The Theory of Change in Psychotherapy

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This chapter delves into the theory of change in psychotherapy, exploring the different perspectives on how therapy leads to better outcomes. It discusses the client's belief in the therapy process, specific changes that occur, and the limitations of explaining cause and effect. The chapter emphasizes a pragmatic approach to therapy and the factors that seem to make a difference.

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How can we make psychotherapy more effective? How much confidence should psychotherapists have in the efficacy of their methods? How does deliberate practice differ from mere repetition? How can we overcome confirmation bias, the Dunning-Kruger effect, and other blind spots in our own fields of expertise? What are the most significant predictors of positive outcome achievement for clients in psychotherapy? When a patient has a physical ailment, doctors gather data, diagnose the ailment, and prescribe a particular treatment; but to what extent is psychotherapy similar to that model? To what extent do psychological models reflect the culture in which they're created? Has psychotherapy improved its efficacy over the course of its existence? When the therapeutic relationship seems less than optimal or even difficult, how long should clients stick with a therapist before switching to a different one? What are some meta-analyzers getting wrong when they compare treatment methods?

Scott D. Miller, Ph.D. is the founder of the International Center for Clinical Excellence, an international consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health services. Dr. Miller conducts workshops and training in the United States and abroad, helping hundreds of agencies and organizations, both public and private, to achieve superior results. He is one of a handful of invited faculty whose work, thinking, and research is featured at the prestigious Evolution of Psychotherapy Conference. Email him at info@scottdmiller.com or learn more at scottdmiller.com.

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