Cognitive therapy on the couch

Cognitive therapy for depression could be improved by the therapist focusing more on the therapeutic process itself. That’s according to Jonathan Kanter (University of Wisconsin-Milwaukee) and colleagues who compared the effectiveness of therapy given by four expert cognitive therapists before and after they were given special training in this kind of therapy-focused technique.

"...sessions with more therapy-focused utterances were associated with better reports of perceived progress in weekly feedback from clients"

The therapists worked with four clients each before training, and six each after the training. Researchers listened to recordings of the therapists’ sessions and noted each time the therapists spoke and whether or not their utterances referred to the therapy or to their relationship with the clients (e.g. “I’ve noticed that you don’t look at me when we are discussing sensitive issues” or “What’s so important about whether I like you or not”). Some therapists claim they already discuss the therapeutic process with clients, but here the researchers confirmed the therapists focused more on the therapeutic process after the training. For example, they looked at the proportion of sessions in which more than one in five therapist utterances were focused on the therapeutic process: this was 3.7 per cent of sessions before training, compared with 21 per cent afterwards.

Crucially, sessions with more therapy-focused utterances were associated with better reports of perceived progress in weekly feedback from clients, and with a tendency for clients to report more improvement in their relationships. However, more focus on the therapeutic process was not related to actual symptomatic improvement, as measured by clients’ weekly completion of the Beck Depression Inventory.

Whereas this study grouped together all therapy-focused utterances, the researchers said future work should probe deeper, to identify what kinds of therapeutic focus are beneficial.
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Kanter, J.W., Schildcrout, J.S. & Kohlenberg, R.J. (2005). In vivo processes in cognitive therapy for depression: Frequency and benefits. Psychotherapy Research, 15, 366-373.

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