Psychotherapy Skills and Methods That Work

Visit the link below to download the full version of this book:

https://medipdf.com/product/psychotherapy-skills-and-methods-that-work/

Click Download Now

 Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

© Clara E. Hill and John C. Norcross 2023

All rights reserved. No part of this publication may be reproduced, stored in

a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-​in-​Publication Data

ISBN 978–​0–​19–​761101–​2

DOI: 10.1093/​oso/​9780197611012.001.0001

Printed by Integrated Books International, United States of America

 Dedicated to

Louis G. Castonguay
Exceptional researcher, gifted teacher, wonderful colleague
 Contents

Preface  ix
Acknowledgments  xv
About the Editors  xvii
List of Contributors  xix

1. Introduction to Psychotherapy Skills and Methods That Work  1

Clara E. Hill, John C. Norcross, and the Steering Committee
2. Affirmation/​Validation, Self-​Disclosure, Immediacy,
and Rupture Repairs  28
Barry A. Farber, Clara E. Hill, Sarah Knox, Catherine F. Eubanks,
J. Christopher Muran, and John C. Norcross
3. Questions  53
Elizabeth Nutt Williams
4. Socratic Questioning and Guided Discovery  74
James C. Overholser and Eleanor Beale
5. Empathic Reflection  99
Robert Elliott, Arthur C. Bohart, Dale G. Larson, Peter Muntigl,
and Olga Smoliak
6. Metaphors  138
Linda M. McMullen and Dennis Tay
7. Interpretations  165
Sigal Zilcha-​Mano, Hadar Fisher, Tohar Dolev-​Amit, John R. Keefe,
and Jacques P. Barber
8. Paradoxical Interventions  199
Paul R. Peluso and Robert Freund
9. Advice, Suggestions, Recommendations  224
Clara E. Hill, Sarah Knox, and Changming Duan
10. Integrating Between-​Session Homework  247
Truls Ryum, Mia Bennion, and Nikolaos Kazantzis
11. Silence  281
Heidi M. Levitt and Zenobia Morrill
12. Facilitating Dyadic Synchrony  327
Dana Atzil-​Slonim, Christina S. Soma, Xinyao Zhang, Adar Paz,
and Zac E. Imel
viii Contents

13. Role Induction  367

Joshua K. Swift, Elizabeth A. Penix, and Ailun Li
14. Collaborative Assessment Methods  399
Filippo Aschieri, Arnold A. P. van Emmerik, Carlijn J. M. Wibbelink,
and Jan H. Kamphuis
15. Routine Outcome Monitoring  429
Michael Barkham, Kim de Jong, Jaime Delgadillo, and Wolfgang Lutz
16. Strength-​Based Methods  472
Christoph Flückiger, Thomas Munder, A. C. Del Re, and Nili Solomonov
17. Enhancing Emotion Regulation  502
Shigeru Iwakabe, Kaori Nakamura, and Nathan C. Thoma
18. Chairwork  547
Antonio Pascual-​Leone and Tabarak Baher
19. Dream Work and Nightmare Treatments  577
Patricia T. Spangler and Wonjin Sim
20. Meditation, Mindfulness, and Acceptance  605
Simon B. Goldberg, Christopher Anders, Shannon L. Stuart-​Maver,
and D. Martin Kivlighan, III
21. Facilitating Behavioral Activation  625
Pim Cuijpers, Eirini Karyotaki, Mathias Harrer, and Yvonne Stikkelbroek
22. Cognitive Restructuring  652
Iony D. Ezawa and Steven D. Hollon
23. Skills and Methods That Work in Psychotherapy: Research
Results, Training Implications, Therapeutic Practices, and
Task Force Conclusions  676
Clara E. Hill, John C. Norcross, and the Steering Committee

Index  703
 Preface

A warm welcome to Psychotherapy Skills and Methods That Work, a mammoth collab-
oration among dozens of scientist–​practitioners and four professional organizations
dedicated to improving the practice of psychotherapy. In this volume, we provide re-
search and clinical evidence for what we know about the effectiveness of therapist skills
and methods.
Psychotherapists must do something in their sessions—​ listen, reflect, ques-
tion, encourage, challenge, interpret, guide, instruct. It would thus be helpful for
psychotherapists across theoretical orientations to have evidence about when, how,
under what conditions, and with whom to use these various skills and methods to guide
their practice and training.
This book is a natural extension and complement to the three editions of
Psychotherapy Relationships That Work (2002, 2011, 2019). In those volumes, John
Norcross, Mike Lambert, and Bruce Wampold sought to combat the pervasive view
that the treatment approach or “package” was the only thing that contributes meaning-
fully to psychotherapy outcome. They presented impressive research evidence that the
therapeutic relationship and clients’ transdiagnostic features, regardless of treatment
package, contributed significantly to outcomes of psychotherapy, probably as much as,
if not more than, the impact of the particular treatment approach. Hence, they sought to
convince practitioners of the rightful place of evidence-​based relationships and respon-
siveness alongside evidence-​based treatments. Our goal in Psychotherapy Skills and
Methods That Work is to continue in that tradition and present evidence of the rightful,
research-​substantiated place of evidence-​based skills (e.g., questions, interpretations)
and methods (e.g., cognitive restructuring, role induction).
Psychotherapy is a complex, multifactorial activity; reducing it to any single com-
ponent does not do it justice and misleads clinical practice and training. We ought, to
paraphrase Freud, consider all the components. Thus, our emphasis is on “alongside”
rather than “instead of ” or “better than.”
As well, note two additional word choices: We use the terms clients and patients as
well as counseling and psychotherapy interchangeably throughout the book. This plu-
ralism is intended not only to avoid theoretical and professional disputes but also to
model the complexity and inclusion of psychotherapy itself. We also strive to be sensi-
tive to theoretical and cultural diversity and have thus asked our contributors to focus
on the use of the skills/​methods from different theoretical perspectives and with dif-
ferent patient populations.
Having proclaimed our mission, let us also articulate our exclusions. We focus
solely on individual adult psychotherapy in this volume; we do not consider group
x Preface

psychotherapy, couple and family treatment, or pharmacotherapy. We sought to ex-

amine available research from around the world, but the majority of reviewed studies
are from English-​ language journals. Given the hundreds of available treatment
methods and skills in the psychotherapy multiverse, we also needed to restrict the skills
and methods included in this volume to a manageable number.

The Task Force and Steering Committee

I (CEH) developed this project as my presidential initiative in 2021–​2022 for the

Society for the Advancement of Psychotherapy (SAP; Division 29 of the American
Psychological Association [APA]) and invited John Norcross to co-​lead the Task
Force on Psychotherapy Skills and Methods That Work with me, given his extensive
experience leading the previous task forces. We subsequently invited and gained co-​
sponsorship from the Society for Counseling Psychology (SCP; Division 17 of the APA),
the Society for Psychotherapy Research (SPR), and the Society for the Exploration of
Psychotherapy Integration (SEPI). These are, in our view, the premier organizations for
psychotherapy research in the world. We are fortunate to have the collaboration and
sponsorship of these major stakeholders in advancing the integration of practice and
research in psychotherapy.
We asked each co-​sponsoring organization of the Task Force to nominate one in-
dividual for our Steering Committee. We invited additional people with expertise in
psychotherapy research, ensuring that we obtained gender, cultural, theoretical, and in-
ternational representation on the Steering Committee. In addition to ourselves as Co-​
Chairs, the members of the Steering Committee were as follows (in alphabetical order):

Louis G. Castonguay, PhD, Pennsylvania State University, USA

Melanie M. Domenech Rodriguez, PhD, Utah State University, USA
Barry A. Farber, PhD, Columbia University, USA
Christoph Flückiger, PhD, University of Kassel, Switzerland (representing SPR)
Myrna L. Friedlander, PhD, University at Albany/​State University of New York, USA
Beatriz (Betty) Gomez, PhD, Aigle Foundation, Argentina (representing SEPI)
Matthew J. Miller, PhD, Loyola University, USA (representing SCP)
Patricia T. Spangler, PhD, Uniformed Services University, USA (representing SAP)
Bernhard Strauss, PhD, University of Jena, Germany
Sigal Zilcha-​Mano, PhD, University of Haifa, Israel

The principal tasks of Steering Committee members were fivefold. First,

they recommended potential chapters and authors. Second, they reviewed the
Introduction chapter and provided rich feedback about the foundation for the
project. Third, they read completed chapters and evaluated the strength of the re-
search evidence for the designated skill or method. Fourth, they reviewed the
Conclusions chapter and provided incredibly helpful feedback about how to
frame out findings. Finally, for those representing professional organizations, they
communicated with their respective groups about the activities of the Task Force.
We are grateful for their contributions.
 Preface xi

Potential Audiences

We have designed Psychotherapy Skills and Methods That Work with four audiences in
mind. Our first intended audience is practitioners of diverse theoretical orientations
and professional disciplines who want to know which skills and methods have been
shown to be effective in individual psychotherapy.
Our second and related audience is psychotherapy educators (trainers and
supervisors). Deciding which skills and methods to teach requires a modicum (or
more) of research evidence in addition to theory and experience. In addition, we need
to teach trainees to think critically about how to gather and evaluate evidence about the
effects of skills and methods.
Our third intended audience is policymakers—​the people who set the requirements
for practice and reimbursement. We hope that policymakers realize that we cannot
simply mandate that mental health professionals implement evidence-​based treatment
packages; rather, the skills and methods in these treatment packages also need to be
evidence-​based in terms of immediate, intermediate, and distal outcomes.
Finally, we hope to influence the current and future generations of psychotherapy
researchers to conduct more and better research. In addition to our current research
designs, measures, and analyses, we need new and innovative strategies to help us un-
derstand the mysteries and complexities of psychotherapy.
We cannot continue to look cluelessly at the black box of the treatment method;
we cannot continue to use as our only design the correlations between poorly defined
skills/​methods and distal outcomes; we cannot continue to ignore individual process
and treatment outcomes in the research. We need to examine what works in terms of the
entire treatment approach, the constituent therapy methods, and the associated skills
for individual clients at specific moments within the context of the whole person of the
client and therapist and their emergent relationship. The contributors to this volume
have taken huge strides toward that lofty goal. But, as Jonas Salk reminds us, “The re-
ward for work well done is the opportunity to do more.”

Organization of the Book

We start with an introductory chapter on psychotherapist skills and methods: reviewing

the controversies surrounding how to assess skills/​methods, what contributes to suc-
cess in psychotherapy, and how to link skills/​methods to patient outcomes. This ma-
terial provides the rationale and frame for our book. We then feature in Chapter 2 an
updated summary of the research evidence on four skills/​methods (affirmation, self-​
disclosure, immediacy, alliance rupture repairs) featured in the previous task forces on
psychotherapy relationships that work.
In the first cluster of chapters, we focus first on specific therapist skills often included in
helping skills textbooks: questions (Williams), Socratic questioning and guided discovery
(Overholser and Beale), empathic reflections (Elliott et al.), metaphors (McMullen and
Tay), interpretations (Zilcha-​Mano et al.), paradoxical interventions (Peluso and Freund),
advice/​suggestions/​recommendation (Hill et al.), integrating between-​session homework
(Ryum et al.), silences (Levitt and Morrill), and facilitating dyadic synchrony (Slonim
xii Preface

et al.). Most of these therapist skills have been referred to as verbal response modes and typ-
ically are discrete pantheoretical behaviors that occur within sentences or speaking turns
of sessions (except for between-​session homework, which we put here to keep it next to
advice, suggestions, and recommendations since they are related constructs).
The next cluster of chapters focuses on therapist methods that are typically more com-
plex or extend over longer periods of time than the previous skills. These are broader
multistep modules that fit within treatment packages. Although most were developed
within particular theoretical traditions, all can be used by therapists across orientations.
Representative transtheoretical methods are role induction (Swift et al.), collabora-
tive assessment methods (Aschieri et al.), dream work (Spangler and Sim), routine
outcome monitoring (Barkham et al.), and strength-​based methods (Flückiger et al.).
Representing more experiential and psychodynamic therapies, we present chapters
on enhancing emotion regulation (Iwakabe et al.) and chairwork (Pascual-​Leone and
Baher). Representing more cognitive and behavioral therapies are chapters on mind-
fulness/​meditation/​acceptance (Goldberg et al.), behavioral activation (Cuijpers et al.),
and cognitive restructuring (Ezawa and Hollon).
In the final chapter, we summarize the research evidence for the various skills and
methods. With the guidance of our Steering Committee, we list the conclusions and
recommendations of the Task Force on Psychotherapy Skills and Methods That Work.
We also address training implications, therapeutic practices, and research directions
grounded in the best of that research evidence.
The end result is a compilation of cutting-​edge, practice-​friendly research reviews
about which therapy skills/​methods work, which do not, and which lack enough re-
search evidence to date to make a judgment about efficacy. We acknowledge up front
that there are few research studies on several of the featured skills and methods; there-
fore, those chapters comprise a mix of research, practice, vision, and heuristics encour-
aging more research on each skill/​method.

Chapter Guidelines

We developed detailed guidelines for the contributors of the skills and methods
chapters to ensure standard section headings and similar chapter structures. We hope
that this consistent format promotes comparability among the chapters and enhances
the readers’ experience of continuity throughout the volume, as well as provides the
necessary information for readers to evaluate the evidence. The focus of the book is
on the association between the skills/​methods and immediate in-​session, interme-
diate, and distal outcomes. Thus, although information about other aspects of the
skills/​methods (e.g., frequency of occurrence, description of subtypes, relation to other
process variables) is important, such empirical data are not included in this book.
The chapter guidelines, in condensed fashion, are presented below as they were given
to the contributors:

• Introduction. Introduce the method or skill in a few, reader-​friendly paragraphs.

• Definitions. Define in theoretically neutral language the skill or method being
reviewed. Identify any highly similar or equivalent constructs from diverse
 Preface xiii

theoretical traditions. Also cover briefly the theoretical background for the
technique. If possible, present how the technique is viewed from two or three
perspectives.
• Clinical Description and Indications. Operationalize the skill or method by
describing how it is implemented in session. Also delineate specific patient char-
acteristics, in-​session markers, and clinical circumstances for which the skill/​
method is indicated versus contraindicated.
• Assessment. Review how the skill/​method has typically been assessed. Then, re-
view how the immediate within-​session outcomes (e.g., client responses), the in-
termediate outcomes (e.g., post-​session), and distal end-​of-​treatment outcomes
(e.g., symptom change) have been assessed. Identify specific measures and their
psychometric properties.
• Clinical Examples. Provide concrete examples of the skill/​method, using de-​
identified or hypothetical transcripts, so that readers can understand how the
skill/​method is used in sessions.
• Landmark Studies and Previous Reviews. Walk readers through one or two land-
mark studies on the topic, describing the design, participants, and results. Then, if
available, provide a quick synopsis of the findings of previous meta-​analyses and
systematic reviews on the skill or method.
• Research Review. Systematically compile all available empirical studies of the
skill/​method in individual psychotherapy written in the English language
(and other languages, if possible). Each included study must link the skill/
​method to some kind of outcome (immediate, intermediate, distal) and can in-
clude case studies, qualitative studies, process studies, controlled trials, and
quantitative studies, but exclude analogue studies or surveys. Divide the re-
search review into three sections: (a) report on the link between the skill/​
method and immediate, in-​session outcomes; (b) report on the link between the
skill/​
method and intermediate (post-​ session, between sessions) outcomes;
and (c) report on the link between the skill/​method and distal, treatment-​end
outcomes.
If possible, conduct an original meta-​analysis of all available studies in each
section, following guidelines in the Appendix of the seventh edition of the APA
Publication Manual). If it is not possible to conduct a meta-​analysis because there
were not enough outcome studies, conduct a box-​score analysis of the results in
each study (positive, neutral, or negative associations). In addition, report on any
evidence for moderators or mediators of the findings.
• Possible Negative Effects and Harm. Provide information about probable negative
effects of this skill or method.
• Diversity Considerations. Describe the results related to diversity (e.g.,
gender, race/​ethnicity, sexual orientation, socioeconomic status) and their in-
tersection in the research evidence of the link between the skill/​method and
outcome.
• Limitations of the Research. Provide a brief description of the major limitations of
the extant research linking the skill/​method and outcome. Also give a concise par-
agraph or two on future research directions, particularly in terms of solutions to
resolve persistent methodological problems.
xiv Preface

• Training Implications. Explicate briefly the take-​home points of the research re-
view for clinical educators and supervisors.
• Therapeutic Practices. Provide in bullet form the evidence-​based implications for
practice.
 Acknowledgments

We are grateful to the Society for the Advancement of Psychotherapy (APA Division
29) for encouraging us to pursue this Task Force and for supporting its multiple-​year
timeline. We appreciate our co-​sponsoring organizations (SCP, SPR, SEPI) for joining
us in this vital endeavor. The contributors endured multiple revisions of their chapters
and faithfully followed demanding chapter guidelines. Our Steering Committee fur-
nished timely research expertise, and Sarah Harrington at Oxford University Press pro-
vided editorial and publication expertise.
We also thank our patients who have taught us so much about using psychotherapy
skills and methods. Likewise, we are indebted to our students and supervisees for chal-
lenging us to articulate and operationalize what we know about what works in psycho-
therapy. We especially recognize the community of psychotherapy scholars who have
supported and encouraged us throughout our careers to think more deeply and reflec-
tively about our craft. Finally, we acknowledge our families, who have provided us with
a secure base from which to venture out and explore the COVID-​plagued world.

Clara E. Hill and John C. Norcross