THE PROCESS OF PSYCHOTHERAPY FOR HELPING PROFESSIONALS: THE ROLE OF EMPIRICAL FINDINGS TO GUIDE PRACTICE
AbstractEver since it achieved respectability as a modality of healing, the practice of psychotherapy hasbeen subjected to considerable discussion, debate and criticism. Often the therapist is attributed thestatus of an emotional saviour, a personal champion or a benevolent confidant. Despite the factthat counselling and psychological treatment feature prominently in modern health care, theinternal mechanisms of the therapeutic process are sometimes shrouded in mystery. Hence, theprofessional and ethical imperative is to lay bare the inner workings of therapist-client dynamicsthat lead to emotional healing and client change. This paper is an articulation of a process ofpsychotherapy and is aimed at identifying the sometimes hidden change processes that effectmental and emotional healing.
AMERICAN ASSOCIATION FOR COUNSELING AND DEVELOPMENT. 1981. Ethical
standards (rev ed). Alexandria, VA: Author.
AMERICAN PSYCHIATRIC ASSOCIATION. 1994. Diagnostic and statistical manual of
mental disorders (4th ed). Washington, DC: American Psychiatric Association.
AMERICAN PSYCHOLOGICAL ASSOCIATION. 1981. Ethical principles of psychologists
(rev ed). Washington, DC: Author.
ANASTASI, A. 1988. Psychological testing. New York: Macmillan Publishing Co.
BACHELOR, A. 1991. Comparison and relationship to outcome of diverse dimensions of the
helping alliance as seen by client and therapist. Psychotherapy, 28:534-549.
BANDURA, A. 1977. Self-efficacy: Toward a unifying theory of behavioral change.
Psychological Review, 84:191-215.
BERNARD, J.M. & GOODYEAR, R.K. 1992. Fundamentals of clinical supervision. Allyn &
Bacon: Needham Heights, MA.
BERNARD, J.M. 1994. Multicultural supervision: A reaction to Leong and Wagner, Cook, Priest
and Fukuyama. Counselor Education and Supervision, 34:159-171.
BLOCK, C.B. 1984. Psychotherapy and the Black patient. The Clinical Psychologist, 37:51.
BOWERS, T & CLUM, G. 1988. Relative contributions of specific and nonspecific treatment
effects: Meta-analysis of placebo-controlled behavior research. Psychological Bulletin, 103:315-
BUELOW, G. & HEBERT, S. 1995. Counselor's resource on psychiatric medications: Issues
in treatment and referral. Pacific Grove, CA: Brooks/Cole Publishing Company.
BULHAN, H.A. 1985. Franz Fanon and the psychology of oppression. New York: Plenum
CADBURY, S., CHILDS-CLARK, A. & SANDHU, S. 1990. Group anxiety management:
Effectiveness, perceived helpfulness and follow-up. British Journal of Clinical Psychology,
CARTER, R.T. 1991. Racial identity attitudes and psychological functioning. Journal of
Multicultural Counseling and Development, 19:105-114.
CHOMSKY, N. 1993. Language and thought. Moyer Bell: Wakefield, RI.
CLEMENTEL-JONES, C., MALAN, D. & TRAUER, T. 1990. A retrospective follow-up study of
patients treated with individual psychoanalytic psychotherapy: Outcome and predictive factors.
British Journal of Psychotherapy, 6:363-374.
COLSON, D.B., CORNSWEET, C., MURPHY, T., O’MALLEY, F., HYLAND, P.S.,
McPARLAND, M. & COYNE, L. 1991. Perceived treatment difficulty and therapeutic alliance on
an adolescent psychiatric hospital unit. American Journal of Orthopsychiatry, 61:221-229.
CONOLEY, C.W. & GARBER, R.A. 1985. Effects of reframing and self-control directives on
loneliness, depression and controllability. Journal of Counseling Psychology, 32:139-142.
COREY, G. 1986. Theory and practice of counseling and psychotherapy (3rd ed). Pacific
Grove, CA: Brooks/Cole Publishing Co.
COTTONE, R.R. 1991. Counselor roles according to two counseling worldviews. Journal of
Multicultural Development, 69:398-401.
EISENBERG, G.M. 1981. Midtherapy training: Extending the present system of pretherapy
training. Dissertation Abstracts International, 41:2754B.
ELLIS, A. 1979. The theory of rational-emotive therapy. In: ELLIS, A. & WHITELY, J. (eds)
Theoretical and empirical foundations of rational emotive therapy. Monterey, CA:
EMMELKAMP, P.M.G., VAN DER HOUT, A. & DE VRIES, K. 1983. Assertiveness training for
agoraphobics. Behavior Research and Therapy, 21:63-68.
FEITEL, B. 1968. Feeling understood as a function of a variety of therapist activities.
Columbia: Teachers College, Columbia University. (Unpublished doctoral dissertation)
FRANK, J., HOEHN-SARIC, R., IMBER, S., LIEBERMAN, B. & STONE, A. 1978. Effective
ingredients of successful psychotherapy. New York: Brunner/Mazel.
FRANK, J.D. 1981. Therapeutic components shared by all psychotherapies. In: HARVEY, J.H. &
PARKS, M.M. (eds) Psychotherapy research and behavior change: The master lecture series
(1):5-37. Washington, DC: American Psychological Association.
FRIEDLANDER, M.L. 1981. The effects of delayed role-induction on counseling process and
outcome. Dissertation Abstracts International, 43:3887-3888B.
GALASSI, J.P. & GALASSI, M.D. 1984. Promoting transfer and maintenance of counseling
outcomes: How do we do it and how do we study it? In: BROWN, S.D. & LENT, R.W. (eds)
Handbook of Counseling Psychology. New York: John Wiley & Sons.
GARFIELD, S.L. & BERGIN, A.E. 1994. Introduction and overview. In: BERGIN, A.E. &
GARFIELD, S.L. (eds) Handbook of psychotherapy and behavior change (4th ed). New York:
John Wiley & Sons, Inc.
GELSO, C.J. & CARTER, J.A. 1985. The relationship in counseling and psychotherapy:
Components, consequences and theoretical antecedents. The Counseling Psychologist, 13:155-
GELSO, C.J., SPIEGEL, S.B. & MILLS, D.H. 1983. Client and therapist factors influencing the
outcomes of time-limited counseling one month and eighteen months after treatment. In: GELSO,
C.J. & JOHNSON, D.H. Explorations in time-limited counseling and psychotherapy. New
York: Teachers College Press.
GREENBERG, L.S. & DOMPIERRE, L.M. 1981. Specific effects of Gestalt two-chair dialogue
on intrapsychic conflict in counseling. Journal of Counseling Psychology, 28:288-294.
GREENBERG, L.S. & SAFRAN, J.D. 1987. Emotion in psychotherapy: Affect, cognition, and
the process of change. New York: The Guilford Press.
HALEY, J. 1976. Problem-solving therapy. New York: Harper Press.
HIGHLEN, P.S. & HILL, C.E. 1984. Factors affecting client change in individual counseling:
Current status and theoretical speculations. In: BROWN, S.D. & LENT, R.W. (eds) The
handbook of counseling psychology. New York: John Wiley.
HILL, D., BEUTLER, L.E. & DALDRUP, R. 1989. The relationship of process to outcome in
brief experiential psychotherapy for chronic pain. Journal of Clinical Psychology, 45:951-957.
HILL, M. 1992. A feminist model for the use of paradoxical techniques in psychotherapy.
Professional Psychology: Research and Practice, 23:287-292.
HILLIARD, A.G. 1985. A framework for focused counseling on the African American man.
Journal of Non-White Concerns in Personnel and Guidance, 13:72-78.
HORVATH, A.O. & GOHEEN, M.D. 1990. Factors mediating the success of defiance- and
compliance-based interventions. Journal of Counseling Psychology, 37:363-371.
HOWARD, K.I., KOPTA, S.M., KRAUSE, M.S. & ORLINSKY, D.E. 1986. The dose-effect
relationship in psychotherapy. American Psychologist, 41:159-164.
HOYT, M., XENAKIS, S., MARMAR, C. & HOROWITZ, M.J. 1983. Therapists’ actions that
influence their perceptions of “good” psychotherapy sessions. Journal of Nervous and Mental
JONES, E.E., CUMMINGS, J.D. & HOROWITZ, M.J. 1988. Another look at the non-specific
hypothesis of therapeutic effectiveness. Journal of Consulting and Clinical Psychology, 56:48-
JONES, E.E., PARKE, L.A. & PULOS, S.M. 1992. How therapy is conducted in the private
consultation room: A multidimensional description of brief psychodynamic treatments.
Psychotherapy Research, 2:16-30.
JONES, N.S.C. 1990. Black/White issue in psychotherapy: A framework for clinical practice.
Journal of Social Behavior and Personality, 5:305-322.
KATZ, J.D. 1985. The sociopolitical nature of counseling. The Counseling Psychologist, 13:615-
KOLB, D.L., BEUTLER, L.E., DAVIS, C.S., CRAGO, M. & SHANFIELD, S. 1985. Patient and
therapist process variables relating to dropout and change in psychotherapy. Psychotherapy:
Theory, Research and Practice, 22:702-710.
LAMBERT, M.J. & BERGIN, A.E. 1994. The effectiveness of psychotherapy. In: BERGIN, A.E.
& GARFIELD, S.L. (eds) Handbook of psychotherapy and behavior change (4th ed). New
York: John Wiley & Sons, Inc.
LAMBERT, M.J. 1991. Introduction to psychotherapy research. In: BEUTLER, L.E. & CRAGO,
M. (eds) Psychotherapy research: An international review of programmatic studies.
Washington, D.C: American Psychological Association.
LANDMAN, J.T. & DAWES, R.M. 1982. Smith and Glass’ conclusions stand up under scrutiny.
American Psychologist, 37:504-516.
LUBORSKY, L. 1976. Helping alliances in psychotherapy: The groundwork for a study of their
relationship to its outcome. In: Claghorn, J.H. (ed) Successful psychotherapy. New York:
LUBORSKY, L., CRITS-CHRISTOPH, P., MINTZ, J. & AUERBACH, A. 1988. Who will
benefit from psychotherapy? Predicting therapeutic outcomes. New York: Basic Books.
MAHONEY, M.J. & LYDDON, W.J. 1988. Recent developments in cognitive approaches to
counseling and psychotherapy. The Counseling Psychologist, 16:190-234.
MANN, P.A. 1978. Community psychology: Concepts and applications. New York: Collier
MARSHALL, W.L. 1988. Behavioral indices of habituation and sensitization during exposure to
phobic stimuli. Behavior Research and Therapy, 26:67.
McCULLOUGH, L., WINSTON, A., FARBER, B.A., PORTER, P., POLLACK, J., LAIKAN,
M., VINGIANO, W. & TRUJILLO, M. 1991. The relationship of patient-therapist interaction to
outcome in brief psychotherapy. Psychotherapy, 28:525-533.
McNEILL, B.W., MAY, R.J. & LEE, V.E. 1987. Perceptions of counselor source characteristics
by premature and successful terminators. Journal of Counseling Psychology, 34:86-89.
MEINBERG, R.A. & YAGER, G.G. 1985. Effects of a workshop fee on women’s stress
management skills and evaluations. Journal of Counseling Psychology, 32:626-629.
MOURSAND, J. 1990. The process of counseling and psychotherapy. New Jersey: Prentice
NICHOLSON, R.A. & BERMAN, J.S. 1983. Is follow-up necessary in evaluating psychotherapy?
Psychological Bulletin, 93:261-278.
O’MALLEY, S.S., SUH, C.S., STRUPP, H.H. 1983. The Vanderbilt Psychotherapy Process Scale:
A report of the scale development and a process-outcome study. Journal of Consulting and
Clinical Psychology, 51:581-586.
ORLINSKY, D.E. & HOWARD, K.I. 1975. Varieties of psychotherapeutic experience:
Multivariate analyses of patients’ and therapists’ reports. New York: Teachers College Press.
ORLINSKY, D.E., GRAWE, K. & PARKS, B.K. 1994. Process and outcome in psychotherapy -
noch einmal. In: BERGIN, A.E. & GARFIELD, S.L. Handbook of psychotherapy and behavior
change (4th ed). New York: John Wiley & Sons.
OST, L.G. 1988. Applied relaxation vs progressive relaxation in the treatment of panic disorder.
Behavior Research and Therapy, 26:13-22.
PAUL, G.L. & LENTZ, R.J. 1977. Psychosocial treatment of chronic mental patients: Milieu
versus social learning programs. Cambridge, MA: Harvard University Press.
PEDERSEN, P. 1987. Ten frequent assumptions of cultural bias in counseling. Journal of
Multicultural Counseling and Development, 15:16-25.
PEISER, I. 1982. Similarity, liking and missed sessions in relation to psychotherapy outcome.
Dissertation Abstracts International, 42:4587B.
PERKEL, A.K. 1988. Towards a model for a South African clinical psychology. Psychology in
PERLS, F. 1969. Gestalt therapy verbatim. Moab, Utah: Real People Press.
QUINTANA, S.M. & HOLAHAN, W. 1992. Termination in short-term counseling: Comparison
of successful and unsuccessful cases. Journal of Counseling Psychology, 39:200-305.
ROGERS, C. 1967. The conditions of change from a client-centered viewpoint. In: BERENSON,
B. & CARKHUFF, R. (eds) Sources of gain in counseling and psychotherapy. New York: Holt,
Rinehart & Winston.
RUDY, J.P. 1983. Predicting therapy outcome using Benjamins’ structural analysis of social
behavior. Dissertation Abstracts International, 43:534B.
SARASON, I.G. & SARASON, B.R. 1989. Abnormal psychology: The problem of
maladaptive behavior. Englewood Cliffs, NJ: Prentice Hall.
SEEDAT, M. & NELL, V. 1990. Third world or one world: Mysticism, pragmatism, and pain in
family therapy in South Africa. South African Journal of Psychology, 20:1-32.
SELIGMAN, L. 1986. Diagnosis and treatment planning in counseling. New York: Human
SLOANE, R.B., STAPLES, F.R., CRISTOL, A.H., YORKSTON, N.J. & WHIPPLE, K. 1975.
Psychotherapy versus behavior therapy. Cambridge, MA: Harvard University Press.
SMITH, M.L. & GLASS, G.V. 1977. Meta-analysis of psychotherapy outcome studies. American
SMITH, M.L., GLASS, G.V. & MILLER, T.I. 1980. The benefits of psychotherapy. Baltimore:
Johns Hopkins University Press.
STANTON, H.E. 1976. Fee-paying and weight-loss: Evidence for an interesting interaction.
American Journal of Clinical Hypnosis, 19:47-49.
STRONG, S.R. 1968. Counseling: An interpersonal influence process. Journal of Counseling
TODISCO, M. & SALOMONE, P.R. 1991. Facilitating effective cross-cultural relationships: The
White counselor and the Black client. Journal of Multicultural Development, 19:146-157.
WADE, J.C. 1994. African American fathers and sons: Social, historical and psychosocial
considerations. Families in Society: The Journal of Contemporary Human Services, 75:561-
WALDEGRAVE, C. 1990. Just Therapy. Dulwich Centre Newsletter, 1:6-64.
WHISTON, S.C. & SEXTON, T.L. 1993. An overview of psychotherapy outcome research:
Implications for practice. Professional Psychotherapy: Research and Practice, 24:43-51.
YOUNG, J.E., BECK, A.T. & WEINBERGER, A. 1993. Depression. In: BARLOW, D.H. (ed)
Clinical handbook of psychological disorders: A step-by-step treatment manual (2nd ed). New
York: Guilford: 240-277.
ZOLA, M.A., HOWARD, K.I. & ORLINSKY, D.E. 1987. The process of outcome: The
individual remission patterns of self-reported psychiatric symptoms. Paper presented at 18th
Annual Meeting of the Society for Psychotherapy Research, Ulm, Germany.
How to Cite
This journal is an open access journal, and the authors and journal should be properly acknowledged when works are cited.
Social Work/Maatskaplike Werk hold copyright.
Auhtors may use the publishers version for teaching purposes, in books, and with conferences.
The following license applies:
Attribution CC BY-4.0
This license lets others distribute, remix, tweak, and build upon your work, even commercially, as long as they credit you for the original creation.
Articles as a whole may not be re-published with another journal.