Abstract
Non-specific factors refer to dimensions that are shared by most psychotherapies and include the therapeutic alliance, the therapist’s competence and adherence to the treatment protocols whereas specific factors refer to the specific techniques and interventions that characterize particular psychotherapies. Review of the literature on non-specific treatment factors reveals that the therapeutic alliance and therapist competence may vary among patients and therapists, and that the therapeutic alliance also varies among treatment modalities. All three non-specific treatment factors, therapeutic alliance, therapist competence and adherence to the specific treatment modality, contribute significantly to treatment outcome and may account for more of the variance in outcome than specific treatment approach. Consequently, these factors need to be considered in the design of psychotherapy studies. In this paper we use the treatment study of infantile anorexia as an example of how to integrate these non-specific factors in the study design and the data analysis of treatment outcome in a psychotherapy study.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barber JP, Crits-Christoph P, Luborsky L (1995) Effects of therapist adherence and competence in patient outcome in brief dynamic therapy. Journal of Consulting and Clinical Psychology 64 (3):619–622
Barrett-Lennard GT (1985) The helping relationship: crisis and advances in theory and research. The Counselling Psychologist 13: 278–294
Bordin ES (1976) The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory Research and Practice 26: 252–260
Carroll KM, Nich C, Rounsaville BJ (1997) Contribution of the therapeutic alliance to outcome in active versus control psychotherapies. Journal of Consulting and Clinical Psychology 65 (3): 510–514
Chatoor I, Hirsch R, Ganiban J, Persinger M, Hamburger E (1998) Diagnosing infantile anorexia: the observation of mother-infant interactions. Journal of American Academy of Child and Adolescent Psychiatry 37 (9): 959–967
Elkin I (1988) The relationship of adherence to outcome. Paper presented at the meeting of the Society for Psychotherapy Research, Santa Fe, NM
Foley SH, O’Malley S, Rounsaville B, Prusoff BA, Weissman MM (1987) The relationship of patient difficulty to therapist performance in interpersonal psychotherapy of depression. Journal of Affective Disorder 12: 207–217
Freud S (1913) On the beginning of treatment: further recommendations on the techniques of psychoanalysis. Journal Strachey (Ed and Trans). The standard edition of the complete psychological works of Sigmund Freud (pp 122–144). London: Hogarth Press
Freud S (1958) The dynamics of transference. Journal Strachey (Ed). The standard edition of the complete psychological works of Sigmund Freud (pp 99–108). London: Hogarth Press (Original work published 1912)
Gaston L (1990) The concept of the alliance and its role in psychotherapy: theoretical and empirical considerations. Psychotherapy 27: 143–153
Greenson RR (1965) The working alliance and the transference neuroses. Psycho-analysis Quarterly 34: 155–181
Hartley DE, Strupp HH (1983) The therapeutic alliance: Its relationship to outcome in brief psychotherapy. In: Journal Masling (Ed). Empirical Studies in Analytic Theories (pp 1–37). Hillside, NJ: Erlbaum
Hill CE, O’Grady KE, Elkin I (1992) Applying the collaborative study psychotherapy rating scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. Journal of Consulting and Clinical Psychology 60 (1): 73–79
Horvath AO, Symonds BD (1991) Relation between working alliance and outcome in psychotherapy: a meta-analysis. Journal of Counselling Psychology 38: 139–149
Horvath AO, Luborsky L (1993) The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology 61 (4): 561–573
Krupnick JL, Sotsky SM, Simmons S (1992) The role of the therapeutic and pharmacotherapy outcome: findings in the NIMH treatment of depression collaborative research program. Presented at the annual meeting of the Society for Psychotherapy Research. Berkeley, CA
Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis PA (1996) The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treament of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology 64 (3): 532–539
Luborsky L, McLellan AT, Woody GE, O’Brien CP, Auerbach A (1985) Therapist success and its determinants. Archives of General Psychiatry 42: 602–611
Moncher FJ, Prinz PJ (1991) Treatment fidelity in outcome studies. Clinical Psychology Review II: 247–266
Raue PJ, Goldfried MR (1997) The therapeutic alliance in psychodynamic interpersonal and cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology 65 (4):582–587
Rogers CR (1957) The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting and Clinical Psychology 22: 95–103
Rogers CR, Gendlin GT, Kiesler DV, Truax LB (1967) The Therapeutic Relationship and Its Impact: a Study of Psychotherapy with Schizophrenics. Madison: University of Wisconsin Press
Samstag LW, Batchelder ST, Muran JC, Safran JD, Winston A (1998) Early identification of treatment failure in short-term psychotherapy: An assessment of therapeutic alliance and interpersonal behavior. Journal of Psychotherapy Practice and Research 7 (2): 126–143
Shaw BF, Yamaguchi IE, Yamaguchi J, Olmsted M, Vallis TM, Dobson KS, Lowery A, Sotsky SM, Watkins JT, Imber SD (1999) Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology 67 (6): 837–846
Waltz J, Addis ME, Koemer K, Jacobson NS (1993) Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology 61 (4):620–630
Waterlow J (1972) Classification and definition of protein-caloric malnutrition. British Medical Journal 3: 556–569
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Chatoor, I., Kurpnick, J. The role of non-specific factors in treatment outcome of psychotherapy studies. European Child & Adolescent Psychiatry 10 (Suppl 1), S19–S25 (2001). https://doi.org/10.1007/s007870170004
Issue Date:
DOI: https://doi.org/10.1007/s007870170004