Concluding Comments In this article we have presented a way to think about the

Concluding comments in this article we have presented

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Concluding Comments In this article, we have presented a way to think about the roles of technique and the rela- tionship in the therapeutic change process from a different perspective than is typically considered. Specifically, we have suggested that technique and the relationship serve to facilitate general principles that are the keys to the change process, including the facilitation of expectations that therapy will help, the establishment of an optimal therapeutic alliance, offering feedback that can help increase awareness, the encouragement of corrective experiences, and an emphasis on con- tinued reality testing. As noted earlier, these ideas have been presented before (Goldfried, 1980), and have even been extended. For example, Beut- ler, Consoli, and Lane (2005) have attempted to specify client variables that need to be considered in any intervention, such as whether or not a client will be receptive to a directive or nondi- rective approach to intervention. Further research is needed to help us better understand the param- eters associated with the role of technique and relationship in fostering the general change prin- ciples. For example, questions need to be ad- dressed about how different components of the therapeutic alliance (e.g., client-therapist bond, agreement on goals, and agreement about meth- ods) are related to change, and how this may vary as a function of such variables as nature of the clinical problem, client characteristics, and type of technique. However, these ideas have not yet become part of mainstream thinking, and with this article, we hope to move the research agenda further in that direction. Fortunately, there are others who share our goals. In a critique of the current randomized clinical trial approach to therapy research, Westen, Morrison, and Thompson-Brenner (2004) argued, among other things, that it is not possible to delineate exactly what needs to be done therapeutically when working with certain clinical problems (e.g., depression). To follow a manual that clearly specifies exactly what the therapist needs to do provides constraints on clin- ical judgment—often to the detriment of thera- peutic success (Castonguay et al., 1996; Henry, Goldfried and Davila 428
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Strupp, Butler, Schacht, & Binder, 1993; Roth & Fonagy, 1996). At the other extreme, to provide no clinical guidelines leaves us where psycho- therapy research was a half century ago, when still in its infancy. Rather than studying compet- ing theory-based treatment interventions whose specifications leave no room for clinical judg- ment, Westen and his colleagues recommend that we shift our research approach and study concep- tions and principles of change. Moreover, shifting the research focus in this way would also impact on training, and would open the door to more collab- oration and integration between relationship-based and technique-based orientations.
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