Clinical Psychology

accepting, nonjudgmental, objective, insightful, and
professional all at the same time. These lavish adjec-
tives scarcely fit all therapists all of the time. Never-
theless, the general ability of therapists to rise above
their personal needs and to respond with profes-
sional skill in a nonjudgmental atmosphere of con-
fidentiality, understanding, and warmth is probably
a major reason for the success and persistence of
psychotherapy in our society.

The Expert Role. It is assumed that the therapist
brings to the therapy situation something more than
acceptance, warmth, respect, and interest. These
personal qualities are not sufficient for certification
as a clinical psychologist. Conventional wisdom
seems to suggest that all one needs to conduct psy-
chotherapy is an unflagging interest in others.
However, this is not enough.
In all forms of psychotherapy, patients have a
right to expect that they are seeing not only a
warm human being but a competent one as well.

Competence can only come from a long, arduous

period of training. Some may be quick to reply

that the assumption of anexpert roleintroduces

an authoritarian element into the relationship,

implying that the patient and the therapist are

not equal and thus destroying the mutual respect

that should exist between them. However, mutual

understanding and mutual acceptance of the

different roles to be played would seem sufficient

to guarantee the maintenance of mutual respect.

Therapists are, of course, no better than patients,

and they cannot lay claim to any superior consid-

eration in the cosmic scheme of things. However,

this kind of equality need not deny the impor-

tance of training, knowledge, and experience

that will assist therapistsin their efforts to resolve

the patient’sproblems.

Building Competence/Mastery. In one sense, a

goal of most therapies is to make the client a

more competent and effective human being. All

T A B L E 11-2 Common Factors of Psychotherapy Associated with Positive Outcome

Support Factors Learning Factors Action Factors

Catharsis Advice Behavioral regulation

Identification with therapist Affective experiencing Cognitive mastery

Mitigation of isolation Assimilation of problematic
experiences

Encouragement of facing fears

Positive relationship Changing expectations for personal
effectiveness

Taking risks

Reassurance Cognitive learning Mastery efforts

Release of tension Corrective emotional experience Modeling

Structure Exploration of internal frame
of reference

Practice

Therapeutic alliance Feedback Reality testing

Therapist/client active participation Insight Success experience

Therapist expertness Rationale Working through

Therapist warmth, respect, empathy,
acceptance, genuineness
Trust

SOURCE: Lambert and Ogles (2004).

320 CHAPTER 11