What is psychotherapy as a profession deconstructed? This paper by Orlinsky (2009) provides some definable guides, providing graphical structure of psychotherapy. The profession of psychotherapy is more complex than meets the eye, because most of what is important in the work is difficult to measure by empirical methods. This is a meta-theory for the use of psychotherapy research.
The “Generic Model of Psychotherapy” was initially presented 25 years ago and was conceived as a trans-theoretical frame for integrating the varied empirical findings of hundreds of studies relating therapeutic process to outcome that had appeared during the previous 3 decades into a coherent body of knowledge.
This conceptual model offers a comprehensive framework in which various clinical theories of psychotherapy can be systematically combined and compared.
It was considered almost impossible to compare these different branches of therapies because of their different focus and “operating language”. This is of course not a very good description of what psychotherapy is about.
Aspects of the Psychotherapeutic Process
If we were to detangle the layers of the psychotherapy profession, we can imagine these parts that make up the whole
1. The Therapeutic Contract:
This is the getting together of the client and therapist; it is an agreement on the set, setting and conditions of the therapy.
2. Therapeutic Operations : Technical Aspects
After the formalities are set, the client comes into the therapy session and begins his/her dialogue with the therapist. The patient presents his/her situation, the therapist provides interventions. From the figure below one can see the co-createdness of this step.
3. The Therapeutic Bond
When people meet, the interpersonal relationship that builds in-between is unique. How this bond is formed is multi-factorial. These factors have been used a variables in psychotherapy research, e.g. age, gender, socio-cultural-economic status, and personality. The therapeutic bond is dynamic and changes over time.
4. Self Relatedness
This is the intra-personal aspects of both therapists and client: how open each are to the conditions and situations that arises within and outside of the therapy sessions.
5. In-Session Impacts
These are happenings that occur during the therapy session that impacts the client-therapist relationship.
6. Temporal Patterns
As the name suggests, this is about taking into account how change evolves with time. Small changes and ah-ha moments, together with outside influences through time creates changes to the therapeutic relationship.
Considering the Context of Therapy
The client and therapists are also affected by what goes on in life outside the therapy hours. This brings into consideration the larger context related to the therapist and client as individuals.
The big picture is a schema of how fluid and ever-changing the influences of the psychotherapeutic alliance is. This makes psychotherapy research very challenging and also interesting.