-signicant.
All 22 common factors were highly signicantly associated with techniques, and each common factor was linked
to a specic set of techniques that were either positively or
negatively associated to this factor. The unique description
of each common factor is given in Table 3a-d. Here, we will
outline three examples: (i) The common factor Therapeutic
alliance (Table 3a) was described as that entity which is best
implemented by Verbalization of emotional reactions, Positive
reinforcement technique and Focusing, but which would be
counteracted by the application of Biofeedback training, the
Reecting team technique and Progressive muscle relaxation.
(ii) The common factor Problem confrontation (Table 3b)
is implemented by Exposure with response prevention, Role
play technique, Empty-chair and two-chair technique and
Clin. Psychol. Psychother. 21, 8296 (2014)
93
Figure 1. Graphical representation of the descriptors of common factors (see Table 1). Relevance is operationalized by the intercepts
of approach a.1 (rescaled 100 for better visualization); Explanation is operationalized by percentage of variance explained by
techniques in approach a.2. The ratio Relevance/Explanation is represented by a line (rescaled 1000 for better visualization). The
abscissa is a dimensionless scale for Relevance and ratio; for Explanation, the scale equals % variance
Focusing. In contrast, Progressive muscle relaxation, Biofeedback training, Therapeutic abstinence and Positive reinforcement
technique are negatively associated to the implementation of
this common factor. (iii) The common factor Self-efcacy
expectations (Table 3d) is realized by Problem-solving training, Role play technique, Exposure with response prevention,
Positive reinforcement technique and Reality testing. Therapeutic abstinence, Free association technique, the Reecting team
technique and Transference interpretation, however, would
down-regulate this common factor.
Figure 2 represents the frequencies by which each technique
was positively and negatively associated to any of the 22 common factors. These frequencies were dened by counting the
Bonferroni-signicant occurrences of techniques among predictors in Table 3ad. It was found that techniques developed by cognitivebehavioural and by humanistic
psychotherapy were predominantly used as positive
descriptors of common factors, whereas psychodynamic,
systemic and body-oriented techniques were predominantly used as negative descriptors.
Copyright 2012 John Wiley & Sons, Ltd.
94
W. Tschacher et al.
Figure 2. Counts of how many single techniques were Bonferroni-signicantly (p < 0.001) associated to any of the common factors in
Table 3 (red bars to the left: frequency of negative associations; black bars to the right: frequency of positive associations)
DISCUSSION
The Taxonomy Project focuses on conceptual inconsistencies associated with the core construct of common factors;
such inconsistencies are currently hampering psychotherapy research. Without concise concepts, further scientic
progress is unlikely. We therefore personally invited a panel
of experts with mixed professional and allegiance backgrounds to participate in a survey and to help clarify the
common factor concept. In this survey, we used standard
psychotherapy techniques as tools for the better description
and denition of common factors. The internet-based
survey was successfully implemented; it delivered a specic
operational description of each of the 22 common factors
discussed in the eld, based on these factors differential
associations to the techniques of psychotherapy.
Copyright 2012 John Wiley & Sons, Ltd.
95
It must be borne in mind that our ndings are based on
the opinions of expert psychotherapy researchers. The
ndings may not sufciently portray the perspective of
psychotherapy patients, nor can they substitute empirical
analyses of the therapeutic process. This limitation is however justied by the present goal of exploring the structure of theoretical constructs. It will be a subsequent
concern to test how these constructs may translate into
the practice of psychotherapy and into the training of
psychotherapists. A further limitation is that in some of
the ratings, especially the complex interaction effects,
the assessment of certain techniques depended on the
adherence of raters to psychotherapy schools. The predominance of cognitivebehavioural backgrounds in the
present sample of raters, although depicting the current
proportions among psychotherapy researchers, may have
had an inuence on some results of the present study.
In conclusion, we hold that the taxonomy of common
factors based on their differential associations to specic
techniques is promising. It will support elaborating concepts
in such a way that common factors increasingly portray and
unify the whole spectrum of the psychotherapeutic endeavour. In the present analysis, this taxonomic approach was
conducive to arrive at a clearer denition and conception
of common factors. We suggest that the currently prevailing
set of common factors of psychotherapy-induced change
should be adapted in two respects: rst, common factors
must cover all effective treatment approaches in an integrative manner. Here, we have found indications that the
current taxonomy is biased, because it does not cover the
embodiment of psychotherapy and does not do justice to
effective psychodynamic and systemic techniques of
psychotherapy. Second, however, this should not lead
to inating the number of common factors, since there
is already a wide variety of terminology for largely
congruent concepts. Reduction of present tautology must
be an important goal of future taxonomic work.
Such conceptual work should be embedded in a bridging
theory. We foresee that this theory will be provided neither
by neuroscientic physicalism nor qualitative theory alone,
but likely by a metatheory such as dynamical systems
theory (Grawe, 2004; Anchin, 2008). On this basis, taxonomic
work will converge in more theoretical clarity and feed into
developing a common scientic theory of psychotherapy
that can inform future research and practice.
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