Common Factors of Psychotherapy: Concepts, Contradictions and a Synthesis

Pfammatter, Mario; Junghan, Ulrich Martin; Tschacher, Wolfgang (2012). Common Factors of Psychotherapy: Concepts, Contradictions and a Synthesis. Psychotherapie in Psychiatrie, Psychotherapeutischer Medizin und Klinischer Psychologie, 17(1), pp. 17-31. CIP-Medien

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A large number of meta-analyses demonstrates that psychotherapy is beneficial to most forms of psychopathology. However, there is considerable disagreement as to what makes psychotherapy effective. The controversy about the comparative efficacy of different forms of psychotherapy has generated two different major perspectives: the specific ingredients assumption and the common-factors model. Supporters of the verdict that distinct psychotherapy approaches show little differences in their efficacy have proposed common factors as the main causes of thera- peutic change. In contrast, proponents of empirically supported therapies believe that psychotherapy works through specific techniques. However, there is no clear definition of common factors. Moreover, contrasting specific with common factors of therapeutic change ignores the fact that both are intertwined. The “Generic Model of Psychotherapy” and process-outcome findings rather suggest a synergistic view of common factors, specific techniques and their interaction with disorder-related and other patient characteristics.
The presented Taxonomy Project aims at identifying the associations between specific techniques of psychotherapy and common factors of therapeutic change. Thereby, the Taxonomy Project attempts to contribute to a clearer defi- nition and conception of common factors. A comprehensive literature search was performed to identify the common factors discussed in psychotherapy research. 22 common factors were extracted from the literature and defined. Afterwards, a questionnaire relating these factors to 22 standard techniques used in the major psychotherapy approaches was constructed. Psychotherapy experts then rated the degree of the association between the techniques and the common factors in a web-based survey. Hierarchical regression analyses were performed to analyze the associations between common factors and specific techniques. The results indicate that the different common factors can be discriminated by their different associations to the various techniques.
At present, research addressing therapeutic change processes in psychotherapy is suffering from a terminological “jungle” and theoretical misconceptions. It is likely that the terminological confusion as well as the conceptual impreciseness impair the exact analysis of psychotherapeutic change mechanisms and, thus, progress in psychotherapy. The presented taxonomical endeavor is a first step towards a clarification of common factors. A more precise concept of common factors is required to look closely at the processes underlying therapeutic change in psychotherapy.

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