https://doi.org/10.4081/ripppo.2024.803
Does technique matter? A multilevel meta-analysis on the association between psychotherapeutic techniques and outcome
Submitted: June 10, 2024
Accepted: August 26, 2024
Published: August 29, 2024
Accepted: August 26, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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The extent to which psychotherapeutic techniques have an impact on outcome has been studied on a regular basis. To date, there are no meta-analytic attempts to clarify the association between techniques and outcome in multi-therapeutic approach measures. This study aims to conduct a meta-analysis of the described association. A three-level meta-analysis and moderator-analysis were used. The meta-analysis revealed 13 studies with a total of 177 effect sizes. There was a significant effect r=.193 (t[176]=4.77, p<.01) with higher use of psychotherapeutic techniques being associated with better outcome. Significant moderator was therapeutic approach-specific subscales. The mean effect of cognitive-behavioral techniques was r=.088 (t[147]=1.50, p=.14, d=0.18; s=11, k=79), and the mean effect of psychodynamic techniques was r=.286 (t[147]=5.06, p<.01, d=0.60; s=11, k=70). The measurements for psychotherapeutic technique (Comparative Psychotherapy Process Scale and Psychotherapy-Process Q-Sort) showed no significant difference related to the association between technique and outcome (F[1, 175]=0.38, p=.54). This meta-analysis showed a positive relation between psychotherapeutic techniques and outcome. This leads to the assumption that specific psychotherapeutic techniques have positive effects on post-treatment outcome.
Ablon, J. S., & Jones, E. E. (1998). How expert clinicians´ prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychotherapy Research, 8(1), 71-83. doi: 10.1093/ptr/8.1.71
DOI: https://doi.org/10.1080/10503309812331332207
Ablon, J. S., & Jones, E. E. (2002). Validity of controlled clinical trials of psychotherapy: findings from the NIMH treatment of depression collaborative research program. American Journal of Psychiatry, 159, 775-783. doi: 10.1176/appi.ajp.159.5.775
DOI: https://doi.org/10.1176/appi.ajp.159.5.775
Ablon, J. S., Levy, R. A., & Katzenstein, T. (2006). Beyond brand names of psychotherapy: Identifying empirically supported change processes. Psychotherapy: Theory, Research, Practice, Training, 43(2), 216-231. doi: 10.1037/0033-3204.43.2.216
DOI: https://doi.org/10.1037/0033-3204.43.2.216
Assink, M., & Wibbelink, C. J. M. (2016). Fitting three-level meta-analytic models in R: a step-by-step tutorial. The Quantitative Methods for Psychology, 12(3), 154-174. doi: 10.20982/tqmp.12.3.p154
DOI: https://doi.org/10.20982/tqmp.12.3.p154
Baldwin, S. A., & Imel, Z. E. (2013). Therapist Effects: Findings and Methods. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (4th ed., pp. 258-297). New York, NY: John Wiley & Sons.
Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842-852. doi: 10.1037/0022-006X.75.6.842
DOI: https://doi.org/10.1037/0022-006X.75.6.842
Bergin A. E., Strupp H. H. (2009). Changing Frontiers in the Science of Psychotherapy. Chicago, IL: Aldine-Atherton.
Clarkin J. F., & Levy K. N. (2004). The influence of client variables on psychotherapy. In M. J. Lambert (Ed.). Bergin and Garfield’s handbook of psychotherapy and behavior change (4th ed.) (pp. 194-226). New York, NY: John Wiley & Sons.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.
de Felice, G., Giuliani, A., Halfon, S., Andreassi, S., Paoloni, G., & Orsucci, F. F. (2019). The misleading Dodo Bird verdict. How much of the outcome variance is explained by common and specific factors? New Ideas in Psychology, 54,50-55. doi: 10.1016/j.newideapsych.2019.01.006
DOI: https://doi.org/10.1016/j.newideapsych.2019.01.006
DeFife, J. A., Hilsenroth, M. J., & Gold, J. R. (2008). Patient ratings of psychodynamic psychotherapy session activities and their relation to outcome. Journal of Nervous and Mental Disease, 196(7), 538-547. doi: 10.1097/NMD.0b013e31817cf6d0
DOI: https://doi.org/10.1097/NMD.0b013e31817cf6d0
Del Re, A. C., Flückiger, C., Horvath, A. O., & Wampold, B. E. (2021). Examining therapist effects in the alliance-outcome relationship: a multilevel meta-analysis. Journal of Consulting and Clinical Psychology, 89(5), 371-378. doi: 10.1037/ccp0000637
DOI: https://doi.org/10.1037/ccp0000637
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy, 55(4), 316–340. doi: 10.1037/pst0000172
DOI: https://doi.org/10.1037/pst0000172
Gentile, D., Colli, A., & Lingiardi, V. (2020). An Italian validation of the comparative psychotherapy process scale: reliability and validity. Clinical psychology & psychotherapy, 27(5), 779-789. doi: 10.1002/cpp.2462
DOI: https://doi.org/10.1002/cpp.2462
Glock, G., Hilsenroth, M., & Curtis, R. (2018). Therapeutic interventions patients with anxiety problems find most helpful: A case for integration? Journal of Psychotherapy Integration, 28(2), 233-241. doi: 10.1037/int0000075
DOI: https://doi.org/10.1037/int0000075
Goodman, G., Edwards, K., & Chung, H. (2015). The relation between prototypical processes and psychological distress in psychodynamic therapy of five inpatients with borderline personality disorder. Clinical psychology & psychotherapy, 22(1), 83-95. doi: 10.1002/cpp.1875
DOI: https://doi.org/10.1002/cpp.1875
Haugen, P. T., Werth, A. S., Foster, A. L., & Owen, J. (2016). The role of theory-specific techniques and therapeutic alliance in promoting positive outcomes: integrative psychotherapy for world trade center responders. The Journal of Nervous and Mental Disease, 204(12). 955-959. doi: 10.1097/NMD.0000000000000631
DOI: https://doi.org/10.1097/NMD.0000000000000631
Hill, C. E., & Norcross, J.C. (2023). Psychotherapy skills and methods that work. New York, NY: Oxford University Press
DOI: https://doi.org/10.1093/oso/9780197611012.001.0001
Hilsenroth, M., Blagys, M. D., Ackerman, S. J., Bonge, D. R., & Blais, M. A. (2005). Measuring psychodynamic-interpersonal and cognitive-behavioral techniques: development of the Comparative Psychotherapy Process Scale (CPPS). Psychotherapy, 42, 340-356. http://dx.doi.org/10.1037/0033-3204.42.3.340
DOI: https://doi.org/10.1037/0033-3204.42.3.340
Hilsenroth, M. J., DeFife, J. A., Blake, M. M., & Cromer, T. D. (2007). The effects of borderline pathology on short-term psychodynamic therapy for depression. Psychotherapy Research, 17, 172-184. http://dx.doi.org/10.1080/10503300600786748
DOI: https://doi.org/10.1080/10503300600786748
Hilsenroth, M., & Slavin-Mulford, J. (2008). Integrative dynamic treatment for co-morbid depression and borderline conditions. Journal of Psychotherapy Integration, 18, 377-409.
DOI: https://doi.org/10.1037/a0014317
Hofmann, N. (2008). Kognitiv-behaviorale und tiefenpsychologisch fundierte Therapie derGeneralisierten Angst: Ein Therapieprozessvergleich [Dissertation; d-nb.info]. https://d-nb.info/988979411/34
Jones, E. E. (1985). Psychotherapy Process Q-Set Coding Manual. Unpublished manuscript, University of California, Berkeley.
Jones, E. E., & Pulos, S. M. (1993). Comparing the process in psychodynamic and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 61(2), 306-16. doi: 10.1037//0022-006x.61.2.306.
DOI: https://doi.org/10.1037//0022-006X.61.2.306
Landis, J., & Koch, G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159-174. doi: 10.2307/2529310
DOI: https://doi.org/10.2307/2529310
Laskoski, P. B., Hauck, S., Orsucci, F., Giuliani, A., Serralta, F. B., & de Felice, G. (2021). Psychodynamic factor as predictor of outcome in the treatment of a psychosomatic spectrum patient. Journal of Contemporary Psychotherapy, 51(2), 145-153. doi: 10.1007/s10879-020-09486-0.
DOI: https://doi.org/10.1007/s10879-020-09486-0
McAleavey, A.A., Castonguay, L.G. (2015). The process of change in psychotherapy: common and unique factors. In: O. Gelo, A. Pritz and B. Rieken (Eds.) Psychotherapy Research (pp. 293-310). Vienna: Springer. doi: 10.1007/978-3-7091-1382-0_15
DOI: https://doi.org/10.1007/978-3-7091-1382-0_15
McCarthy, K. S., & Barber, J. P. (2009). The Multitheoretical List of Therapeutic Interventions (MULTI): initial report. Psychotherapy Research, 19(1). 96-113. doi: 10.1080/10503300802524343.
DOI: https://doi.org/10.1080/10503300802524343
McMullen, L. M., & Tay, D. (2023). Metaphors In: Psychotherapy Skills and Methods That Work. In C. E. Hill and J. C. Norcross (Eds.), Psychotherapy Skills and Methods That Work (pp. 138-164), Oxford: Oxford University Press. doi: 10.1093/oso/9780197611012.003.0006
DOI: https://doi.org/10.1093/oso/9780197611012.003.0006
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine, 6(7), e1000097. doi: 10.1371/journal.pmed.1000097
DOI: https://doi.org/10.1371/journal.pmed.1000097
Mullin, A. S. J., Hilsenroth, M. J., Gold, J., & Farber, B. A. (2018). Facets of object representation: process and outcome over the course of psychodynamic psychotherapy. Journal of personality assessment, 100(2), 145-155. doi: 10.1080/00223891.2016.1215320
DOI: https://doi.org/10.1080/00223891.2016.1215320
Norcross J. C., Goldfried M. R. (2005). Handbook of Psychotherapy Integration (2nd Ed.). Oxford: Oxford University Press
DOI: https://doi.org/10.1093/med/9780195165791.001.0001
Owen, J., & Hilsenroth, M. J. (2014). Treatment adherence: the importance of therapist flexibility in relation to therapy outcomes. Journal of Counseling Psychology, 61(2), 280-288. doi: 10.1037/a0035753
DOI: https://doi.org/10.1037/a0035753
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. The BMJ, 372, Article n71. doi: 10.1136/bmj.n71
DOI: https://doi.org/10.1136/bmj.n71
Perepletchikova, F., & Kazdin, A. E. (2005). Treatment integrity and therapeutic change: issues and research recommendations. Clinical Psychology: Science and Practice, 12(4), 365–383. doi: 10.1093/clipsy.bpi045
DOI: https://doi.org/10.1093/clipsy.bpi045
Philips, B., Karlsson, R., Nygren, R., Rother-Schirren, A., & Werbart, A. (2018). Early therapeutic process related to dropout in mentalization-based treatment with dual diagnosis patients. Psychoanalytic Psychology, 35(2), 205-216. doi: 10.1037/pap0000170
DOI: https://doi.org/10.1037/pap0000170
Power, N., Noble, L., Simmonds-Buckley, M., Kellett, S., Stockton, C., Firth, N., & Delgadillo, J. (2022). Associations between treatment adherence-competence-integrity (ACI) and adult psychotherapy outcomes: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 90(5). 427-445. ISSN 0022-006X. doi: 10.1037/ccp0000736
DOI: https://doi.org/10.1037/ccp0000736
Richards, L.K., Shingleton, R., Goldman, R.E., Siegel, D., & Thompson-Brenner, H. (2016). Integrative dynamic therapy for bulimia nervosa: an evidence-based case study. Psychotherapy, 53(2), 195-205
DOI: https://doi.org/10.1037/pst0000054
Roussos, A. J., Gomez Penedo, J. M., & Muiños, R. (2018). A time-series analysis of therapeutic alliance, interventions, and client’s clinical status in an evidence-based single-case study: Evidence for establishing change mechanisms in psychotherapy. Psychotherapy Research, 28(1), 137-149. doi: 10.1080/10503307.2016.1174346
DOI: https://doi.org/10.1080/10503307.2016.1174346
Ryum, T., Bennion, M., & Kazantzis, N. (2023). Integrating between-session homework in psychotherapy: a systematic review of immediate in-session and intermediate outcomes. Psychotherapy, 60(3), 306-319. doi: 10.1037/pst0000488
DOI: https://doi.org/10.1037/pst0000488
Schöttke, H., Flückiger, C., Goldberg, S. B., Eversmann, J., & Lange, J. (2017). Predicting psychotherapy outcome based on therapist interpersonal skills: a five-year longitudinal study of a therapist assessment protocol. Psychotherapy research: journal of the Society for Psychotherapy Research, 27(6), 642-652. doi: 10.1080/10503307.2015.1125546
DOI: https://doi.org/10.1080/10503307.2015.1125546
Schweyer, D. (2008). Prozessforschung in der Psychotherapie bei manisch-depressiven Patienten [Dissertation, Eberhard-Karls-Universität Tübingen].
Sell, C., Möller, H., & Taubner, S. (2018). Effectiveness of integrative imagery- and trance-based psychodynamic therapies: guided imagery psychotherapy and hypnopsychotherapy. Journal of Psychotherapy Integration, 28(1), 90-113. doi: 10.1037/int0000073
DOI: https://doi.org/10.1037/int0000073
Sharpless, B. A., & Barber, J. P. (2009). A conceptual and empirical review of the meaning, measurement, development, and teaching of intervention competence in clinical psychology. Clinical psychology review, 29(1), 47-56. doi: 10.1016/j.cpr.2008.09.008
DOI: https://doi.org/10.1016/j.cpr.2008.09.008
Solomonov, N., Falkenström, F., Gorman, B. S., McCarthy, K. S., Milrod, B., Rudden, M. G., Chambless, D. L., & Barber, J. P. (2020). Differential effects of alliance and techniques on Panic-Specific Reflective Function and misinterpretation of bodily sensations in two treatments for panic. Psychotherapy Research, 30(1), 97-111. doi: 10.1080/10503307.2019.1585591
DOI: https://doi.org/10.1080/10503307.2019.1585591
Taylor, W.-M. (2010). Traveling the Road to Healing: An Examination of the Relationships between Psychotherapeutic Technique and Cognitive, Emotional and Physiological Outcomes in Women Exposed to Violence (Dissertation, University of Michigan). Library University of Michigan. https://deepblue.lib.umich.edu/handle/2027.42/75898.
Van den Noortgate, W., López-López, J. A., Marín-Martínez, F., & Sánchez-Meca, J. (2013). Three-level meta-analysis of dependent effect sizes. Behavior Research Methods, 45(2), 576-594. doi: 10.3758/s13428-012-0261-6
DOI: https://doi.org/10.3758/s13428-012-0261-6
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36(3), 1-48. doi: 10.18637/jss.v036.i03
DOI: https://doi.org/10.18637/jss.v036.i03
Wampold, B. E., & Flückiger, C. (2023). The alliance in mental health care: conceptualization, evidence and clinical applications. World Psychiatry, 22(1), 25–41. doi: 10.1002/wps.21035
DOI: https://doi.org/10.1002/wps.21035
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. New York, NY: Routledge/Taylor & Francis Group.
DOI: https://doi.org/10.4324/9780203582015
Wampold, B. E., & Owen, J. (2021). Therapist effects: History, methods, magnitude, and characteristics of effective therapists. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield's handbook of psychotherapy and behavior change: 50th anniversary edition (pp. 297-326). New York, NY: John Wiley & Sons.
Webb, C. A., Derubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of consulting and clinical psychology, 78(2), 200-211. doi: 10.1037/a0018912
DOI: https://doi.org/10.1037/a0018912
How to Cite
Grevenhaus, C. J., Flückiger, C., Theimer, L., & Benecke, C. (2024). Does technique matter? A multilevel meta-analysis on the association between psychotherapeutic techniques and outcome. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(2). https://doi.org/10.4081/ripppo.2024.803
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