It's the therapist and the treatment: The structure of common therapeutic relationship factors

Abstract

Prior research has established that common therapeutic relationship factors are potent predictors of change in psychotherapy, but such factors are typically studied one at a time and their underlying structure when studied simultaneously is not clear. We assembled empirically validated relationship factors (e.g., therapist empathy; patient expectations; agreement about goals) into a single instrument and subjected it to factor analysis. Method: The instrument was applied to patients (N = 332) undergoing intensive psychotherapy of different types for depressive disorders, anxiety disorders, eating disorders, and childhood trauma in an inpatient specialized mental health setting. In order to examine the psychometric properties of the scale, we used half the sample (N=164) to conduct exploratory factor analysis (EFA) and parallel analysis before we tested the solution using exploratory structural equation modeling (ESEM) on the second half of the sample (N=168). Measurement invariance analysis was conducted to examine the stability of the factor structure. Results: The analysis yielded two factors, which were termed 1. "Confidence in the therapist" and 2. "Confidence in the treatment." Discussion: When assessed simultaneously, patients differentiate between their evaluation of the therapist and of the treatment. The results indicate that there is substantial overlap among previously established relationship factors. Trial registration: ClinicalTrials.gov identifier: NCT03503981.

Rapid transition from in‐person to videoconferencing psychotherapy in a counselor training clinic: A safety and feasibility study during the COVID‐19 pandemic

“…Under this framework, change is presumably enabled via the interaction among three pathways (1) the relationship, (2) specific ingredients, and (3) expectations. The contextual model contends that the underlying mechanism of change in therapy is less related to therapeutic specificity, but more to those processes common across all modalities that invite clients to engage in new, health promoting behaviors (Finsrud et al., 2021 ). The contextual model is synthesized from the empirical process and outcome research.…”

Confidence in the therapist and confidence in the treatment predict symptomatic improvement week by week in therapy: A latent curve modeling approach.

“…The analyses were conducted using the statistical program R (R Core Team, 2020), with the Lavaan package (Rosseel, 2012). The present study builds on Finsrud et al (2022), and there is some overlap in the data sample. Research materials are available from the corresponding author upon request.…”

“…Thus, while they are not equivalent to existing relationship constructs, we find that "Confidence in therapist" and "Confidence in treatment" span the array of the main ideas of the common factor theories; that is, the notion that psychotherapy is effective due to the personal relationship between therapist and patient, and a collaborative process where patients experience raised expectations and engage in therapy through a meaningful and coherent treatment rationale. Importantly, the study of Finsrud et al (2022) indicates that patient's confidence in the therapist and the treatment are two central social appraisals that patients make during therapy.…”

Healing in a Social Context: The Importance of Clinician and Patient Relationship

“…As mentioned previously, there is a conjecture that the therapeutic relationship is composed of two components, cognitive and emotional (44,45). Howe et al (45) attempted to tease out these two aspects of the clinical relationship.…”