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'''Common factors theory''', a theory guiding some research in [[clinical psychology]] and [[counseling psychology]], proposes that different approaches and [[evidence-based practice]]s in [[psychotherapy]] and counseling share ''common factors'' that account for much of the effectiveness of a psychological treatment.<ref>Some sources summarizing common factors theory include: {{harvnb|Carr|2008|p=49–67}}; {{harvnb|Imel|Wampold|2008}}; {{harvnb|McAleavey|Castonguay|2015}}; {{harvnb|Wampold|Imel|2015}}</ref> This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors (notably, particular methods or procedures) that are suited to treatment of particular problems.<ref name="ChamblessOllendick2001">{{harvnb|Chambless|Ollendick|2001}}</ref> According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness".<ref>{{harvnb|Boswell|Sharpless|Greenberg|Heatherington|2014|p=118}}; this conclusion is also found in, for example, {{harvnb|Butler|Strupp|1986}}, {{harvnb|Arkowitz|1995}}, {{harvnb|McAleavey|Castonguay|2015}}</ref> In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate".<ref>{{harvnb|Carr|2008|p=53}}</ref>
{{essay-like|date=July 2009}}


== Common factors theory in psychotherapy ==
==History of common factors==
[[Saul Rosenzweig]] started the conversation on common factors in an article published in 1936 that discussed some psychotherapies of his time.<ref>{{harvnb|Rosenzweig|1936}}, {{harvnb|Rosenzweig|1940}}; {{harvnb|Duncan|2002|p=10}}; Lisa Wallner Samstag has argued that Saul Rosenzweig's contribution to common factors theory has often been misunderstood ({{harvnb|Samstag|2002}})</ref> [[John Dollard]] and [[Neal E. Miller]]'s 1950 book ''Personality and Psychotherapy'' emphasized that the psychological principles and social conditions of [[learning]] are the most important common factors.<ref name="DollardMiller1950">{{harvnb|Dollard|Miller|1950}}; more recently, Warren Tryon has championed learning as a common factor, e.g. {{harvnb|Tryon|Tryon|2011|p=152}}: "Therapists, and the therapeutic approaches that currently divide us, differ only with regard to what is to be learned and how it is to be acquired... This makes learning and memory basic to our science and profession and should motivate us to search for mechanisms that underlie all effective psychological interventions..."</ref> Sol Garfield (who would later go on to edit many editions of the ''Handbook of Psychotherapy and Behavior Change'' with [[Allen Bergin]]) included a 10-page discussion of common factors in his 1957 textbook ''Introductory Clinical Psychology''.<ref>{{harvnb|Garfield|1957}}; {{harvnb|Duncan|2002|p=14}}</ref> In the same year, [[Carl Rogers]] published a paper outlining what he considered to be common factors (which he called "sufficient conditions") of successful therapeutic personality change, emphasizing the [[therapeutic relationship]] factors which would become central to the theory of [[person-centered therapy]].<ref>{{harvnb|Rogers|1957}}; 50 years later, in 2007, a series of 13 articles reviewed Rogers' 1957 article; some of those articles argued that Rogers' "sufficient conditions" are not common factors: {{cite journal |title=Special section: The necessary and sufficient conditions at the half century mark |journal=[[Psychotherapy (journal)|Psychotherapy: Theory, Research, Practice, Training]] |volume=44 |issue=3 |pages=239–299 |url=http://psycnet.apa.org/journals/pst/44/3/}}</ref>
Within [[psychotherapy]] research, '''common factors theory''' proposes that different theoretical and evidence-based approaches to psychotherapy and counseling have common components and that those components account for outcome more than components that are unique to each approach.<ref>Imel,Z., & Wampold, B. (2008). The Importance of Treatment and the Science of Common Factors in Psychotherapy. Handbook of counseling Psychology, (4th ed.). (pp. 249-262): John Wiley & Sons Inc.</ref> This is in opposition to the medical model, which proposes that the efficacy of psychotherapy is because of specific, critical ingredients in treatment for specific problems (Imel & Wampold, 2008). Based on studies that combine the results of as many psychotherapy outcome studies, it seems that there is no significant difference between various common psychotherapy approaches in terms of client outcome.<ref>Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empiricially, "all must have prizes.". Psychological Bulletin, 122(3), 203-215.</ref> This is known as the "[[Dodo bird verdict|Dodo-bird Hypothesis]]," so-named after a scene in Alice in Wonderland when, after the characters race and everyone wins, the Dodo bird says, "everyone has won, so all must have prizes."


In 1961, [[Jerome Frank (psychiatrist)|Jerome Frank]] published ''Persuasion and Healing'', a book entirely devoted to examining the common factors among psychotherapies and related healing approaches.<ref name="Frank">{{harvnb|Frank|Frank|1991}}; the legacy of Frank's work is discussed in {{harvnb|Alarcón|Frank|2011}}</ref> Frank emphasized the importance of (1) the [[Expectation (epistemic)|expectation]] of help (a component of the [[placebo]] effect), (2) the [[therapeutic relationship]], (3) a rationale or conceptual scheme that explains the given symptoms and prescribes a given [[ritual]] or procedure for resolving them, and (4) the active participation of both patient and therapist in carrying out that ritual or procedure.<ref name="Frank1971">See also {{harvnb|Frank|1971|p=350}}: "A historical overview of Western psychotherapy reveals that the dominant psychotherapeutic approach of an era reflects contemporary cultural attitudes and values, and that the same techniques (e.g., abreaction) reappear under new names. Common to all psychotherapies are (a) an emotionally charged, confiding relationship; (b) a therapeutic rationale accepted by patient and therapist; (c) provision of new information by precept, example and self-discovery; (d) strengthening of the patient's expectation of help; (e) providing the patient with success experiences; and (f) facilitation of emotional arousal. Prevalent forms of disability and their treatment include drug therapy for constitutional vulnerabilities, emotional support for environmental crises, spiritual guidance for existential anxieties, and therapeutic maneuvers to correct faulty perceptual and behavioral habits learned early in life. Only the latter form requires therapists trained in specific psychotherapeutic methods."</ref>
It is important to clarify that the term psychotherapy is most commonly used in the sources cited, but common factors theory also applies to counseling. The literature and implications for common factors theory span counseling and psychotherapy.


After [[Lester Luborsky]] and colleagues published a literature review of empirical studies of psychotherapy outcomes in 1975,<ref>{{harvnb|Luborsky|Singer|Luborsky|1975}}</ref> the idea that all psychotherapies are effective became known as the [[Dodo bird verdict]], referring to a scene from ''[[Alice's Adventures in Wonderland]]'' quoted by Rosenzweig in his 1936 article; in that scene, after the characters race and everyone wins, the Dodo bird says, "everybody has won, and all must have prizes."<ref>The question of whether all psychotherapies are all roughly equally effective (known as the [[Dodo bird verdict]]) and the question of whether all effective psychotherapies share common factors (known as common factors theory) are two different questions: "Though many authors view outcome equivalence as the main reason to study common factors in psychotherapy, we cheerfully disagree. Regardless of outcome, it is noncontroversial to say that psychotherapies of many origins share several features of process and content, and it follows that better understanding the patterns of these commonalities may be an important part of better understanding the effects of psychotherapies. That is, irrespective of whether some psychotherapies are equivalent to others in symptomatic outcome, understanding what part of clients' improvement is due to factors that are shared by several approaches appears to us to be a conceptually and clinically important question." ({{harvnb|McAleavey|Castonguay|2015|p=294}})</ref> Luborsky's research was an attempt (and not the first attempt, nor the last one) to disprove [[Hans Eysenck]]'s 1952 study on the [[efficacy]] of psychotherapy; Eysenck found that psychotherapy generally did not seem to lead to improved patient outcomes.<ref>{{harvnb|Eysenck|1952}}</ref> A number of studies after 1975 presented more evidence in support of the general efficacy of psychotherapy,<ref>For example: {{harvnb|Smith|Glass|1977}}; {{harvnb|Lipsey|Wilson|1993}}; {{harvnb|Carr|2008}}</ref> but the question of how common and specific factors could enhance or thwart therapy effectiveness in particular cases continued to fuel theoretical and empirical research over the following decades.<ref>For an overview of the work of some prominent psychotherapy researchers who have explored this question, see: {{harvnb|Castonguay|Muran|Angus|Hayes|2010}}</ref>
Common factors theory predicts that different psychotherapy treatments lead to similar outcomes, and that different treatments have similar underlying components that contribute to outcome (Imel & Wampold, 2008). Studies that test common factors theory tend to investigate possible differences in outcomes in psychotherapy efficacy studies, and the nature of the approaches being compared.


The landmark 1982 book ''Converging Themes in Psychotherapy'' gathered a number of chapters by different authors promoting common factors, including an introduction by Marvin R. Goldfried and Wendy Padawer, a [[reprint]] of Rosenzweig's 1936 article, and futher chapters (some of them reprints) by [[John Dollard]] and [[Neal E. Miller]], [[Franz Alexander]], [[Jerome Frank (psychiatrist)|Jerome Frank]], [[Arnold Lazarus]], [[Hans Herrman Strupp]], Sol Garfield, John Paul Brady, [[Judd Marmor]], Paul L. Wachtel, [[Abraham Maslow]], Arnold P. Goldstein, [[Anthony Ryle]], and others.<ref>{{harvnb|Goldfried|1982}}</ref> The chapter by Goldfried and Padawer distinguished between three levels of intervention in therapy: first, theories of change (therapists' theories about how change occurs); second, principles or strategies of change; third, therapy techniques (interventions that therapists suppose will be effective).<ref name="GoldfriedPadawar1982">{{harvnb|Goldfried|1982|pp=3–49}}</ref> They argued that while therapists may talk about their theories using very different [[jargon]], there is more commonality among skilled therapists at the level of principles or strategies. Goldfried and Padawar's emphasis on principles or strategies of change was an important contribution to common factors theory because they clearly showed how principles or strategies can be considered common factors (they are shared by therapists who may espouse different theories of change) and specific factors (they are manifested in particular ways within different approaches) at the same time.<ref>{{harvnb|McAleavey|Castonguay|2015|p=298}}</ref>
Eysenck's study<ref>Eysenck, H. J. (1952). The effects of psychotherapy: an evaluation. Journal of Consulting Psychology, 16(5), 319-324.</ref> on the efficacy of psychotherapy found that psychotherapy generally did not seem to lead to improved client outcomes. Numerous studies later showed substantial evidence in support of the general efficacy of psychotherapy,<ref>Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32(9), 752-760.</ref><ref>Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings: Lawrence Erlbaum Associates Publishers: Mahwah.</ref>). There is also evidence that different approaches to psychotherapy tend to be similar in terms of outcome (Wampold, 1997). It is possible that specific disorders might require specific types of treatment, but so far comparisons between treatments for different disorders have not shown the superiority of one treatment over another (Imel & Wampold, 2008).


In 1986, David Orlinsky and Kenneth Howard presented their ''generic model of psychotherapy'', which proposed that five process variables are active in any psychotherapy: the therapeutic contract, therapeutic interventions, the therapeutic bond between therapist and patient, the patient's and therapist's states of self-relatedness, and therapeutic realization.<ref>{{harvnb|Orlinsky|Howard|1986}}</ref>
It is also possible that different approaches are equally effective but still distinct in their mechanisms for client change. Therefore, methods for testing common factors theory use a variety of methods for comparing psychotherapy studies. One method used involves comparing placebo or common factor control groups to treatment groups. Another method involves testing specific components within a theory or approach, such as by comparing a behavioral therapy with a cognitive-behavioral therapy (Imel & Wampold, 2008). Finally, if a specific aspect to treatment is critical for successful outcomes, then therapists' adherence to a type of treatment should be related to outcome. Imel and Wampold state “[o]ver the past 50 years researchers have conducted hundreds of clinical trials, comparing the effects of one psychotherapy to others. Meta-analyses of psychotherapy studies have consistently demonstrated that there are no substantial differences in outcomes among treatments” (2008, p. 250).


In 1990, Lisa Grencavage and [[John C. Norcross]] reviewed accounts of common factors in 50 publications, with 89 common factors in all, from which Grencavage and Norcross selected the 35 most common factors and grouped them into five areas: client characteristics, therapist qualities, change processes, treatment structure, and therapeutic relationship.<ref name="GrencavageNorcross1990">{{harvnb|Grencavage|Norcross|1990}}</ref> In the same year, [[Larry E. Beutler]] and colleagues published their ''systematic treatment selection model'', which attempted to integrate common and specific factors into a single model that therapists could use to guide treatment, considering variables of patient dimensions, environments, settings, therapist dimensions, and treatment types.<ref>{{harvnb|Beutler|Clarkin|1990}}</ref> Beutler and colleagues would later describe their approach as "identifying common and differential principles of change".<ref>{{harvnb|Beutler|Moleiro|Talebi|2002}}</ref>
=== The Common Factors ===
There are several models of common factors. One empirically-derived model proposes two dimensions (thinking and feeling) and three clusters: bond, information, and role.<ref>Tracey, T.J.G., Lictenberg, J.W., Goodyear, R.K., Claiborn,C.D., and Wampold, B.E. (2003). Concept mapping of the therapeutic factors. Psychotherapy Research, 13, 401-413.</ref> Studies suggest that 30% to 70% of therapy outcome is due to common factors (Imel & Wampold, 2008).


In 1992, [[Michael J. Lambert]] summarized psychotherapy outcome research and grouped the factors of successful therapy into four areas, ordered by [[hypothesized]] percent of change in clients as a function of therapeutic factors: first, ''extratherapeutic change'' (40%), those factors that are qualities of the client or qualities of his or her environment and that aid in recovery regardless of his or her participation in therapy; second, ''common factors'' (30%) that are found in a variety of therapy approaches, such as empathy and the therapeutic relationship; third, ''expectancy'' (15%), the portion of improvement that results from the client's expectation of help or belief in the rationale or effectiveness of therapy; fourth, ''techniques'' (10%), those factors unique to specific therapies and tailored to treatment of specific problems.<ref name="Lambert1992">{{harvnb|Lambert|1992}}</ref> Lambert's research later inspired a book on common factors theory in the practice of therapy titled ''The Heart and Soul of Change''.<ref>{{harvnb|Duncan|Hubble|Miller|2010}}</ref>
=== Criticisms of Common Factors Theory ===
One criticism of common factors theory is that though all the factors are necessary, they are not sufficient for client change. The theory does not account for techniques and therapist behavior. Another criticism is that common factors are nothing more than a good [[therapeutic relationship]], though Imel & Wampold suggest that, though the therapeutic relationship is important, it is not the only common factor. Finally, some feel that common factors theory is not scientific, especially in comparison to the medical model.


In the mid-1990s, as [[managed care]] in [[mental health]] services became more widespread in the [[United States]], more researchers began to investigate the efficacy of psychotherapy in terms of ''empirically supported treatments'' (ESTs) for particular problems, emphasizing [[randomized controlled trial]]s as the [[Gold standard (test)|gold standard]] of empirical support for a treatment.<ref>{{harvnb|Wampold|Imel|2015}}, ch. 1</ref> In 1995, the [[American Psychological Association]]'s Divsion 12 ([[clinical psychology]]) formed a [[task force]] that developed lists of empirically supported treatments for particular problems such as [[agoraphobia]], [[blood-injection-injury type phobia]], [[generalized anxiety disorder]], [[obsessive–compulsive disorder]], [[panic disorder]], etc.<ref name="ChamblessOllendick2001"/> In 2001, Bruce Wampold published ''The Great Psychotherapy Debate'', a book that criticized what he considered to be an overemphasis on ESTs for particular problems, and he called for continued research in common factors theory.<ref>{{harvnb|Wampold|Imel|2015}}</ref>
== See also ==

In 2014, a series of ten articles on common factors theory was published in the [[American Psychological Association|APA]] journal ''[[Psychotherapy (journal)|Psychotherapy]]''.<ref name="APA2014">{{cite journal |title=Special section: Common factors |journal=[[Psychotherapy (journal)|Psychotherapy: Theory, Research, Practice, Training]] |volume=51 |issue=4 |pages=476–524 |url=http://psycnet.apa.org/journals/pst/51/4/}}</ref> The articles emphasized the compatibility between ESTs and common factors theory, highlighted the importance of multiple variables in psychotherapy effectiveness, called for more empirical research on common factors (especially client and therapist variables), and argued that individual therapists can do much to improve the quality of therapy by rigorously using feedback measures (during treatment) and outcome measures (after termination of treatment).<ref name="APA2014"/> The article by Stephan Hoffmann and David Barlow, two prominent researchers in [[cognitive behavioral therapy]], pointed out how their recent shift in emphasis from distinct procedures for different diagnoses to a transdiagnostic approach was increasingly similar to common factors theory.<ref>{{harvnb|Hoffmann|Barlow|2014|p=511}}</ref>

==Models of common factors==
There are many models of common factors in successful psychotherapy process and outcome. Already in 1990, Grencavage and Norcross identified 89 common factors in a [[literature review]], which showed the diversity of models of common factors.<ref name="GrencavageNorcross1990"/> To be useful for purposes of psychotherapy practice and training, most models reduce the number of common factors to a handful, typically around five. Frank listed six common factors in 1971 and explained their interaction.<ref name="Frank1971"/> Goldfried and Padawar listed five common strategies or principles in 1982: corrective experiences and new behaviors, feedback from the therapist to the client promoting new understanding in the client, expectation that psychotherapy will be helpful, establishment of the desired therapeutic relationship, and ongoing reality testing by the client.<ref name="GoldfriedPadawar1982"/> Grencavage and Norcross grouped common factors into five areas in 1990.<ref name="GrencavageNorcross1990"/> Lambert formulated four groups of therapeutic factors in 1992.<ref name="Lambert1992"/> Joel Weinberger and Cristina Rasco listed five common factors in 2007 and reviewed the empirical support for each factor: the therapeutic relationship, expectations of treatment effectiveness, confronting or facing the problem (exposure), mastery or control experiences, and patients' attributions of successful outcome to internal or external causes.<ref>{{harvnb|Weinberger|Rasco|2007}}</ref>

Terence Tracy and colleagues modified the common factors of Grencavage and Norcross, and used them to develop a [[questionnaire]] which they provided to 16 [[board certified]] psychologists and 5 experienced psychotherapy researchers; then they analyzed the responses and published the results in 2003.<ref name="Tracey2003">{{harvnb|Tracey|Lichtenberg|Goodyear|Claiborn|2003|pp=406–410}}</ref> Their [[multidimensional scaling]] analysis represented the results on a [[two-dimensional graph]], with one dimension representing hot processing versus cool processing (roughly, closeness and emotional experience versus technical information and persuasion) and the other dimension representing therapeutic activity. Their [[cluster analysis]] represented the results as three clusters: the first related to bond (roughly, [[therapeutic alliance]]), the second related to information (roughly, the meanings communicated between therapist and client), and the third related to role (roughly, a logical structure so that clients can make sense of the therapy process).<ref name="Tracey2003"/>

In addition to these models that incorporate multiple common factors, a number of theorists have proposed and investigated single common factors, common principles, and common mechanisms of change, such as [[learning]]. For examples, see {{section link||Further reading}}, below.

==Empirical research on common factors==
While many models of common factors have been proposed, they have not all received the same amount of [[empirical research]]. There is general consensus on the importance of a good [[therapeutic relationship]] in all forms of psychotherapy and counseling.<ref>{{harvnb|McAleavey|Castonguay|2015|pp=301–302}}</ref>

A review of common factors research in 2008 suggested that 30% to 70% of the [[variance]] in therapy outcome is due to common factors.<ref>{{harvnb|Imel|Wampold|2008|p=255}}</ref> A summary of research in 2014 suggested that 11.5% of variance in therapy outcome is due to the common factor of [[goal]] consensus/[[collaboration]], 9% is due to [[empathy]], 7.5% is due to [[therapeutic alliance]], 6.3% is due to positive regard/affirmation, 5.7% is due to congruence/genuineness, and 5% is due to therapist factors; in contrast, treatment method accounts for roughly 1% of outcome variance.<ref>{{harvnb|Laska|Gurman|Wampold|2014|p=472}}</ref>

[[Alan E. Kazdin]] has argued that psychotherapy researchers must not only find statistical evidence that certain factors contribute to successful outcomes; they must also be able to fomulate evidence-based explanations for how and why those factors contribute to successful outcomes, that is, the [[Mechanism (biology)|mechanism]]s through which successful psychotherapy leads to change.<ref>{{harvnb|Kazdin|2009}}</ref> Common factors theory has been dominated by research on psychotherapy process and outcome variables, and there is a need for further work explaining the mechanisms of psychotherapy common factors in terms of emerging theoretical and empirical research in the [[neuroscience]]s and [[social science]]s,<ref>{{harvnb|Imel|Wampold|2008|p=261}}</ref> just as earlier works such as Dollard and Miller's ''Personality and Psychotherapy''<ref name="DollardMiller1950"/> or Frank's ''Persuasion and Healing''<ref name="Frank"/> explained psychotherapy common factors in terms of the sciences of their time.

==Criticisms of common factors theory==
There are several criticisms of common factors theory: for example, that common factors theory dismisses the need for specific therapeutic techniques or procedures, that common factors are nothing more than a good [[therapeutic relationship]], and that common factors theory is not scientific.<ref>{{harvnb|Imel|Wampold|2008|p=256–258}}</ref> Some common factors theorists have argued that these criticisms are based on a limited knowledge of the common factors literature; a thorough review of the literature shows that a coherent treatment procedure is a crucial medium for the common factors to operate, that most models of common factors define interactions between multiple variables (including but not limited to therapeutic relationship variables), and that some models of common factors provide evidence-based explanations for the [[Mechanism (biology)|mechanism]]s of the proposed common factors.<ref>{{harvnb|Imel|Wampold|2008|p=258–260}}</ref>

==See also==
*[[Dodo bird verdict]]
*[[Integrative psychotherapy]]
*[[Integrative psychotherapy]]
*[[Psychotherapy]]


== References ==
==Notes==
{{Reflist|colwidth=22em}}
<references/>

==References==
* {{cite book |editor1-last=Alarcón |editor1-first=Renato D |editor2-last=Frank |editor2-first=Julia |date=2011 |title=The psychotherapy of hope: the legacy of Persuasion and healing |location=Baltimore |publisher=[[Johns Hopkins University Press]] |isbn=9781421403045 |oclc=706784241 |url=http://books.google.com/books?id=DNDpDyNn7H4C |ref=harv}}
* {{cite journal |last=Arkowitz |first=Hal |date=March 1995 |title=Common factors or processes of change in psychotherapy? |journal=Clinical Psychology: Science and Practice |volume=2 |issue=1 |pages=94–100 |doi=10.1111/j.1468-2850.1995.tb00031.x |ref=harv}}
* {{cite book |last1=Beutler |first1=Larry E |authorlink1=Larry E. Beutler |last2=Clarkin |first2=John F |date=1990 |title=Systematic treatment selection: toward targeted therapeutic interventions |series=Brunner/Mazel integrative psychotherapy series |volume=3 |location=New York |publisher=Brunner/Mazel |isbn=0876305761 |oclc=20826889 |url=http://books.google.com/books?id=uovFBQAAQBAJ |ref=harv}}
* {{cite journal |last1=Beutler |first1=Larry E |authorlink1=Larry E. Beutler |last2=Moleiro |first2=Carla |last3=Talebi |first3=Hani |date=October 2002 |title=How practitioners can systematically use empirical evidence in treatment selection |journal=[[Journal of Clinical Psychology]] |volume=58 |issue=10 |pages=1199–1212 |doi=10.1002/jclp.10106 |pmid=12357437 |ref=harv}}
* {{cite book |last1=Boswell |first1=James F |last2=Sharpless |first2=Brian A |last3=Greenberg |first3=Leslie S |authorlink3=Les Greenberg |last4=Heatherington |first4=Laurie |last5=Huppert |first5=Jonathan D |last6=Barber |first6=Jacques P |last7=Goldfried |first7=Marvin R |last8=Castonguay |first8=Louis G |date=2014 |chapter=Schools of psychotherapy and the beginnings of a scientific approach |editor-last=Barlow |editor-first=David H |title=The Oxford handbook of clinical psychology |edition=Updated |series=Oxford library of psychology |location=New York |publisher=[[Oxford University Press]] |pages=98–127 |isbn=9780199328710 |oclc=874118501 |chapterurl=http://books.google.com/books?id=Cr0iAwAAQBAJ&pg=PA98 |ref=harv}}
* {{cite journal |last1=Butler |first1=Stephen F |last2=Strupp |first2=Hans H |authorlink2=Hans Herrman Strupp |date=1986 |title=Specific and nonspecific factors in psychotherapy: a problematic paradigm for psychotherapy research |journal=[[Psychotherapy (journal)|Psychotherapy: Theory, Research, Practice, Training]] |volume=23 |issue=1 |pages=30–40 |doi=10.1037/h0085590 |ref=harv}}
* {{cite book |last=Carr |first=Alan |date=2008 |title=What works with children, adolescents, and adults: a review of research on the effectiveness of psychotherapy |location=New York |publisher=[[Routledge]] |isbn=9780415452915 |oclc=192042194 |url=http://books.google.com/books?id=fOc2pSbobc8C |ref=harv}}
* {{cite book |editor1-last=Castonguay |editor1-first=Louis G |editor2-last=Muran |editor2-first=J Christopher |editor3-last=Angus |editor3-first=Lynne E |editor4-last=Hayes |editor4-first=Jeffrey A |editor5-last=Ladany |editor5-first=Nicholas |editor6-last=Anderson |editor6-first=Timothy |date=2010 |title=Bringing psychotherapy research to life: understanding change through the work of leading clinical researchers |location=Washington, DC |publisher=[[American Psychological Association]] |isbn=9781433807749 |oclc=463855600 |ref=harv}}
* {{cite journal |last1=Chambless |first1=Dianne L |last2=Ollendick |first2=Thomas H |date=February 2001 |title=Empirically supported psychological interventions: controversies and evidence |journal=[[Annual Review of Psychology]] |volume=52 |issue=1 |pages=685–716 |doi=10.1146/annurev.psych.52.1.685 |url=http://www.researchgate.net/profile/Thomas_Ollendick/publication/12181680_Empirically_supported_psychological_interventions_controversies_and_evidence/links/02e7e521f7fd0d7d99000000.pdf |pmid=11148322 |ref=harv}}
* {{cite book |last1=Dollard |first1=John |authorlink1=John Dollard |last2=Miller |first2=Neal E |authorlink2=Neal E. Miller |title=Personality and psychotherapy: an analysis in terms of learning, thinking, and culture |series=McGraw-Hill publications in psychology |date=1950 |location=New York |publisher=[[McGraw-Hill]] |oclc=964374 |ref=harv}}
* {{cite journal |last=Eysenck |first=Hans J |authorlink=Hans Eysenck |date=October 1952 |title=The effects of psychotherapy: an evaluation |journal=Journal of Consulting Psychology |volume=16 |issue=5 |pages=319–324 |doi=10.1037/h0063633 |url=http://psychclassics.yorku.ca/Eysenck/psychotherapy.htm |ref=harv}}
* {{cite journal |last=Duncan |first=Barry L |date=March 2002 |title=The founder of common factors: a conversation with Saul Rosenzweig |journal=[[Journal of Psychotherapy Integration]] |volume=12 |issue=1 |pages=10–31 |doi=10.1037/1053-0479.12.1.10 |url=http://www.researchgate.net/profile/Barry_Duncan2/publication/232592263_The_founder_of_common_factors_A_conversation_with_Saul_Rosenzweig/links/53eb4bfe0cf2fb1b9b6b0b9d.pdf |ref=harv}}
* {{cite book |editor1-last=Duncan |editor1-first=Barry L |editor2-last=Hubble |editor2-first=Mark A |editor3-last=Miller |editor3-first=Scott D |date=2010 |origyear=1999 |title=The heart & soul of change: delivering what works in therapy |edition=2nd |location=Washington, DC |publisher=[[American Psychological Association]] |isbn=9781433807091 |oclc=370605648 |ref=harv}}
* {{cite journal |last=Frank |first=Jerome D |authorlink=Jerome Frank (psychiatrist) |date=July 1971 |title=Therapeutic factors in psychotherapy |journal=[[American Journal of Psychotherapy]] |volume=25 |issue=3 |pages=350–361 |pmid=4936109 |ref=harv}}
* {{cite book |last1=Frank |first1=Jerome D |authorlink1=Jerome Frank (psychiatrist) |last2=Frank |first2=Julia |title=Persuasion and healing: a comparative study of psychotherapy |date=1991 |origyear=1961 |edition=3rd |location=Baltimore |publisher=[[Johns Hopkins University Press]] |isbn=0801840678 |oclc=21764135 |ref=harv}}
* {{cite book |last=Garfield |first=Sol L |title=Introductory clinical psychology: an overview of the functions, methods, and problems of contemporary clinical psychology |date=1957 |location=New York |publisher=Macmillan |oclc=1458147 |ref=harv}}
* {{cite book |editor-last=Goldfried |editor-first=Marvin R |date=1982 |title=Converging themes in psychotherapy: trends in psychodynamic, humanistic, and behavioral practice |location=New York |publisher=Springer Pub. Co. |isbn=0826136214 |oclc=8169372 |ref=harv}}
* {{cite journal |last1=Grencavage |first1=Lisa M |last2=Norcross |first2=John C |authorlink2=John C. Norcross |date=October 1990 |title=Where are the commonalities among the therapeutic common factors? |journal=[[Professional Psychology: Research and Practice]] |volume=21 |issue=5 |pages=372–378 |doi=10.1037/0735-7028.21.5.372 |url=http://www.researchgate.net/profile/John_Norcross/publication/232519607_Where_are_the_commonalities_among_the_therapeutic_common_factors/links/0fcfd50ae2f01a465c000000.pdf |ref=harv}}
* {{cite journal |last1=Hofmann |first1=Stefan G |last2=Barlow |first2=David H |date=December 2014 |title=Evidence-based psychological interventions and the common factors approach: the beginnings of a rapprochement? |journal=[[Psychotherapy (journal)|Psychotherapy: Theory, Research, Practice, Training]] |volume=51 |issue=4 |pages=510–513 |doi=10.1037/a0037045 |url=http://www.researchgate.net/profile/Stefan_Hofmann/publication/264628212_Evidence-Based_Psychological_Interventions_and_the_Common_Factors_Approach_The_Beginnings_of_a_Rapprochement/links/543555af0cf2dc341db09427.pdf |ref=harv}}
* {{cite book |last1=Imel |first1=Zac E |last2=Wampold |first2=Bruce E |date=2008 |chapter=The importance of treatment and the science of common factors in psychotherapy |editor1-last=Brown |editor1-first=Steven D |editor2-last=Lent |editor2-first=Robert W |title=Handbook of counseling psychology |edition=4th |location=Hoboken, NJ |publisher=[[John Wiley & Sons]] |pages=249–262 |isbn=9780470096222 |oclc=145942481 |chapterurl=http://books.google.com/books?id=oF_CwsBO8kQC&pg=PA249 |ref=harv}}
* {{cite journal |last=Kazdin |first=Alan E |authorlink=Alan E. Kazdin |date=July 2009 |title=Understanding how and why psychotherapy leads to change |journal=[[Psychotherapy Research]] |volume=19 |issue=4–5 |pages=418–428 |doi=10.1080/10503300802448899 |pmid=19034715 |ref=harv}}
* {{cite book |last=Lambert |first=Michael J |authorlink=Michael J. Lambert |date=1992 |chapter=Psychotherapy outcome research: implications for integrative and eclectic therapists |editor1-last=Norcross |editor1-first=John C |editor1-link=John C. Norcross |editor2-last=Goldfried |editor2-first=Marvin R |title=Handbook of psychotherapy integration |edition=1st |location=New York |publisher=[[Basic Books]] |pages=94–129 |isbn=0465028799 |oclc=25547822 |chapterurl=http://www.researchgate.net/profile/Lambert_Michael/publication/232507437_Psychotherapy_outcome_research_Implications_for_integrative_and_eclectical_therapists/links/0046353615897bbd44000000.pdf |ref=harv}}
* {{cite journal |last1=Laska |first1=Kevin M |last2=Gurman |first2=Alan S |last3=Wampold |first3=Bruce E |date=December 2014 |title=Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective |journal=[[Psychotherapy (journal)|Psychotherapy: Theory, Research, Practice, Training]] |volume=51 |issue=4 |pages=467–481 |doi=10.1037/a0034332 |url=http://www.researchgate.net/profile/Kevin_Laska/publication/259497860_Expanding_the_Lens_of_Evidence-Based_Practice_in_Psychotherapy_A_Common_Factors_Perspective/links/5491bff20cf23b7c974c1681.pdf |ref=harv}}
* {{cite journal |last1=Lipsey |first1=Mark W |last2=Wilson |first2=David B |date=December 1993 |title=The efficacy of psychological, educational, and behavioral treatment: confirmation from meta-analysis |journal=[[American Psychologist]] |volume=48 |issue=12 |pages=1181–1209 |doi=10.1037/0003-066X.48.12.1181 |ref=harv}}
* {{cite journal |last1=Luborsky |first1=Lester |authorlink1=Lester Luborsky |last2=Singer |first2=Barton |last3=Luborsky |first3=Lise |date=August 1975 |title=Comparative studies of psychotherapies: is it true that everyone has won and all must have prizes? |journal=[[Archives of General Psychiatry]] |volume=32 |issue=8 |pages=995–1008 |doi=10.1001/archpsyc.1975.01760260059004 |ref=harv}}
* {{cite book |last1=McAleavey |first1= |last2=Castonguay |first2=Louis G |chapter=The process of change in psychotherapy: common and unique factors |editor1-last=Gelo |editor1-first=Omar CG |editor2-last=Pritz |editor2-first=Alfred |editor3-last=Rieken |editor3-first=Bernd |date=2015 |title=Psychotherapy research: foundations, process, and outcome |location=New York |publisher=Springer |pages=293–310 |isbn=9783709113813 |oclc=900722269 |doi=10.1007/978-3-7091-1382-0_15 |chapterurl=http://books.google.com/books?id=JYTwBQAAQBAJ&pg=PA293 |ref=harv}}
* {{cite book |last1=Orlinsky |first1=David E |last2=Howard |first2=Kenneth I |date=1986 |chapter=Process and outcome in psychotherapy |editor1-last=Garfield |editor1-first=Sol L |editor2-last=Bergin |editor2-first=Allen E |title=Handbook of psychotherapy and behavior change |edition=3rd |location=New York |publisher=Wiley |pages=311–381 |isbn=0471799955 |oclc=13425136 |ref=harv}}
* {{cite journal |last=Rogers |first=Carl R |authorlink=Carl Rogers |date=April 1957 |title=The necessary and sufficient conditions of therapeutic personality change |journal=Journal of Consulting Psychology |volume=21 |issue=2 |pages=95–103 |doi=10.1037/h0045357 |url=http://www.person-centred.co.uk/pdf%20props/necessary%20and%20sufficient.pdf |ref=harv}}
* {{cite journal |last=Rosenzweig |first=Saul |authorlink=Saul Rosenzweig |date=July 1936 |title=Some implicit common factors in diverse methods of psychotherapy |journal=[[American Journal of Orthopsychiatry]] |volume=6 |issue=3 |pages=412–415 |doi=10.1111/j.1939-0025.1936.tb05248.x}}
* {{cite journal |last=Rosenzweig |first=Saul |authorlink=Saul Rosenzweig |date=October 1940 |title=Areas of agreement in psychotherapy |journal=[[American Journal of Orthopsychiatry]] |volume=10 |issue=4 |pages=703–704 |doi=10.1111/j.1939-0025.1940.tb05736.x}}
* {{cite journal |last1=Smith |first1=Mary L |last2=Glass |first2=Gene V |date=September 1977 |title=Meta-analysis of psychotherapy outcome studies |journal=[[American Psychologist]] |volume=32 |issue=9 |pages=752–760 |doi=10.1037/0003-066X.32.9.752 |ref=harv}}
* {{cite journal |last1=Tracey |first1=Terence GJ |last2=Lichtenberg |first2=James W |last3=Goodyear |first3=Rodney K |last4=Claiborn |first4=Charles D |last5=Wampold |first5=Bruce E |date=December 2003 |title=Concept mapping of therapeutic common factors |journal=[[Psychotherapy Research]] |volume=13 |issue=4 |pages=401–413 |doi=10.1093/ptr/kpg041 |url=http://www.researchgate.net/profile/Rod_Goodyear/publication/245536619_Concept_mapping_of_therapeutic_common_factors/links/00b4951d786d505481000000.pdf |ref=harv}}
* {{cite journal |last1=Tryon |first1=Warren W |last2=Tryon |first2=Georgiana Shick |date=February 2011 |title=No ownership of common factors |journal=[[American Psychologist]] |volume=66 |issue=2 |pages=151–152 |doi=10.1037/a0021056 |ref=harv}}
* {{cite journal |last=Samstag |first=Lisa Wallner |date=March 2002 |title=The common versus unique factors hypothesis in psychotherapy research: did we misinterpret Rosenzweig? |journal=[[Journal of Psychotherapy Integration]] |volume=12 |issue=1 |pages=58–66 |doi=10.1037/1053-0479.12.1.58 |ref=harv}}
* {{cite book |last1=Wampold |first1=Bruce E |last2=Imel |first2=Zac E |title=The great psychotherapy debate: the evidence for what makes psychotherapy work |date=2015 |origyear=2001 |edition=2nd |location=New York |publisher=[[Routledge]] |isbn=9780805857092 |oclc=227918397 |url=http://books.google.com/books?id=ljZyBgAAQBAJ |ref=harv}}
* {{cite book |last1=Weinberger |first1=Joel L |last2=Rasco |first2=Cristina |chapter=Empirically supported common factors |date=2007 |editor1-last=Hofmann |editor1-first=Stefan G. |editor2-last=Weinberger |editor2-first=Joel L |title=The art and science of psychotherapy |location=New York |publisher=Routledge |pages=103–129 |isbn=0415952158 |oclc=71241861 |chapterurl=http://books.google.com/books?id=_YqVBhAuLDUC&pg=PA101 |ref=harv}}

==Further reading==

===Sources emphasizing learning as a common factor===
* {{cite book |last=Basseches |first=Michael |chapter=Adult development and the practice of psychotherapy |date=2003 |editor1-last=Demick |editor1-first=Jack |editor2-last=Andreoletti |editor2-first=Carrie |title=Handbook of adult development |series=Plenum series in adult development and aging |pages=533–563 |location=New York |publisher=[[Kluwer Academic]]/Plenum |isbn=0306467585 |oclc=49519013 |doi=10.1007/978-1-4615-0617-1_28 |chapterurl=http://books.google.com/books?id=ynbZBQAAQBAJ&pg=PA533 |ref=harv}}
* {{cite book |last1=Basseches |first1=Michael |last2=Mascolo |first2=Michael F |date=2009 |title=Psychotherapy as a developmental process |location=New York |publisher=[[Routledge]] |isbn=0805857303 |oclc=244063508 |url=http://books.google.com/books?id=tS9MLQU0c14C |ref=harv}}
* {{cite journal |last1=Breger |first1=Louis |authorlink1=Louis Breger |last2=McGaugh |first2=James L |authorlink2=James McGaugh |date=May 1965 |title=Critique and reformulation of 'learning-theory' approaches to psychotherapy and neurosis |journal=[[Psychological Bulletin]] |volume=63 |issue=5 |pages=338–358 |doi=10.1037/h0021788 |ref=harv}}
* {{cite journal |last=Carey |first=Timothy A |title=Exposure and reorganization: the what and how of effective psychotherapy |date=March 2011 |journal=[[Clinical Psychology Review]] |volume=31 |issue=2 |pages=236–248 |doi=10.1016/j.cpr.2010.04.004 |ref=harv}}
* {{cite book |editor1-last=Castonguay |editor1-first=Louis G |editor2-last=Hill |editor2-first=Clara E |date=2012 |title=Transformation in psychotherapy: corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches |location=Washington, DC |publisher=[[American Psychological Association]] |isbn=9781433811593 |oclc=776999993 |ref=harv}}
* {{cite journal |last=Curtis |first=Rebecca Coleman |title=New experiences and meanings: a model of change for psychoanalysis |date=January 2012 |journal=Psychoanalytic Psychology |volume=29 |issue=1 |pages=81–98 |doi=10.1037/a0025086 |ref=harv}}
* {{cite book |last1=Harvey |first1=Allison G |last2=Watkins |first2=Edward R |last3=Mansell |first3=Warren |last4=Shafran |first4=Roz |title=Cognitive behavioural processes across psychological disorders: a transdiagnostic approach to research and treatment |date=2004 |location=New York |publisher=[[Oxford University Press]] |isbn=0198528876 |oclc=55143988 |ref=harv}}
* {{cite book |last=Mahoney |first=Michael J |title=Human change processes: the scientific foundations of psychotherapy |date=1991 |location=New York |publisher=[[Basic Books]] |isbn=0465031188 |oclc=22489415 |url=http://books.google.com/books?id=McfjIKtEJqMC |ref=harv}}
* {{cite book |last=Marmor |first=Judd |authorlink=Judd Marmor |chapter=Psychoanalytic therapy as an educational process: common denominators in the therapeutic approaches of different psychoanalytic 'schools' |date=1962 |editor-last=Masserman |editor-first=Jules H |title=Psychoanalytic education |series=Science and psychoanalysis |volume=5 |location=New York |publisher=Grune & Stratton |pages=286–299 |oclc=2546835 |ref=harv}}
* {{cite journal |last=Scaturo |first=Douglas J |title=A tripartite learning conceptualization of psychotherapy: the therapeutic alliance, technical interventions, and relearning |date=March 2010 |journal=[[American Journal of Psychotherapy]] |volume=64 |issue=1 |pages=1–27 |pmid=20405762 |ref=harv}}
* {{cite book |last=Tryon |first=Warren W |title=Cognitive neuroscience and psychotherapy: network principles for a unified theory |date=2014 |location=London |publisher=[[Elsevier]]/[[Academic Press]] |isbn=9780124200715 |oclc=871061526 |url=http://books.google.com/books?id=sFgXAwAAQBAJ |ref=harv}}
* {{cite journal |last=Tryon |first=Warren W |title=Learning as core of psychological science and clinical practice |date=January 2010 |journal=The Behavior Therapist |volume=33 |issue=1 |pages=10–12 |url=http://abct.org/docs/PastIssue/33n1.pdf |ref=harv}}
* {{cite journal |last1=Tryon |first1=Warren W |last2=Misurell |first2=Justin R |title=Dissonance induction and reduction: a possible principle and connectionist mechanism for why therapies are effective |date=December 2008 |journal=[[Clinical Psychology Review]] |volume=28 |issue=8 |pages=1297–1309 |doi=10.1016/j.cpr.2008.06.003 |ref=harv}}

===Sources emphasizing other common factors===
* {{cite journal |last=Andersen |first=David T |date=Fall 2005 |title=Empathy, psychotherapy integration, and meditation: a Buddhist contribution to the common factors movement |journal=[[Journal of Humanistic Psychology]] |volume=45 |issue=4 |pages=483–502 |doi=10.1177/0022167805280264 |ref=harv}}
* {{cite book |last1=Barlow |first1=David H |last2=Farchione |first2=Todd J |last3=Fairholme |first3=Christopher P |last4=Ellard |first4=Kristen K |last5=Boisseau |first5=Christina L |last6=Allen |first6=Laura B |last7=Ehrenreich-May |first7=Jill |date=2011 |title=Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide |series=Treatments that work |location=New York |publisher=[[Oxford University Press]] |isbn=9780199772667 |oclc=658536234 |url=http://books.google.com/books?id=_Cx-R-YksgIC |ref=harv}}
* {{cite journal |last1=Barth |first1=Richard P |last2=Lee |first2=Bethany R |last3=Lindsey |first3=Michael A |last4=Collins |first4=Kathryn S |last5=Strieder |first5=Frederick |last6=Chorpita |first6=Bruce F |last7=Becker |first7=Kimberly D |last8=Sparks |first8=Jacqueline A |date=January 2012 |title=Evidence-based practice at a crossroads: the timely emergence of common elements and common factors |journal=[[Research on Social Work Practice]] |volume=22 |issue=1 |pages=108–119 |doi=10.1177/1049731511408440 |url=http://www.researchgate.net/profile/Richard_Barth/publication/258183690_Evidence-Based_Practice_at_a_Crossroads_The_Timely_Emergence_of_Common_Elements_and_Common_Factors/links/02e7e528d1b9a893b5000000.pdf |ref=harv}}
* {{cite book |last1=Beitman |first1=Bernard D |last2=Soth |first2=Angela M |last3=Bumby |first3=Nancy A |chapter=The future as an integrating force through the schools of psychotherapy |editor1-last=Norcross |editor1-first=John C |editor1-link=John C. Norcross |editor2-last=Goldfried |editor2-first=Marvin R |date=2005 |title=Handbook of psychotherapy integration |edition=2nd |series=Oxford series in clinical psychology |location=New York |publisher=[[Oxford University Press]] |pages=65–89 |isbn=0195165799 |oclc=54803644 |chapterurl=http://books.google.com/books?id=w-wpACyzL9gC&pg=PA65 |ref=harv}}
* {{cite journal |last1=DeFife |first1=Jared A |last2=Hilsenroth |first2=Mark J |date=June 2011 |title=Starting off on the right foot: common factor elements in early psychotherapy process |journal=[[Journal of Psychotherapy Integration]] |volume=21 |issue=2 |pages=172–191 |doi=10.1037/a0023889 |url=http://www.researchgate.net/profile/Jared_DeFife/publication/232461821_Starting_off_on_the_right_foot_Common_factor_elements_in_early_psychotherapy_process/links/0046353395b70c6276000000.pdf |ref=harv}}
* {{cite journal |last1=Levitt |first1=Heidi M |last2=Neimeyer |first2=Robert A |last3=Williams |first3=Daniel C |date=March 2005 |title=Rules versus principles in psychotherapy: implications of the quest for universal guidelines in the movement for empirically supported treatments |journal=Journal of Contemporary Psychotherapy |volume=35 |issue=1 |pages=117–129 |doi=10.1007/s10879-005-0807-3 |ref=harv}}
* {{cite journal |last1=Levitt |first1=Heidi M |last2=Williams |first2=Daniel C |date=May 2010 |title=Facilitating client change: principles based upon the experience of eminent psychotherapists |journal=[[Psychotherapy Research]] |volume=20 |issue=3 |pages=337–352 |doi=10.1080/10503300903476708 |ref=harv}}
* {{cite journal |last=Martin |first=Jeffery R |date=December 1997 |title=Mindfulness: a proposed common factor |journal=[[Journal of Psychotherapy Integration]] |volume=7 |issue=4 |pages=291–312 |doi=10.1023/B:JOPI.0000010885.18025.bc |ref=harv}}
* {{cite book |editor-last=Norcross |editor-first=John C |editor-link=John C. Norcross |date=2011 |origyear=2002 |title=Psychotherapy relationships that work: evidence-based responsiveness |edition=2nd |location=New York |publisher=[[Oxford University Press]] |isbn=9780199737208 |oclc=663370182 |ref=harv}}
* {{cite book |last=Rosenfeld |first=George W |date=2009 |title=Beyond evidence-based psychotherapy: fostering the eight sources of change in child and adolescent treatment |series=Counseling and psychotherapy |location=New York |publisher=[[Routledge]] |isbn=9780415993357 |oclc=221961147 |url=http://books.google.com/books?id=f-32J6NSTcsC |ref=harv}}
* {{cite book |last1=Sprenkle |first1=Douglas H |last2=Davis |first2=Sean D |last3=Lebow |first3=Jay |date=2009 |title=Common factors in couple and family therapy: the overlooked foundation for effective practice |location=New York |publisher=[[Guilford Press]] |isbn=9781606233252 |oclc=310400353 |url=http://books.google.com/books?id=zEUmYzA6PCEC |ref=harv}}
* {{cite journal |last1=Stangier |first1=Ulrich |last2=Consbruch |first2=Katrin Von |last3=Schramm |first3=Elisabeth |last4=Heidenreich |first4=Thomas |date=May 2010 |title=Common factors of cognitive therapy and interpersonal psychotherapy in the treatment of social phobia |journal=Anxiety, Stress & Coping |volume=23 |issue=3 |pages=289–301 |doi=10.1080/10615800903180239 |pmid=19662551 |ref=harv}}
* {{cite book |editor1-last=Stricker |editor1-first=George |editor2-last=Gold |editor2-first=Jerold R |date=2006 |title=A casebook of psychotherapy integration |location=Washington, DC |publisher=[[American Psychological Association]] |isbn=1591474051 |oclc=61879691 |ref=harv}}
* {{cite journal |last=Welling |first=Hans |date=June 2012 |title=Transformative emotional sequence: towards a common principle of change |journal=[[Journal of Psychotherapy Integration]] |volume=22 |issue=2 |pages=109–136 |doi=10.1037/a0027786 |url=http://www.apa.org/pubs/journals/features/int-a0027786.pdf |ref=harv}}

===Sources emphasizing specific or unique factors===
* {{cite journal |last1=Beutler |first1=Larry E |authorlink1=Larry E. Beutler |last2=Forrester |first2=Bryan |last3=Gallagher-Thompson |first3=Delores |last4=Thompson |first4=Larry |last5=Tomlins |first5=Joseph B |date=September 2012 |title=Common, specific, and treatment fit variables in psychotherapy outcome |journal=[[Journal of Psychotherapy Integration]] |volume=22 |issue=3 |pages=255–281 |doi=10.1037/a0029695 |ref=harv}}
* {{cite book |editor1-last=Castonguay |editor1-first=Louis G |editor2-last=Beutler |editor2-first=Larry E |editor2-link=Larry E. Beutler |date=2006 |title=Principles of therapeutic change that work |location=New York |publisher=[[Oxford University Press]] |isbn=0195156846 |oclc=57311478 |url=http://books.google.com/books?id=IaQVDGl8-OQC |ref=harv}}
* {{cite web |last=Coughlin |first=Patricia Ann |title=The case for specific factors in psychotherapy outcome |publisher=[[YouTube]] |url=http://www.youtube.com/watch?v=UJlVCzKM_gA |date=11 November 2011 |accessdate=8 February 2015 |ref=harv}}
* {{cite journal |last1=Dudley |first1=Robert |last2=Kuyken |first2=Willem |last3=Padesky |first3=Christine A |date=March 2011 |title=Disorder specific and trans-diagnostic case conceptualisation |journal=[[Clinical Psychology Review]] |volume=31 |issue=2 |pages=213–224 |doi=10.1016/j.cpr.2010.07.005 |ref=harv}}
* {{cite journal |last1=Greenberg |first1=Leslie S |authorlink1=Les Greenberg |last2=Warwar |first2=Warwar, Serine H |last3=Malcolm |first3=Wanda M |date=April 2008 |title=Differential effects of emotion-focused therapy and psychoeducation in facilitating forgiveness and letting go of emotional injuries |journal=[[Journal of Counseling Psychology]] |volume=55 |issue=2 |pages=185–196 |doi=10.1037/0022-0167.55.2.185 |url=http://www.emotionfocusedclinic.org/documents/ForgivenessDifferentialEffects2007.doc |ref=harv}}
* {{cite journal |last1=Lohr |first1=Jeffrey M |last2=DeMaio |first2=Christine |last3=McGlynn |first3=F Dudley |date=July 2003 |title=Specific and nonspecific treatment factors in the experimental analysis of behavioral treatment efficacy |journal=[[Behavior Modification]] |volume=27 |issue=3 |pages=322--368 |doi=10.1177/0145445503027003005 |pmid=12841588 |ref=harv}}
* {{cite journal |last1=Lohr |first1=Jeffrey M |last2=Olatunji |first2=Bunmi O |last3=Parker |first3=Lisa |last4=DeMaio |first4=Christine |date=July 2005 |title=Experimental analysis of specific treatment factors: efficacy and practice implications |journal=[[Journal of Clinical Psychology]] |volume=61 |issue=7 |pages=819–834 |doi=10.1002/jclp.20128 |pmid=15827994 |ref=harv}}
* {{cite thesis |type=Ph.D. |last=McCarthy |first=Kevin S |title=Specific, common, and unintended factors in psychotherapy: descriptive and correlational approaches to what creates change |location=Philadelphia |publisher=[[University of Pennsylvania]] |date=December 2009 |url=http://repository.upenn.edu/edissertations/62/ |oclc=727897457 |ref=harv}}
* {{cite journal |last1=McCarthy |first1=Kevin S |last2=Barber |first2=Jacques P |date=January 2009 |title=The multitheoretical list of therapeutic interventions (MULTI): initial report |journal=[[Psychotherapy Research]] |volume=19 |issue=1 |pages=96–113 |doi=10.1080/10503300802524343 |pmid=19065285 |ref=harv}}
* {{cite journal |last1=Norton |first1=Peter J |last2=Barrera |first2=Terri L |date=October 2012 |title=Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: a preliminary randomized controlled non-inferiority trial |journal=[[Depression and Anxiety]] |volume=29 |issue=10 |pages=874–882 |doi=10.1002/da.21974 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463777/ |pmid=22767410 |ref=harv}}
* {{cite journal |last1=Norton |first1=Peter J |last2=Barrera |first2=Terri L |last3=Mathew |first3=Amanda R |last4=Chamberlain |first4=Lance D |last5=Szafranski |first5=Derek D |last6=Reddy |first6=Radhika |last7=Smith |first7=Angela H |date=February 2013 |title=Effect of transdiagnostic CBT for anxiety disorders on comorbid diagnoses |journal=[[Depression and Anxiety]] |volume=30 |issue=2 |pages=168–173 |doi=10.1002/da.22018 |pmid=23212696 |ref=harv}}
* {{cite journal |last1=Oei |first1=Tian PS |last2=Shuttlewood |first2=Greg J |date=September 1997 |title=Comparison of specific and nonspecific factors in a group cognitive therapy for depression |journal=Journal of Behavior Therapy and Experimental Psychiatry |volume=28 |issue=3 |pages=221–231 |doi=10.1016/S0005-7916(97)00019-0 |pmid=9327301 |ref=harv}}
* {{cite journal |last1=Oei |first1=Tian PS |last2=Shuttlewood |first2=Greg J |date=1996 |title=Specific and nonspecific factors in psychotherapy: a case of cognitive therapy for depression |journal=[[Clinical Psychology Review]] |volume=16 |issue=2 |pages=83–103 |doi=10.1016/0272-7358(96)00009-8 |ref=harv}}


[[Category:Integrative psychotherapy]]
[[Category:Psychotherapy]]
[[Category:Psychotherapy]]

Revision as of 17:56, 11 February 2015

Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment.[1] This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors (notably, particular methods or procedures) that are suited to treatment of particular problems.[2] According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness".[3] In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate".[4]

History of common factors

Saul Rosenzweig started the conversation on common factors in an article published in 1936 that discussed some psychotherapies of his time.[5] John Dollard and Neal E. Miller's 1950 book Personality and Psychotherapy emphasized that the psychological principles and social conditions of learning are the most important common factors.[6] Sol Garfield (who would later go on to edit many editions of the Handbook of Psychotherapy and Behavior Change with Allen Bergin) included a 10-page discussion of common factors in his 1957 textbook Introductory Clinical Psychology.[7] In the same year, Carl Rogers published a paper outlining what he considered to be common factors (which he called "sufficient conditions") of successful therapeutic personality change, emphasizing the therapeutic relationship factors which would become central to the theory of person-centered therapy.[8]

In 1961, Jerome Frank published Persuasion and Healing, a book entirely devoted to examining the common factors among psychotherapies and related healing approaches.[9] Frank emphasized the importance of (1) the expectation of help (a component of the placebo effect), (2) the therapeutic relationship, (3) a rationale or conceptual scheme that explains the given symptoms and prescribes a given ritual or procedure for resolving them, and (4) the active participation of both patient and therapist in carrying out that ritual or procedure.[10]

After Lester Luborsky and colleagues published a literature review of empirical studies of psychotherapy outcomes in 1975,[11] the idea that all psychotherapies are effective became known as the Dodo bird verdict, referring to a scene from Alice's Adventures in Wonderland quoted by Rosenzweig in his 1936 article; in that scene, after the characters race and everyone wins, the Dodo bird says, "everybody has won, and all must have prizes."[12] Luborsky's research was an attempt (and not the first attempt, nor the last one) to disprove Hans Eysenck's 1952 study on the efficacy of psychotherapy; Eysenck found that psychotherapy generally did not seem to lead to improved patient outcomes.[13] A number of studies after 1975 presented more evidence in support of the general efficacy of psychotherapy,[14] but the question of how common and specific factors could enhance or thwart therapy effectiveness in particular cases continued to fuel theoretical and empirical research over the following decades.[15]

The landmark 1982 book Converging Themes in Psychotherapy gathered a number of chapters by different authors promoting common factors, including an introduction by Marvin R. Goldfried and Wendy Padawer, a reprint of Rosenzweig's 1936 article, and futher chapters (some of them reprints) by John Dollard and Neal E. Miller, Franz Alexander, Jerome Frank, Arnold Lazarus, Hans Herrman Strupp, Sol Garfield, John Paul Brady, Judd Marmor, Paul L. Wachtel, Abraham Maslow, Arnold P. Goldstein, Anthony Ryle, and others.[16] The chapter by Goldfried and Padawer distinguished between three levels of intervention in therapy: first, theories of change (therapists' theories about how change occurs); second, principles or strategies of change; third, therapy techniques (interventions that therapists suppose will be effective).[17] They argued that while therapists may talk about their theories using very different jargon, there is more commonality among skilled therapists at the level of principles or strategies. Goldfried and Padawar's emphasis on principles or strategies of change was an important contribution to common factors theory because they clearly showed how principles or strategies can be considered common factors (they are shared by therapists who may espouse different theories of change) and specific factors (they are manifested in particular ways within different approaches) at the same time.[18]

In 1986, David Orlinsky and Kenneth Howard presented their generic model of psychotherapy, which proposed that five process variables are active in any psychotherapy: the therapeutic contract, therapeutic interventions, the therapeutic bond between therapist and patient, the patient's and therapist's states of self-relatedness, and therapeutic realization.[19]

In 1990, Lisa Grencavage and John C. Norcross reviewed accounts of common factors in 50 publications, with 89 common factors in all, from which Grencavage and Norcross selected the 35 most common factors and grouped them into five areas: client characteristics, therapist qualities, change processes, treatment structure, and therapeutic relationship.[20] In the same year, Larry E. Beutler and colleagues published their systematic treatment selection model, which attempted to integrate common and specific factors into a single model that therapists could use to guide treatment, considering variables of patient dimensions, environments, settings, therapist dimensions, and treatment types.[21] Beutler and colleagues would later describe their approach as "identifying common and differential principles of change".[22]

In 1992, Michael J. Lambert summarized psychotherapy outcome research and grouped the factors of successful therapy into four areas, ordered by hypothesized percent of change in clients as a function of therapeutic factors: first, extratherapeutic change (40%), those factors that are qualities of the client or qualities of his or her environment and that aid in recovery regardless of his or her participation in therapy; second, common factors (30%) that are found in a variety of therapy approaches, such as empathy and the therapeutic relationship; third, expectancy (15%), the portion of improvement that results from the client's expectation of help or belief in the rationale or effectiveness of therapy; fourth, techniques (10%), those factors unique to specific therapies and tailored to treatment of specific problems.[23] Lambert's research later inspired a book on common factors theory in the practice of therapy titled The Heart and Soul of Change.[24]

In the mid-1990s, as managed care in mental health services became more widespread in the United States, more researchers began to investigate the efficacy of psychotherapy in terms of empirically supported treatments (ESTs) for particular problems, emphasizing randomized controlled trials as the gold standard of empirical support for a treatment.[25] In 1995, the American Psychological Association's Divsion 12 (clinical psychology) formed a task force that developed lists of empirically supported treatments for particular problems such as agoraphobia, blood-injection-injury type phobia, generalized anxiety disorder, obsessive–compulsive disorder, panic disorder, etc.[2] In 2001, Bruce Wampold published The Great Psychotherapy Debate, a book that criticized what he considered to be an overemphasis on ESTs for particular problems, and he called for continued research in common factors theory.[26]

In 2014, a series of ten articles on common factors theory was published in the APA journal Psychotherapy.[27] The articles emphasized the compatibility between ESTs and common factors theory, highlighted the importance of multiple variables in psychotherapy effectiveness, called for more empirical research on common factors (especially client and therapist variables), and argued that individual therapists can do much to improve the quality of therapy by rigorously using feedback measures (during treatment) and outcome measures (after termination of treatment).[27] The article by Stephan Hoffmann and David Barlow, two prominent researchers in cognitive behavioral therapy, pointed out how their recent shift in emphasis from distinct procedures for different diagnoses to a transdiagnostic approach was increasingly similar to common factors theory.[28]

Models of common factors

There are many models of common factors in successful psychotherapy process and outcome. Already in 1990, Grencavage and Norcross identified 89 common factors in a literature review, which showed the diversity of models of common factors.[20] To be useful for purposes of psychotherapy practice and training, most models reduce the number of common factors to a handful, typically around five. Frank listed six common factors in 1971 and explained their interaction.[10] Goldfried and Padawar listed five common strategies or principles in 1982: corrective experiences and new behaviors, feedback from the therapist to the client promoting new understanding in the client, expectation that psychotherapy will be helpful, establishment of the desired therapeutic relationship, and ongoing reality testing by the client.[17] Grencavage and Norcross grouped common factors into five areas in 1990.[20] Lambert formulated four groups of therapeutic factors in 1992.[23] Joel Weinberger and Cristina Rasco listed five common factors in 2007 and reviewed the empirical support for each factor: the therapeutic relationship, expectations of treatment effectiveness, confronting or facing the problem (exposure), mastery or control experiences, and patients' attributions of successful outcome to internal or external causes.[29]

Terence Tracy and colleagues modified the common factors of Grencavage and Norcross, and used them to develop a questionnaire which they provided to 16 board certified psychologists and 5 experienced psychotherapy researchers; then they analyzed the responses and published the results in 2003.[30] Their multidimensional scaling analysis represented the results on a two-dimensional graph, with one dimension representing hot processing versus cool processing (roughly, closeness and emotional experience versus technical information and persuasion) and the other dimension representing therapeutic activity. Their cluster analysis represented the results as three clusters: the first related to bond (roughly, therapeutic alliance), the second related to information (roughly, the meanings communicated between therapist and client), and the third related to role (roughly, a logical structure so that clients can make sense of the therapy process).[30]

In addition to these models that incorporate multiple common factors, a number of theorists have proposed and investigated single common factors, common principles, and common mechanisms of change, such as learning. For examples, see § Further reading, below.

Empirical research on common factors

While many models of common factors have been proposed, they have not all received the same amount of empirical research. There is general consensus on the importance of a good therapeutic relationship in all forms of psychotherapy and counseling.[31]

A review of common factors research in 2008 suggested that 30% to 70% of the variance in therapy outcome is due to common factors.[32] A summary of research in 2014 suggested that 11.5% of variance in therapy outcome is due to the common factor of goal consensus/collaboration, 9% is due to empathy, 7.5% is due to therapeutic alliance, 6.3% is due to positive regard/affirmation, 5.7% is due to congruence/genuineness, and 5% is due to therapist factors; in contrast, treatment method accounts for roughly 1% of outcome variance.[33]

Alan E. Kazdin has argued that psychotherapy researchers must not only find statistical evidence that certain factors contribute to successful outcomes; they must also be able to fomulate evidence-based explanations for how and why those factors contribute to successful outcomes, that is, the mechanisms through which successful psychotherapy leads to change.[34] Common factors theory has been dominated by research on psychotherapy process and outcome variables, and there is a need for further work explaining the mechanisms of psychotherapy common factors in terms of emerging theoretical and empirical research in the neurosciences and social sciences,[35] just as earlier works such as Dollard and Miller's Personality and Psychotherapy[6] or Frank's Persuasion and Healing[9] explained psychotherapy common factors in terms of the sciences of their time.

Criticisms of common factors theory

There are several criticisms of common factors theory: for example, that common factors theory dismisses the need for specific therapeutic techniques or procedures, that common factors are nothing more than a good therapeutic relationship, and that common factors theory is not scientific.[36] Some common factors theorists have argued that these criticisms are based on a limited knowledge of the common factors literature; a thorough review of the literature shows that a coherent treatment procedure is a crucial medium for the common factors to operate, that most models of common factors define interactions between multiple variables (including but not limited to therapeutic relationship variables), and that some models of common factors provide evidence-based explanations for the mechanisms of the proposed common factors.[37]

See also

Notes

  1. ^ Some sources summarizing common factors theory include: Carr 2008, p. 49–67; Imel & Wampold 2008; McAleavey & Castonguay 2015; Wampold & Imel 2015
  2. ^ a b Chambless & Ollendick 2001
  3. ^ Boswell et al. 2014, p. 118; this conclusion is also found in, for example, Butler & Strupp 1986, Arkowitz 1995, McAleavey & Castonguay 2015
  4. ^ Carr 2008, p. 53
  5. ^ Rosenzweig 1936, Rosenzweig 1940; Duncan 2002, p. 10; Lisa Wallner Samstag has argued that Saul Rosenzweig's contribution to common factors theory has often been misunderstood (Samstag 2002)
  6. ^ a b Dollard & Miller 1950; more recently, Warren Tryon has championed learning as a common factor, e.g. Tryon & Tryon 2011, p. 152: "Therapists, and the therapeutic approaches that currently divide us, differ only with regard to what is to be learned and how it is to be acquired... This makes learning and memory basic to our science and profession and should motivate us to search for mechanisms that underlie all effective psychological interventions..."
  7. ^ Garfield 1957; Duncan 2002, p. 14
  8. ^ Rogers 1957; 50 years later, in 2007, a series of 13 articles reviewed Rogers' 1957 article; some of those articles argued that Rogers' "sufficient conditions" are not common factors: "Special section: The necessary and sufficient conditions at the half century mark". Psychotherapy: Theory, Research, Practice, Training. 44 (3): 239–299.
  9. ^ a b Frank & Frank 1991; the legacy of Frank's work is discussed in Alarcón & Frank 2011
  10. ^ a b See also Frank 1971, p. 350: "A historical overview of Western psychotherapy reveals that the dominant psychotherapeutic approach of an era reflects contemporary cultural attitudes and values, and that the same techniques (e.g., abreaction) reappear under new names. Common to all psychotherapies are (a) an emotionally charged, confiding relationship; (b) a therapeutic rationale accepted by patient and therapist; (c) provision of new information by precept, example and self-discovery; (d) strengthening of the patient's expectation of help; (e) providing the patient with success experiences; and (f) facilitation of emotional arousal. Prevalent forms of disability and their treatment include drug therapy for constitutional vulnerabilities, emotional support for environmental crises, spiritual guidance for existential anxieties, and therapeutic maneuvers to correct faulty perceptual and behavioral habits learned early in life. Only the latter form requires therapists trained in specific psychotherapeutic methods."
  11. ^ Luborsky, Singer & Luborsky 1975
  12. ^ The question of whether all psychotherapies are all roughly equally effective (known as the Dodo bird verdict) and the question of whether all effective psychotherapies share common factors (known as common factors theory) are two different questions: "Though many authors view outcome equivalence as the main reason to study common factors in psychotherapy, we cheerfully disagree. Regardless of outcome, it is noncontroversial to say that psychotherapies of many origins share several features of process and content, and it follows that better understanding the patterns of these commonalities may be an important part of better understanding the effects of psychotherapies. That is, irrespective of whether some psychotherapies are equivalent to others in symptomatic outcome, understanding what part of clients' improvement is due to factors that are shared by several approaches appears to us to be a conceptually and clinically important question." (McAleavey & Castonguay 2015, p. 294)
  13. ^ Eysenck 1952
  14. ^ For example: Smith & Glass 1977; Lipsey & Wilson 1993; Carr 2008
  15. ^ For an overview of the work of some prominent psychotherapy researchers who have explored this question, see: Castonguay et al. 2010
  16. ^ Goldfried 1982
  17. ^ a b Goldfried 1982, pp. 3–49
  18. ^ McAleavey & Castonguay 2015, p. 298
  19. ^ Orlinsky & Howard 1986
  20. ^ a b c Grencavage & Norcross 1990
  21. ^ Beutler & Clarkin 1990
  22. ^ Beutler, Moleiro & Talebi 2002
  23. ^ a b Lambert 1992
  24. ^ Duncan, Hubble & Miller 2010
  25. ^ Wampold & Imel 2015, ch. 1
  26. ^ Wampold & Imel 2015
  27. ^ a b "Special section: Common factors". Psychotherapy: Theory, Research, Practice, Training. 51 (4): 476–524.
  28. ^ Hoffmann & Barlow 2014, p. 511
  29. ^ Weinberger & Rasco 2007
  30. ^ a b Tracey et al. 2003, pp. 406–410
  31. ^ McAleavey & Castonguay 2015, pp. 301–302
  32. ^ Imel & Wampold 2008, p. 255
  33. ^ Laska, Gurman & Wampold 2014, p. 472
  34. ^ Kazdin 2009
  35. ^ Imel & Wampold 2008, p. 261
  36. ^ Imel & Wampold 2008, p. 256–258
  37. ^ Imel & Wampold 2008, p. 258–260

References

Further reading

Sources emphasizing learning as a common factor

Sources emphasizing other common factors

Sources emphasizing specific or unique factors

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