Comprehensive Psychotherapeutic Interventions Rating Scale (CPIRS)

The Comprehensive Psychotherapeutic Interventions Rating Scale (CPIRS) was designed to study different orientations of psychotherapy used in researched practices. It is a way to measure treatment adherence and/or treatment differentiation.

Psychotherapeutic methods described in this scale

Client Centered, psychodynamic, behavioral, cognitive, group psychodynamic, and systemic orientations are included in the CPIRS.

Apart from these orientations, interventions and attitudes derived from common factors are included. The scale is also useful in determining how far the treatment is eclectic/integrative or pure form.

Items of the Interventions Rating Scale

 

Validity Studies

3 Studies were carried out, that are also presented in this article to validate this scale.

The first 2 studies indicated unconvincing differentiation between psychodynamic therapies and experiential therapies studied.  The differentiation was clearer in the third study.

General Conclusion


Bibliography

Trijsburg, R. W., Frederiks, G. C., Gorlee, M., Klouwer, E., den Hollander, A. M., & Duivenvoorden, H. J. (2002). Development of the comprehensive psychotherapeutic interventions rating scale (CPIRS). Psychotherapy Research12(3), 287-317.

Research: Orlinsky Generic Model of Psychotherapy

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.

Read also my essay on the psychotherapeutic alliance and change.

Bibliography

Orlinsky, D. E. (2009). The “Generic Model of Psychotherapy” after 25 years: Evolution of a research-based metatheory. Journal of Psychotherapy Integration19(4), 319.

Research: The Psychotherapeutic Alliance in Research

Interdependent factors that make an alliance:

  • *the agreement between patient and therapist on the tasks and goals of treatment and
  • *the affective bond between patient and therapist.

Ruptures

Refer also to the 3RS manual on ruptures here.

Ruptures are understood as: misunderstanding events, impasses, alliance threats and markers of enactments.


A rupture is a deterioration in the alliance, manifested by

  1. a lack of collaboration between patient and therapist on tasks or goals, or
  2. by a strain in the emotional bond.

Although the word “rupture” connotes a major breakdown in the relationship, the term is also used to describe minor tensions of which one or both of the participants may be only vaguely aware. Ruptures can be obstacles to treatment and can contribute to patient dropout.

Resolution of Rupture as Opportunity for Therapeutic Change

Successful resolution of a rupture can serve as a corrective emotional experience (Alexander & French, 1946), providing a powerful opportunity for therapeutic change

Recognizing the negative impact that unresolved ruptures can have on
treatment outcome, and realizing that these ruptures can go unnoticed by the therapists research is done that is centered around the investigation of whether integrating rupture resolution techniques can improve the efficacy of a particular treatment.

The chapter in this reference gives a detailed account of the kind of research that has been done, that works on the alliance rupture and repair, with the goal of improving probability of training therapists to focus on the alliance.

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Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. Psychotherapy, 48(1), 80-87.
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Barber, J. P., Khalsa, S. R., Sharpless, B. A., Muran, J. C., & Barber, J. P. (2010). The validity of the alliance as a predictor of psychotherapy outcome. The therapeutic alliance: An evidence-based guide to practice, 29-43.

Empirical studies that have shown that alliance is correlated to good outcome:

Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 37–70). New York: Oxford University Press.

Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438–450.

Samstag, L. W., Batchelder, S. T., Muran, J. C., Safran, J. D., & Winston, A. (1998). Early identification of treatment failures in short-term psychotherapy: An assessment of therapeutic alliance and interpersonal behavior. Journal of Psychotherapy Practice and Research, 7, 126–143.

Samstag, L. W., Muran, J. C., Wachtel, P. L., Slade, A., Safran, J. D., & Winston, A. (2008). Evaluating negative process: A comparison of working alliance, interpersonal behavior, and narrative coherency among three psychotherapy outcome conditions. American Journal of Psychotherapy, 62, 165–194.

Tryon, G. S., & Kane, A. S. (1990). The helping alliance and premature termination. Counselling Psychology Quarterly, 3, 233–238.

Tryon, G. S., & Kane, A. S. (1993). Relationship of working alliance to mutual and unilateral termination. Journal of Counseling Psychology, 40, 33–36.

Tryon, G. S., & Kane, A. S. (1995). Client involvement, working alliance, and type of therapy termination. Psychotherapy Research, 5, 189–198.

Reference

Eubanks-Carter, C., Muran, J. C., & Safran, J. D. (2010). Alliance ruptures and resolution. The therapeutic alliance: An evidence-based guide to practice, 74-94.

Index of this book:

I. Critical Studies of the Therapeutic Alliance

  1. Alliance Theory and Measurement 7 Robert L. Hatcher

  2. The Validity of the Alliance as a Predictor 29 of Psychotherapy Outcome Jacques P. Barber, Shabad-Ratan Khalsa, and Brian A. Sharpless

  3. The Alliance over Time 44 William B. Stiles and Jacob Z. Goldsmith

  4. Qualitative Studies of Negative Experiences 63 in Psychotherapy Clara E. Hill

  5. Alliance Ruptures and Resolution 74 Catherine Eubanks-Carter, J. Christopher Muran, and Jeremy D. Safran xiv

Contents II. Practice and the Therapeutic Alliance

  1. A Psychodynamic Perspective 97 on the Therapeutic Alliance: Theory, Research, and Practice Stanley B. Messer and David L. Wolitzky 7. An Interpersonal Perspective on Therapy 123 Alliances and Techniques Lorna Smith Benjamin and Kenneth L. Critchfield 8. The Therapeutic Alliance 150 in Cognitive-Behavioral Therapy Louis G. Castonguay, Michael J. Constantino, Andrew A. McAleavey, and Marvin R. Goldfried 9. A Functional Analytic Psychotherapy (FAP) 172 Approach to the Therapeutic Alliance Mavis Tsai, Robert J. Kohlenberg, and Jonathan W. Kanter 10. The Therapeutic Alliance 191 in Humanistic Psychotherapy Jeanne C. Watson and Freda Kalogerakos 11. Therapeutic Alliances in Couple Therapy: 210 The Web of Relationships Adam O. Horvath, Dianne Symonds, and Luis Tapia 12. Therapeutic Alliances and Alliance Building 240 in Family Therapy Valentín Escudero, Laurie Heatherington, and Myrna L. Friedlander 13. The Therapeutic Alliance in Group Therapy 263 William E. Piper and John S. Ogrodniczuk III. Training Programs on the Therapeutic Alliance 14. Developing Skills in Managing 285 Negative Process Jeffrey L. Binder and William P. Henry Contents xv 15. Training in Alliance-Fostering Techniques 304 Paul Crits-Christoph, Katherine Crits-Christoph, and Mary Beth Connolly Gibbons 16. Developing Therapist Abilities to Negotiate 320 Alliance Ruptures J. Christopher Muran, Jeremy D. Safran, and Catherine Eubanks-Carter 17. Coda: Recommendations for Practice 341 and Training Brian A. Sharpless, J. Christopher Muran, and Jacques P. Barber
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