Principles of therapeutic change (more than just alliance)

Larry Beutler and Benny Martin have conducted a major review of the literature on therapeutic change and have proposed the following 10 principles:

Relationship Principles

1. Therapeutic change is greatest when the therapist successfully conveys trust, acceptance, acknowledgement, and respect for the patient and does so in an environment that both supports risk and provides maximal safety from criticism.

2. Therapeutic change is most likely when the patient is realistically informed about the probable length and effectiveness of treatment and has a clear understanding of the roles and activities that are expected during the course of treatment.

Adjusting Level of Treatment

3. Therapeutic change is most likely and maximal when the intensity of treatment is consistent with the patient's level of psychological and functional impairment.

Differential Treatment Change

4. Therapeutic change is most likely when the patient is exposed to the objects or targets of behavioral and emotional avoidance.

5. Therapeutic change is greatest when the internal or external focus of the selected interventions paralell the external or internal methods of avoidance that are characteristically used by the patient to cope with stressors.

6. Therapeutic change is most likely if the initial focus of change efforts is to alter disruptive symptoms.

7. Therapeutic change is most likely when the therapeutic procedures do not evoke therapeutic resistance.

8. Therapeutic change is greatest when the directiveness of the intervention is either inversely correspondent with the patient's current level of resistance or authoritatively prescribes a continuation of the current symptomatic behavior.

9. The likelihood of therapeutic change is greatest when the patient's level of emotional stress is moderate, neither being excessively high nor excessively low.

10. Therapeutic change is greatest when the patient is confronted with avoided behaviors and experiences to the point of raising emotional distress until problematic responses diminish or extinguish.

from: Beutler, L. E. & Martin, B. R. (2000). Prescribing therapeutic interventions through strategic treatment selection. Cognitive and Behavioral Practice, 7, 1-16.

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