Generic Model of Psychotherapy

The Generic Model of Psychotherapy (dt. General model of psychotherapy ) by David Orlinsky and Kenneth I. Howard is a work based on empirical results model in the field of psychotherapy research . It serves to integrate the results of a large number of individual studies from the field of process-result research into a uniform conceptual framework. It was first published in 1986 and has been continuously developed since then.

content

General

Psychotherapy can be understood as an interaction between (usually two) people (patient and therapist) that takes place in a specific contextual framework. This interaction is influenced by the life and personality of both the patient and the therapist. Further context factors are e.g. B. the therapeutic environment ( treatment setting , e.g. clinic, private practice), the supply system ( service delivery system , e.g. health insurance), other social institutions inside or outside the care system ( other social institutions , e.g. Families of the patient and the therapist, non-profit institutions, courts) as well as social, economic or political events / trends ( currents of change , e.g. holiday season, economic recession, national crises). In addition, cultural normative ideas (about the normal personality, adequate forms of emotional experience or expression, norms of communication, type and reasons for deviations (pathology), the right way of helping, etc.) have an important influence on therapeutic events. Thus, both individual and collective context factors exert an influence on the therapeutic process ( input ). Conversely, the therapeutic event also has an influence not only on the life and personality of the patient ( outcome ), but also on the therapist, society, etc. ( output ).

The psychotherapeutic action system , i.e. H. all interactions between patient and therapist during therapeutic sessions (and the related behavior and experience outside the meetings) is, as a therapeutic process ( treatment process referred to). The empirically observed is Separate from this process of change ( change process ).

Based on the research literature of the time, five aspects were described in 1986. In 1994, further developments in the sequential analysis of temporal processes or sequences led to a sixth aspect being added to the model:

1. Formal relationship ("therapeutic contract", normative or organizational aspect)
2. Therapeutic activities ("therapeutic operations", technical or procedural aspect)
3. Informal relationship ("therapeutic bond", interpersonal aspect)
4. Self-relatedness (intrapersonal or reflexive aspect)
5. direct influences of the session ("in-session impacts", clinical or pragmatic aspect)
6. temporal patterns ("temporal patterns", sequential aspect, temporal sequence)

1. Formal relationship (Therapeutic Contract)

On the one hand, this describes the normative framework in which the patient and therapist move, e.g. B. social roles or norms (such as how an ideal patient or an ideal therapist should behave). These are z. B. influenced by therapy training and supervision, on the patient side z. B. through television, films, or stories from the private sphere. In addition, framework conditions such as B. describes the therapeutic orientation of the therapist (psychoanalysis, behavior therapy, etc.).

Contractual provisions describes the formal therapeutic agreements, i.e. H. (which are generally related to the therapeutic orientation) treatment goals, methods (e.g. individual, group, couple, family therapy), number of sessions per week, financial agreements, etc.

Contractual implementation refers to the specific behavior that is carried out to implement the agreements (e.g. agreeing therapy goals, fulfilling the "norms" by the patient, dealing with breaches of contract or norms, etc.)

2. Therapeutic Operations

Therapeutic activities can be described (depending on the role) as

• Problem presentation ( problem-presentation ): the patient must have a way to communicate his problem
• Understanding of the therapist ( expert understanding ): the therapist must use his professional skills and expertise to capture the patient's problem
• Intervention by the therapist ( therapist intervention ): the therapist must respond to the above. Make a proposal on how to deal with the problem
• Cooperation of the patient ( patient cooperation ): the patient must in some way actively participate or cooperate in the implementation of the proposal

3. Informal Relationship (Therapeutic Bond)

Here the informal and interpersonal aspects of the relationship between patient and therapist are described qualitatively, e.g. B. by

• The quality of the collaboration ( collaborative teamwork ), based on personal investment , i.e. the extent to which the patient or therapist fulfills their role) or the coordination of the interactions ( interactive coordination , i.e. how well or poorly their actions are coordinated ).
• the quality of the personal rapport ( personal rapport ), based on the emotional expression ( expressive attunement , d. e. how effectively and empathetically communicating) and the affective attitude to each other ( affective attitudes , d. e. how strong and how positive or negative they fit feeling).

4. Participant self-relatedness

Aspects such as self-perception, self-control and self-worth of patient and therapist are described, which play a role in every interaction (e.g. perception and generation of physiological arousal, moods, desires, intentions; exercising self-control over action impulses; perception of self-efficacy, etc. ), as well as the (intuitive or unconscious) perception of these processes in the interaction partner. Negative aspects of self-centeredness in therapy would be e.g. B. defense or narrowing, positive aspects z. B. Openness or satisfaction.

5. In-session impacts

The immediate short-term, positive or negative effects of a therapy session are described. Positive examples in the patient are e.g. B. Insight into contexts ("insight"), catharsis, resolution of interpersonal conflicts, experience of self-efficacy, increase in hope etc. However, it can also lead to negative effects such as e. B. Confusion, embarrassment, or fear come. Positive or negative effects of therapy sessions can also be described for therapists (e.g. experiences of self-efficacy vs. frustration, professional development vs. burnout).

6. Temporal Patterns

Until the early 1990s, only the duration of therapy (time or number of sessions) played a role here. Since then, improved statistical possibilities have increasingly led to the investigation of temporal patterns within the sessions ( session development ), successive sessions ( treatment stage ) or an entire therapy ( treatment course ).

meaning

According to Klaus Grawe, this model is a “milestone in the development of psychotherapeutic process research”. ^{Pp. 152-153}

Individual evidence

1. ↑ ^{a b} Michael J. Lambert (Ed.): Bergin and Garfield's Handbook of Psychotherapy and Behavior Change . 5th edition. John Wiley & Sons, New York NY 2004, ISBN 0-471-37755-4 , pp. 316 ff.
2. ^ David Orlinsky, Kenneth Howard: Process and Outcome in Psychotherapy . In: SL Garfield, AE Bergin (Ed.): Handbook of Psychotherapy and Behavior Change. 3. Edition. Wiley, New York 1986, pp. 311-384.
3. ↑ David E. Orlinsky, Kenneth I. Howard: A generic model of psychotherapy. In: Journal of Integrative & Eclectic Psychotherapy. 6 (1), 1987, pp. 6-27 [1]
4. ^ David E. Orlinsky, Klaus Grawe, Barbara K. Parks: Process and outcome in psychotherapy: Once again. In: Allen E. Bergin, Sol L. Garfield: Handbook of psychotherapy and behavior change. 4th edition. 1994, pp. 270-376.
5. ↑ David E. Orlinsky, Michael Helge Ronnestad, Ulrike Willutzki: Fifty Years of Psychotherapy Process-Outcome Research: Continuity and Change. In: Michael J. Lambert (Eds.): Bergin and Garfield's Handbook of Psychotherapy and Behavior Change. 5th edition. Wiley, New York 2004, pp. 307-389.
6. ^ Klaus Grawe: Psychotherapy research at the beginning of the nineties. In: Psychological Rundschau. 43, 1992, pp. 132-162.