Consensus on the Perceived Presence of Transtheoretical Principles of Change in Routine Psychotherapy Practice: A Survey of Clinicians and Researchers

Twomey Conal; OReilly Gary; Goldfried Marvin R. R.

摘要

Goldfried (1982) hypothesized that there are five transtheoretical principles of change that guide routine psychotherapy practice. This survey investigated if there is consensus on the perceived presence of these principles in the approaches of a professionally diverse pool of psychotherapy clinicians and researchers. One thousand nine hundred ninety-eight participants, aged 21-85 years (M = 50.4 years, SD = 15.59) and representing a wide variety of theoretical orientations, completed an online survey. For consensus to be indicated, 95% confidence intervals of mean agreement scores had to be above 4.0 (out of 5). Mean agreement levels in response to "the extent to which you agree that the following principles are present in your own approach to psychotherapy" indicated consensus for all five principles: (a) fostering hope, positive expectations, and motivation (M = 4.58; 95% CI [4.53, 4.62]); (b) facilitating the therapeutic alliance (M = 4.76; 95% CI [4.73, 4.80]); (c) increasing awareness and insight (M = 4.66; 95% CI [4.63, 4.70]); (d) encouraging corrective experiences (M = 4.44; 95% CI [4.39, 4.48]); (e) emphasizing ongoing reality testing (M = 4.15; 95% CI [4.09, 4.20]). These findings were unaffected by age, gender, working patterns, practice (clinician or researcher), and years of experience; however, consensus on the final two principles was not indicated for both psychodynamic and experiential psychotherapists. The demonstrated consensus surrounding the transtheoretical principles of change corresponds with their consistently yielded outcome associations in previous research. The combination of these evidence sources points to the importance of the principles in routine psychotherapy practice, which warrants further investigation.Clinical Impact StatementQuestion: Is there consensus on the perceived presence of Goldfried's (1982) five transtheoretical principles of change among a large and professionally diverse pool of psychotherapy clinicians and researchers? Findings: Consensus was found for all five principles of change, and this consensus corresponds with their considerable empirical support. The combination of clinical observation (showing consensus) and the best-available research evidence allows us to be more confident that these principles are present in most psychotherapy clinicians' daily practices. Meaning: Focusing on transtheoretical principles of change provides an agreed-upon and shared framework for psychotherapy interventions, to which further principles and new ideas can be added. This framework encompasses a flexible, evidence-based, transtheoretical, and principles-led approach to psychotherapy that allows clinicians to match the array of available clinical techniques to the client's formulation-based needs. Next Steps: Worthy of investigation is comparing the levels of consensus on the current set of principles with other evidence-based principles of change and determining if consensus occurs in directly observable clinical practice.

Consensus on the Perceived Presence of Transtheoretical Principles of Change in Routine Psychotherapy Practice: A Survey of Clinicians and Researchers

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