Do Common Factors Matter in Psychotherapy Clinical Psychology Review

Introduction

Common Factors in Psychotherapy

In this theoretical and methodological paper, nosotros wish to address the therapeutic alliance, an essential constituent of psychotherapy, in a novel way. We will starting time from the common factors debate in psychotherapy research, which has focused on alliance as a prominent common factor of psychotherapy process. An important, albeit ofttimes tacit, issue in psychotherapy and in cognitive science is the persisting duality of experiential (outset-person) and behavioral (third-person) approaches in investigations of psychological entities such as the therapeutic alliance. Each mutual factor, each agile ingredient of psychotherapy, can be divers and monitored either at the experiential or at the behavioral level.

A basic definition of psychotherapy may be this: Psychotherapy is a learning process, which relies on general mechanisms of action that are implemented using psychological techniques and interventions. Techniques are provided during a scheduled social interaction between therapist and patient with the goal of alleviating the patient's disorders and improving health and well-being.

Psychotherapy research has shown a sequence of developmental stages since its beginnings in the early 19th century (Freud, 1900/1989). A large number of modalities of psychotherapy have evolved since Freud'south psychoanalysis: humanistic, (cognitive-) behavioral, and systemic schools. In the 1950s, the field entered its "legitimation stage" considering general concerns had been prominently voiced that psychotherapy effectiveness would not exceed spontaneous remission rates. In response to this criticism, a vast number of efficacy studies, reviews, and meta-analyses were conducted; they demonstrated that psychotherapies of many unlike approaches are at least moderately, often highly effective for the treatment of many different kinds of psychopathology. The field thus arrived at a house bear witness-based consensus that psychotherapy is considerably more than effective than no handling or placebo treatment. One result of the legitimation phase was withal unexpected: all meta-analyses consistently institute merely few signs of a superiority of any particular 1 of the many psychotherapy modalities (Wampold, 2001). As a outcome, a novel research priority developed, aimed at identifying the mutual factors that obviously underlie all psychotherapies. The field entered a new phase with a focus on the psychotherapy process in general: What is it that makes therapy effective?

The current word in psychotherapy enquiry strongly emphasizes these common factors. Such factors are called "common" for 2 reasons: Starting time, they are present in quite different and fifty-fifty opposing therapy modalities. A second meaning of "common" is that these factors are effective in the treatment of quite dissimilar disorders and problems. In the discussion on the general mechanisms of how psychotherapy works, common (i.east., unspecific) factors are commonly contrasted with specific factors that are grounded in the therapist'south specific techniques and interventions. Proponents of the mutual factors view would assume that the common factors, not the specific techniques, are crucially or even exclusively involved in bringing about psychotherapy effects. Examples of common factors that are shared past all psychotherapy modalities are "promise instilled in the patient," the "cognitive restructuring" of the patient'due south belief arrangement, the patient's "corrective emotional feel," and patient and therapist establishing a trusting, cooperative relationship, namely a "therapeutic alliance." A survey-based description of those 22 common factors that have been discussed most frequently was provided past Tschacher et al. (2014b).

Many of the common factors put forward past psychotherapy researchers take overlapping content. Therefore, several authors have tried to systematize the discussion past grouping the common factors. One may distinguish (Cornsweet, 1983) aspects of the therapeutic human relationship, cognitive factors and therapist factors. Omer and London (1989) amassed common factors in iv higher-level categories: Human relationship factors, expectancy effects, reorganizing factors, and therapeutic touch. Grencavage and Norcross (1990) found in their review of the literature five groups of mutual factors: Client characteristics, therapist qualities, change processes, treatment structure, and therapeutic relationship. Grawe (2004) reviewed the empirical bear witness of psychotherapy research accumulated toward the terminate of the 20th century, and proposed four essential common factors: Activation of the trouble in the therapeutic setting; activation of a patient's resources; motivational description; coping with the problem. Finally, factor analysis of the mentioned listing of 22 common factors (Tschacher et al., 2014b) resulted in iv dimensions: Patient'south cerebral processing, problem solving, emotional processing, and the building upward of a therapeutic brotherhood.

The common cistron that is, sometimes implicitly, present in all of these groupings, and that was investigated in well-nigh detail is clearly the therapeutic relationship or alliance; the general importance of alliance as a change gene is recognized by virtually all researchers of psychotherapy process. By the mid-1990s, a bulk of empirical studies had supported a positive effect of alliance on outcome, compared to some studies finding no clan and a single study finding a negative association. This articulate bear witness in favor of the contribution of alliance was strengthened by additional empirical studies one decade later (Orlinsky et al., 2004).

Alliance, as information technology is discussed in psychotherapy enquiry, is itself composed of a number of variables. An encompassing meta-analytic review of the effectiveness of therapeutic relationships was conducted in a task force project of the American Psychological Association to establish an evidence base for therapy relationships (Norcross, 2011). The post-obit aspects of therapeutic relationships were distinguished: Bond, empathy, goal consensus, positive regard, congruence, collecting feedback from the patient, repairing relationship ruptures, avoiding countertransference, and matching the individual patient. In sum, each of these aspects of a multi-faceted alliance construct positively and significantly predicts therapy outcome. The respective meta-analyses yielded result sizes around 0.iii, i.e., a weak to moderate consequence of brotherhood with respect to therapy success.

The Duality of Perspectives on Alliance

In psychotherapy research, alliance is addressed at two categorically different levels. From a showtime-person perspective, alliance is something that is experienced past the members of the relationship. A mutual representation of interpersonal experiences in psychology is the interpersonal circumplex model (Leary, 1957). Interpersonal space is causeless to take two dimensions, communion (love) and bureau (power). Interactional experiences in a social human relationship such as the therapeutic alliance can exist described as a blend of experiences of communion and agency, thus as a region in a two-dimensional circumplex (Figure 1). A characterizing belongings of experiential states is that they accept "intentionality" (Brentano, 1874): Experiences are "nearly something" in the sense that an experience almost always contains a reference to something.

Figure one. Circumplex model of interpersonal experiences and issues. The clarification of a trouble is given for each octant of the circumplex (after Horowitz, 2004).

A third-person perspective of alliance is accessible by the objective ascertainment of relationship beliefs. Behavioral measures are overt torso movement, the pressing of buttons in a psychological experiment, physiological responses etc. In improver, there is a standard short-cut in psychology by which even experiential data (i.due east., subjective judgments) can be transformed into an objective, tertiary-person form. To do this, experiential judgments are operationalized by intersubjectively validated measures such as questionnaires. This has been done extensively in the context of (experiential) circumplex theory, e.g., past the Inventory of Interpersonal Problems (IIP, Horowitz et al., 1988), a measure out of current difficulties in interpersonal functioning. The eight subscales of the IIP pertain to eight octants of the circumplex model of interpersonal beliefs (Effigy 1), and the respective alloy of bureau and communion is assessed using questionnaire items, which quantify a person's judgments.

The physical level of alliance also yields a third-person description; it tin be directly addressed through observable motor beliefs and may be defined in terms of the degree of behavioral coordination and cooperation of persons. There are a number of implementations of this full general idea. A method that assesses such coordination by the quantification of synchronized motor behavior of a patient-therapist dyad is Motility energy analysis (MEA, Ramseyer and Tschacher, 2014; Tschacher et al., 2014a). MEA measures the correlation of body movement of interactants, where movement may be estimated by the amount of pixel changes in a digital video of the respective interaction (Figure ii). The resulting correlational measure yields the degree of non-verbal synchrony, which has been repeatedly shown to be a significant marker of alliance quality.

Figure 2. Movement of interactants in a video (left) can exist visualized by highlighting of pixel changes between sequent frames (right). The correlation of both persons' time series of pixel changes yields a measure of non-verbal synchrony.

The idea of objectifying social alliance by a synchrony measure tin be generalized to several other fields of social interaction. Synchrony may come to the fore also in the shape of verbal synchrony, such every bit the interactants' shared use of words, symbols, idioms, or narratives—the higher the overlap in their vocabularies, the closer the alliance. People interacting closely also tend to show similar patterns of facial expressions (such every bit smiling or frowning), features of the voice (e.g., alignment of prosody), and body postures (e.g., both interactants crossing arms in forepart of the chest). In social psychology, such phenomena of bodily synchronizations are summarized past the concepts of contagion (Hatfield et al., 1994) or mimicry (Chartrand and Lakin, 2013). At an abstract level, the various synchrony findings indicate that social relationships are non merely experienced simply definitely also embodied.

Our goal in this article is to go far at a more encompassing agreement of the common factor "therapeutic brotherhood." According to our hypothesis it is thereby necessary, and feasible, to overcome the conventional separation between the subjective-experiential and the objective-behavioral descriptions of relationship. The methodology of operationalization in psychology likewise attempts to overcome this separation by translating experiences into behavioral data. We wish to go on a step further still, and explore a level that is neither experiential nor behavioral. We demonstrate that in that location are methodologies past which this may exist accomplished: the structural scientific discipline of systems theory and the enactive arroyo in embodied cognitive science. Finally, both methodologies volition be implemented to elucidate the concept of therapeutic brotherhood.

Methodology: Beyond Duality

Enactivism

In a previous article, Kyselo (2014) conceptualized the psychological self as an autonomous organisation (Maturana and Varela, 1980) that is socially "co-enacted" and constituted by two poles, distinction and participation. The psychological self, within mental architecture seemingly the cadre of individuality, is therefore at the same time a social construction. This means that the human self is brought forth through interactions and relations with others and is characterized by two dialectical strivings, on the ane hand toward a sense of cocky equally existence distinct from others, and on the other hand toward a sense of cocky as being open to and afflicted past others. The resulting directions or poles, stardom and participation, shape the individual's relations and interactions. They may exist viewed every bit a central dimension of the self, and at the aforementioned time, the building block of sociality and thus, in a next step, social alliance. Maintenance of the self is effected past the intersubjective co-negotiation betwixt distinction and participation.

The enactive approach aims at bridging the gap between the first-person and third-person perspectives described in the previous section. It holds that subjectivity and third-person organizational description are complementary: With the generation of an autonomous identity a organization is considered to acquire its very own perspective on the world, based of which it evaluates interactions and constructs meanings (Varela, 1995; Weber and Varela, 2002; Thompson, 2007). Therefore, enactivism transcends the duality of subjective and objective knowledge in the fundamental psychological construct of the self: Objectively speaking, the self is a cocky-other enacted network of social relations, subjectively speaking this network brings about a sense of cocky which grounds a basic perspective on the world. Subjective and objective perspectives are thus joined in the lived social existence of the self.

Dynamical Systems Theory and Synergetics

A second method to mend the duality of perspectives may be seen on the background of the theory of science (Brunner et al., 2011), which differentiates non only the natural sciences (e.g., physics, biological science, geology) from the humanities and arts (Geisteswissenschaften such as history, science of art, philology), merely also recognizes a further grouping of sciences, the structural sciences (east.g., mathematics, cybernetics, systems theory). Structural sciences reside at a level where just the relations between formal objects are addressed, irrespective of whatever content or ontology. Correspondingly, research subjects in psychology, including the cocky and the therapeutic alliance, may be analyzed using a threefold concrete-mental-structural view instead of the dualist body-heed dichotomy. This grouping corresponds to Popper's three worlds theory, which distinguishes the physical world, the mental globe, and the earth of thought products and fine art works (Popper, 1972).

The general idea is that the structural perspective is neither a offset- nor third-person perspective. Nevertheless, experiential or objective information may serve as the components of structural models. In other words, structural models suspend the categorical difference of first- and third-person descriptions. An encompassing structural framework is for instance offered by dynamical systems theory (DST, eastward.m., Guckenheimer and Holmes, 2002) and self-organization theory (synergetics: Haken, 2000). DST is aimed at the deterministic modeling of modify and stability of a system, whereas synergetics specifically models pattern formation and stage transitions, in which deterministic and stochastic processes are combined. Both structural disciplines are based on a formal mathematical terminology.

Proponents of self-organization theory accept presented diverse approaches to model the emergence of novel properties arising from lower levels of a hierarchy. Such "contextual emergence" (Atmanspacher and beim Graben, 2009) assumes a structural relation between unlike levels of description. For case, the mind may be viewed in the context of neuronal dynamics (Haken and Tschacher, 2010). A contempo reconstruction of intentionality, the defining property of beginning-person experience, in terms of synergetics and contextual emergence was presented by beim Graben (2014). He used a dissipative not-equilibrium system (then-called magnetic surface swimmers) to prove that cocky-assembling patterns with intentional beliefs can be based on, but not reduced to, simple physical and electromagnetic laws.

In this vein, Kyselo and Tschacher (2014) accept previously elaborated the idea that the psychological self—and social relationships between selves—may exist analyzed using structural concepts joining enactive embodied theorizing with DST. As mentioned, the individual self is hypothesized, in enactivist terms, to exhibit two contained strivings, distinction and participation. Kyselo and Tschacher (2014) proposed a model using a geometrical phase space that is spanned by distinction and participation every bit two different dimensions; they are seen as the coordinate axes of phase space. The stability of all distinction/participation states were symbolized by basins and hills in the "landscape" of such a phase space. The peak of a state in phase space, its 3rd dimension, reflects an "energetic" value (the potential Five) of that country. Equally system states 10 tend to relax toward states of lower energy, the momentary country of a arrangement follows trajectories (like a brawl that would roll downhill). In DST, a potential minimum (bowl) is an attractor of the phase infinite of a system, cogent states with lower potential and thus college probability; analogously, a hill denotes a repellor. One may say that the beliefs in x follows a probability distribution p, where p(x) is negatively related to Five(x).

Here, nosotros continue the project of describing interaction dynamics in structural terms. We presume that distinction and participation are two poles of a unmarried dimension x, akin to Horowitz' communion axis of the circumplex (cf. Figure i). Compared to Kyselo and Tschacher (2014), who immune orthogonal (uncorrelated) distinction and participation dimensions, this ways a simplified initial step of modeling. Thus we premise here that stardom and participation are mutually exclusive states of x. Ii examples of the ensuing one-dimensional phase space are depicted in Figure three. Let us illustrate this for the case of an individual who usually interacts (behaviorally) "in sync" with other individuals, which may (experientially) exist related to wishes of signaling social connexion. In the structural model, this translates to a country of ten more than toward participation. Consequently, the stage infinite of this individual may have an attractor in a region with rather high participation (Figure 3A). Qualitatively different beliefs is represented by the attractor in Figure 3B, which is flatter and broader.

Figure 3. Two examples of structural models of the phase space of the self of an private. The potential role represents repelling and attracting regions of the distinction / participation centrality x. The current state of the individual is illustrated by the position of the "ball" in the mural. With fourth dimension the ball tends to roll "downhill," into an attractor with depression potential values (trajectory: red arrow). Notation that when started from identical initial conditions, the self-state changes in opposite directions in (A,B).

In what follows nosotros will apply this methodological framework—enactive terms integrated in a DST approach—in lodge to address our chief question: How can we use these tools to model and sympathise the therapeutic alliance?

Toward a Minimal Model of Therapeutic Alliance

Nosotros have argued that the individual core of mental architecture, the self, can at the same time be seen equally a social structure. In the post-obit, we will rely on the assumption that each individual can be described in terms of the socially enacted self and as obeying a two-fold norm of (social) stardom and (social) participation. From this perspective it is therefore less than surprising that psychotherapeutic intervention, equally a learning procedure interim on the patient's cocky, is a social project at all levels—the "commonest" of all common factors of psychotherapy is the social alliance betwixt therapist and patient. In Kyselo and Tschacher (2014) we have described a conceptualization of dyadic relationships. Our goal in the nowadays article is to elucidate a particular relationship, namely that betwixt therapist and patient. We thus aim at a minimal model of (dyadic) therapeutic relationships.

Brotherhood is a system that evolves through the coupling of the individual self-systems of the interactants; such self-systems were depicted in Figure 3. In terms of DST, the therapeutic brotherhood tin exist described equally a new, joint phase infinite on the ground of the selves of therapist and patient. Changes in the interaction dynamics of the alliance tin can be modeled equally trajectories through this phase space, and recurring or stable interaction patterns are represented by attractors in it. The individual self-models of Figure 3 consisted of the distinction-participation dimension x, and a farther dimension, the potential V, that gives a value to each x. Appropriately, the alliance phase space is constructed by merging two individual phase spaces (the therapist's and the patient'southward, x _i and x ₂) and a potential value. This three-dimensional structure represents the joint complication of the alliance in terms of autonomy of two individuals who negotiate their respective identities. The alliance phase space is spanned by ten _i, x _ii, and the allure/repulsion of each signal in the plane, V(x _ane, x _two). V(10 _i, x ₂) represents the result of therapist'due south and patient'due south negotiations of the brotherhood between them.

Even if we know the individual phase spaces, they will non suffice to fully specify what the "landscape" of alliance stage space looks like. We cannot know the negotiation results. The structure of the landscape depends on the contributions or behavior of the specific individuals, just their resultant detail interaction dynamics over fourth dimension is not completely adamant by them, instead it emerges from their interaction. This "negotiation" may appear reminiscent of game theory, a mathematical tool used by determination-making theory in economic science, biological science and linguistics (Benz et al., 2006). Game theory would conceive of brotherhood formation every bit the result of 2 rational players who employ linguistic and other strategies to maximize their respective utilities and pay-offs. Some game-theoretical scenarios atomic number 82 to a Nash equilibrium, which might be viewed as representing the alliance that is formed by the cooperative, competitive, or mixed strategies of the players, therapist and patient. Game theory, however, is fraught with a priori assumptions such as players' rationality and the presence of a defined utility matrix, which appears rather far-fetched in the psychotherapy context. In therapy, one "player," the therapist, will not pursue his own benefit but the patient's best interests. Furthermore, psychotherapy concerns the clarification of irrational experiences and behaviors.

Let us continue with our description of alliance phase infinite. Two possible examples for the formation of an alliance phase space are illustrated in Figure 4A. It shows an alliance with a single attractor, which is located in a region with moderately participatory behavior of person 1 (x _one) and distinctive beliefs of person 2 (ten ₂). A quite different alliance pattern is given by Figure 4B: in addition to the attractor of the other case, person 1'southward preference for highly distinctive beliefs prevails for all values x ₂ of the other person. The 2 participants of this dyad accept synthetic a 1-sided, but quite coherent social system. In the extreme case of dyadic interaction completely lacking, the alliance phase space would be flat, unless where both persons incidentally have overlapping potential basins or hills.

Effigy 4. 2 exemplary structural models of the stage infinite of an brotherhood. The potential function Five(x) represents repelling and attracting regions of the distinction/participation aeroplane of therapist and patient, 10 ₁ and ten _two (red arrows: trajectories). (A) Phase space with one attractor. (B) Ii attractors.

In other words, the formation of an brotherhood is not simply determined by the stage spaces of the private persons lonely, but critically depends on the kind of coupling between the persons when the alliance is formed. Alliance formation will in turn also influence individual self-maintenance. We may know the shapes of the individual phase spaces and thus their probability distributions, but the articulation probability p(x ₁, x ₂) is unknown. In club to shed more light on this process of alliance germination and the emerging joint probability distribution, we will now model the brotherhood in formal terms.

Beginning we consider the individual person. Nosotros assume that his/her self can be described by a potential V that depends on a unmarried variable x, i.e., V = V(x), which has a single minimum (see the examples in Effigy 3). According to our groundwork assumptions, 10 belongs to the interval x ⊂ (x _stardom, ten _{participation}). We attach to V(x) a probability distribution

$\begin{array}{cc}p(x)=\text{Northward exp}(-5(\mathrm{ten})/\text{Q}).& (1)\end{array}$

V(x)/Q is an analog to the thermodynamical concept of free energy (Friston, 2011). In Equation (1) the normalization constant N is called such that all probabilities add up to 1:

i.e.,

$\begin{array}{cc}\text{N}={\left({\displaystyle \int \exp }\left(-V(x)/\text{Q}\right)dx\right)}^{-\mathrm{i}}.& (3)\end{array}$

Q is a constant parameter (see likewise beneath). A elementary though plausible model for Equation (1) is a Gaussian distribution,

$\begin{array}{cc}p(\mathrm{ten})=\sqrt{\frac{\alpha }{\pi }}\exp \left(-\alpha {(\mathrm{ten}-\beta )}^{\mathrm{two}}\right)& (4)\end{array}$

$\begin{array}{cc}\text{which}\text{is}\text{centered}\text{effectually}x=\beta & (\mathrm{five})\end{array}$

The Gaussian Equation (4) becomes flat for α small (cf. Figure 3B), and strongly peaked for α large (cf. Effigy 3A). This invites a psychological interpretation: α big models a "strong" or rigid personality x, which is stable against external perturbations. Modest α represents an "unstable cocky" that is easily influenced past outside forces (in terms of social science statistics, α is the inverse of variance, β is the mean of the distribution).

2nd, let the states turn to an alliance of two individuals i and 2, who take stardom-participation variables x _ane and x _two, respectively. In this example information technology is more than convenient to commencement with the joint probability p(10 ₁, ten ₂), which nosotros write in illustration to Equation (1) as

$\begin{array}{cc}p({\mathrm{10}}_{\mathrm{i}},x_2)=N_{1,\mathrm{ii}}\exp (-\mathrm{Five}({\mathrm{ten}}_1,x_{\mathrm{two}})/\text{Q})& (\mathrm{six})\end{array}$

We kickoff consider ii limiting cases. The get-go case is: there is no alliance germination, thus the two selves are independent of each other. Co-ordinate to probability theory, Equation (half dozen) then factorizes, i.eastward., the joint probability is simply the product of the individual probabilities

$\begin{array}{cc}p(x_1,x_2)=p({\mathrm{10}}_{\mathrm{one}})p({\mathrm{ten}}_2).& (\mathrm{vii})\end{array}$

Independence in brotherhood germination may lead to a phase space as in Figure 4A: The attractor is in a region where both persons have p(ten) > 0.

A very strong common (symmetric) alliance, on the other hand, implies a strong coupling between x _ane and ten _two, which can exist modeled past Dirac'south (infinitely) peaked δ-function

Our concern in psychotherapy is a moderately to strongly unidirectional alliance in the sense of a bond of the patient with the therapist: the patient's self is "jump" to the therapist. An alliance stage space of this kind may look similar in Figure 4B.

To capitalize on relevant results of synergetics, nosotros characterize the behavioral patterns of persons 1 and 2 every bit follows: Person 1 (the therapist) changes his/her behavior slowly over fourth dimension (due to the therapist's role behavior, which is rooted in work experience and training) with the limiting case of a therapist who is non subject to whatever external influences at all:

$\begin{array}{cc}p(x_1)\approx \delta \left(x_1-x_{\text{fixed}}\right)& (9)\end{array}$

Person 2, the patient, is willing (and able) to alter beliefs within a certain time. In mathematical terms, these "relaxation times" of beliefs modify ("relaxation" is unrelated to the psychological meaning of this word—in physical sciences, relaxation time is defined as the fourth dimension needed by a system to return to equilibrium later on a perturbation) are t ₁ ≫ t _two. Correspondingly, the relaxation constants γ = 1/t obey

Under these atmospheric condition, the slaving principle of synergetics holds (Haken, 1977). The slaving principle states that slowly varying systems achieve control over systems varying more quickly (it should exist noted that slaving is a purely technical term not to be confused with political connotations such equally "enslavement"). Co-ordinate to this principle, the joint probability p(ten _one, ten ₂) can exist written, other than in Equation (7), every bit

$\begin{array}{cc}p({\mathrm{ten}}_{\mathrm{i}},x_{\mathrm{two}})=p\left({\mathrm{10}}_1|x_{\mathrm{two}}\right)p({\mathrm{10}}_1)& (\mathrm{xi})\end{array}$

where the provisional probability

$\begin{array}{cc}p(x_1|x_2)={\mathrm{Due\; north}}_{\mathrm{two}|\mathrm{ane}}\exp \left(-{\gamma }_{\mathrm{two}}/{\text{Q}}_2{(x_{\mathrm{ii}}-f({\mathrm{10}}_1))}^2\right),& (12)\end{array}$

and p(ten _one) is strongly peaked, as expressed e.g., in Equation (9) and Effigy 3A. While Equation (11) is the standard formula of probability theory, Equation (12) is our specific result, which is derived from a Fokker-Planck equation (Haken, 2004, pp. 202–204). In the present context, Q_two represents the consequence of random influences on 2, the patient. Large Q_ii entails small Q^−one ₂ ~ α in Equation (iv), significant high variance of cocky-states, i.e., volatility and fiddling resilience.

An interesting upshot for the therapist is this: It makes sense in therapy to adjourn Q₂, e.k., past strengthening the self-efficacy and the resilience of a patient. f(x _one) in Equation (12) means shifting the patient'southward distinction-participation attractor of x ₂ (from a former x ₂ = β_ii) to a new value x ₂ = f(ten ₁) fixed by the therapist. In the nowadays context, the explicit course of f(ten ₁) is not needed because the therapist just has to give information technology a special value (which, according to Equation (9) depends on his/her stable attractor x ₁ = β_one).

While in concrete systems (in thermal equilibrium) a fixed relation between γ₂ and Q₂ holds, this is not then in self-organizing systems. In psychological systems, we may assume that γ and Q can be chosen independently. Then person 1 (the therapist) is characterized by γ_one small-scale, Q₁ very small-scale, so that $\alpha ={\gamma }_{\mathrm{ane}}/{\text{Q}}_1\to \infty$ (the therapist is allowed to the impact of perturbations). Private 2 (the patient) is characterized past γ₂ large (willingness and/or capability of adaptation). γ₂ is maintained or even strengthened past therapy, while Q₂ is originally big. The job is to enhance ${\gamma }_{\mathrm{ii}}/{\text{Q}}_{\mathrm{ii}}$.

The outcome of therapy concerns the result on person 2's potential, Five ₂(10 _ii). From Equations (1, 11, 12, 9) follows $\ln N-{\text{Q}}_2^{-1}{\mathrm{Five}}_2({\mathrm{ten}}_{\mathrm{ii}})=\ln p({\mathrm{ten}}_2|{\mathrm{10}}_1)=\ln N_{\mathrm{two}|\mathrm{ane}}-{\gamma }_2/{\text{Q}}_2{(x_2-f(x_{\mathrm{i}}))}^{\mathrm{two}}$, so that

$\begin{array}{cc}{V}_2=co\mathrm{due\; north}\mathrm{southward}t+{\gamma }_{\mathrm{ii}}{({\mathrm{10}}_{\mathrm{two}}-f(x_1))}^2\text{with}f({\mathrm{10}}_{\mathrm{ane}})=x_{2,\mathrm{northward}e\mathrm{due\; west}}\text{fixed}& (13)\end{array}$

Clearly, the effect of therapy is a shift of the position of the minimum of Five ₂, i.e., a new stable attractor in the patient's stardom/participation. This reflects new attitudes and/or behavior patterns. One may add that, in addition to the shifting of x ₂, a further goal of therapy is to lower Q₂ toward the stop of therapy and thus to increase the patient'southward resilience. Resilience is essential to preserve therapeutic gains post-therapy, and to prevent the patient's returning to old attractors in response to stressful live events.

Discussion

We have initiated this paper with an introduction to the current focus of psychotherapy research on common factors. The well-nigh frequently discussed single cistron is the therapeutic brotherhood. We explored this cistron from three different perspectives: The first-person/experiential perspective provides subjective data, the third-person/behavioral perspective objective data, and, importantly, the structural/dynamical systems perspective models both kinds of data in an abstruse way. We believe that the latter structural view is a significant amendment to the theory of psychotherapy considering it promises to bridge the duality of subjective vs. objective approaches. Both subjective and objective data sources are valuable and indispensable, but they are much supported past an additional structural scaffold and generator of hypotheses, which we accept shown can be provided by enactivist ideas that are then framed in the structural formalism of synergetics.

Before nosotros discuss implications of the structural model presented above, we wish to address limitations of our treatment of the therapeutic brotherhood. An important attribute that we accept not discussed in this article is the role of apotheosis (Leiblichkeit in phenomenology, the textile cocky of James, 1890). Apotheosis is emphasized by the enactive arroyo to the cocky, which determines the status and part of the trunk more explicitly. The body is both the mediator and the matrix of social relationship and interaction. It grounds a sense of identity as split (distinction), but also allows the person to be affected past the other (participation). The delevolped styles of engagement and qualities of interaction are inscribed in interactants' bodies, thus determining their electric current patterns of interaction. An important goal of future research volition be to investigate how subjects co-negotiate their selves through bodily mediated engagements and how this is experienced in terms of a bodily sense of cocky. A further essential attribute is that a self is self-referential: Tschacher and Rössler (1996). We as well did non explicitly cover the idea that the self is an emergent construction. Thus several farther aspects of the self are discussed in the philosophical and psychological literature on consciousness and the self. The present considerations are non a total-fledged theory of the cocky, but they practice provide a "minimal model" of therapeutic alliance that tin be used as a heuristics and as a footing for farther investigations.

We are enlightened that our employ of enactivist, structural, and mathematical concepts may announced unusual to psychotherapy researchers and especially clinicians. Hence, information technology is all the more important to tie our approach to empirical evidence in the field of psychotherapy, and to show that new hypotheses and explanations may arise from it. We at present sketch some of these empirical and practical implications in the following remarks.

Complexity Reduction in Brotherhood Formation

We have stressed the idea that alliance formation is crucial for change to occur in psychotherapy. This was illustrated by the geometrical phase space models (Figure iv) and expressed by the articulation probability distribution of Equation (half-dozen) and its elaboration past the slaving principle of synergetics in Equation (11). Such alliance formation processes were observed in empirical studies, which showed that functional alliance is non generated by the "summation" of the participating individual systems, i.due east., by the multiplication of individual probability distributions every bit in Equation (7). Instead, a novel organization with interactive autonomy is formed during social interaction processes. This is what some enactive theorists would refer to as "participatory sense-making" (De Jaegher and Di Paolo, 2007). Without going into detail here, we may mention that numerous empirical findings speak for a reduction of complexity during the formation of therapeutic relationships (Tschacher et al., 2007). Reduced complication means higher order and organization of the observed behavior due to the presence of attractors in brotherhood phase infinite. Effigy five depicts how club changed in a single, exemplary therapy course. This psychotherapy of 59 sessions—which allowed computation of 39 consecutive omega values roofing the complete course of therapy—was a Rogerian, client-centered therapy conducted at the outpatient psychotherapy clinic of the Academy of Bern. The patient was a adult female anile 33 years. Her treatment entailed a larger than average symptom reduction (in a higher place the 75th percentile of the symptom checklist of the cohort at that time: Tschacher et al., 1998). The upshot in this therapy was especially favorable with respect to the social and phobic anxiety and depression symptoms of this patient.

Figure 5. Omega, a measure of system order (the changed of complexity), was measured in a moving window throughout an exemplary therapy of 59 sessions. Linear tendency, quadratic trend, and a spline approximation (λ = 10) are shown equally dashed, green, and brown lines. The data illustrate the overall order increase (reduction of complexity) in the course of this psychotherapy.

Pregnant complexity reduction was also consistently found in empirical studies where the MEA methodology, mentioned in Section Introduction, was used (Tschacher et al., 2014a). Verbal, not-verbal, and other synchronies (east.g., based on judgments and meaning) indicate that the individuals are now parts of a coupled system. Coupled systems, especially non-linearly coupled systems, cannot be reduced to their components—a novel structure has emerged.

Alliance is a Special Human relationship

Therapeutic brotherhood is a special, asymmetrical relationship. In whatsoever social interaction, individuals have to negotiate their own self-maintenance in particular ways. In that location are some social interactions, however, that become more relevant than others to the private'south ability for preservation and organization of the cocky. The therapeutic alliance is one example for such a special relationship because information technology provides the patient with an opportunity for forming a human relationship that is expected to not only perturb the patient's self-maintenance but besides to foster and develop the patient's cocky-maintenance in the kickoff place. That said, we see that the therapeutic brotherhood is an asymmetrical social relation because the focus of the interactions is on the patient, and the very goal of forming the relationship is to improve the patient's self-maintenance and non the therapist'due south (Equations 8, ix). In this, the patient-therapist brotherhood resembles an infant-caregiver relationship.

In the therapeutic alliance the therapist'southward phase space has go part of the patient's stage space offer calibration opportunities in regions that a "normal" articulation phase space would potentially offer, merely that the patient cannot achieve by him-/herself because of developed attractors and meta-stable attractor ruins (Tsuda, 2013). In terms of the enactive approach this is to say that the therapist, instead of evaluating the social interaction with regards to his/her own self-maintenance (past the negotiation of stardom/participation), evaluates it with regards to the patient's self-maintenance. One might say that the 2 individuals effectively form a new autonomous identity whose self-organization relies on the contribution of ii individuals but at the same time refers to just one of them (the patient). The therapist "offers" his/her striving for autonomy to the patient engaging in the interaction as an autonomous subject but at the same time evaluates the interactions heteronomously as contributions to the autonomy of the patient.

This besides explains why authenticity is then important: the therapist must be both able to provide experiences of connection and of separation; if the therapist nonetheless acts "superior" or detached and not as a proper subject, the patient cannot feel the sense of open up-ness required for developing a counterbalanced distinction/participation. The therapist experiences the social interaction but reacts in information technology in a way as to suit the agreed goal of the alliance, that is to assist the patient's cocky-maintenance. The therapist lends him-/herself equally a field of study to build up a new identity for the patient; the tool for this is the interactive autonomy of the alliance.

Temporality

The temporality of the therapeutic alliance is essential in several respects. Quite fundamentally, time scales play an important office as a key premise of self-system processes. The 2 participants of the alliance accept different relaxation times (Equation x), which is the basis of the slaving principle. Therapists therefore have deeper and steeper attractors, see Equation (9), which they tin employ to shift the location of patients' attractors and thus accomplish a desired outcome.

Timing is also important because therapy courses pass through different stages. The therapy course shown in Figure 5 is illustrative in this respect because it shows that the order of the alliance often reaches a maximum at a time prior to the termination of therapy. Thus, later in the therapy course, the therapeutic bond has to deliquesce, which can be measured by indicators of club and complication.

Corrective Experience

In the germination of alliance, the patient's phase infinite is augmented through the therapist'due south phase space in that the therapist enables the patient to undergo "corrective emotional experiences," one of the acknowledged common factors of psychotherapy (Tschacher et al., 2014b). This modifies the attractor landscape and allows the system to shift to formerly unattainable regions and to develop new trajectories and attractors (Equation thirteen). The therapist provides attractors to the brotherhood mural that the patient cannot provide and does not (yet) have.

There are three points to be considered in the provision of corrective experiences. The get-go is the ability of the therapist to provide the patient with an augmented attractor landscape—can the therapist be a subject who offers both experiences of stardom and participation while non evaluating them with regards to him-/herself simply to the patient? In other words, tin can therapist and patient form a new system past merging their private phase spaces into one? It should be noted that information technology is only a partial fusion as the therapist is non to evaluate the outcome of the merging interaction with regards to him-/herself.

The 2d point is the potential of the interaction dynamics to gradually enable the patient to maneuver the augmented attractor landscape according to the goals of the patient'due south self-maintenance. This requires a flexibility and increased awareness on side of the therapist who has to provide the missing attractors/repellors when needed and/or when it is possible.

A third, and very crucial point is whether the alliance provides the patient with the chapters to dwell in his/her own new attractors in a way that does no longer involve the intervention and scaffolding provided past the therapist. The ultimate goal of a successful brotherhood is that the joint stage infinite becomes properly incorporated into the self-maintenance structure of the patient so that the therapist's contribution becomes obsolete. The therapist therefore has to enable the patient, by curbing Q_ii, to develop and rely on own abilities. In other words, the successful alliance allows the patient to interact with the therapist without staying emotionally dependent. Alliance dissolution is a major goal of psychotherapy when the alter work is done.

Outlook

We formulated a minimal model of therapeutic alliance starting from a one-dimensional concept of the psychological self with the poles stardom and participation. It will be a task of extended structural modeling to capture further aspects of the self (the agentic, embodied, cocky-referential, emergent self) in more circuitous models or through case-by-example analyses of the presented minimal model.

For empirical psychotherapy enquiry, the present model generates a number of testable hypotheses, which to our cognition are novel in psychology. The model claims, in Equation (10), that therapist and patient variables show markedly divergent relaxation times. The deviation of relaxation times leads to the slaving principle, a cadre proposition of "microscopic" synergetics (Haken, 2004), which provides a directed hypothesis for psychotherapy inquiry: Successful therapists have much longer relaxation times than their patients. Ensuingly, some try should be invested in exploring appropriate psychological indicators and measures of relaxation time, a psychometric task that appears to exist resolvable. Enhancing ${\gamma }_2/{\text{Q}}_2$, as we stated higher up, is the goal during therapy: Information technology tin exist achieved past patient'southward curt relaxation time (which means high relaxation abiding γ₂) and high resilience against stressful perturbations (which ways small Q₂).

The testing of the core premise of our structural model—via the relaxation times and resilience of therapist and patient—could serve every bit an elegant cantankerous-validation of previous "macroscopic" findings that psychotherapy systems as a whole self-organize, leading to the complexity reductions mentioned above in Section Complexity Reduction in Alliance Formation. Patient'due south resilience as a target of intervention is quite familiar to psychotherapy—one may think of stress inoculation grooming in cognitive behavioral approaches, which enhance Grawe's common cistron "coping with the problem" (Meichenbaum, 1977). If, in add-on, relaxation times evidence to have favorable psychometric properties, a number of practical applications volition come inside sight. These applications may lead to feedback systems and innovations in therapist training, both major topics in current psychotherapy enquiry (cf. Lutz et al., 2009; Taubner et al., 2013): A measure of relaxation time could be installed as a feedback device to predict positive outcome based on the dynamics of the therapeutic brotherhood, and therapists' training may in the future include interventions into own and patients' relaxation times.

Conflict of Interest Statement

The authors declare that the research was conducted in the absenteeism of whatever commercial or financial relationships that could be construed every bit a potential conflict of involvement.

Acquittance

Miriam Kyselo's work was supported by the "Science beyond Scientism" project at the VU Amsterdam.

References

Benz, A., Jäger, G., and van Rooij, R. (2006). "An introduction to game theory for linguists," in Game Theory and Pragmatics, eds A. Benz, 1000. Jäger, and R. van Rooij, (Basinstoke: Palgrave Macmillan), one–82.

Google Scholar

Brentano, F. (1874). Psychologie vom empirischen Standpunkte. Leipzig: Duncker & Humblot.

Google Scholar

Brunner, Eastward. J., Tschacher, W., and Kenklies, K. (eds.). (2011). Selbstorganisation von Wissenschaft. Jena: Verlag IKS Garamond.

De Jaegher, H., and Di Paolo, E. (2007). Participatory sense-making: an enactive approach to social cognition. Phenomenol. Cogn. Sci. 6, 485–507. doi: 10.1007/s11097-007-9076-9

CrossRef Total Text | Google Scholar

Freud, Due south. (1900/1989). Traumdeutung. Frankfurt am Main: S. Fischer.

Google Scholar

Friston, Grand. J. (2011). "Embodied Inference: or "I think therefore I am, if I am what I think"," in The Implications of Embodiment – Cognition and Communication, eds W. Tschacher and C. Bergomi (Exeter: Banner Academic), 89–125.

Grawe, K. (2004). Psychological Therapy. Seattle, WA: Hogrefe and Huber.

Google Scholar

Grencavage, L. M., and Norcross, J. C. (1990). Where are the commonalities among the therapeutic common factors? Prof. Psychol. Res. Pr. 21, 372–378.

Google Scholar

Guckenheimer, J., and Holmes, P. (2002). Nonlinear Oscillations, Dynamical Systems, and Bifurcations of Vector Fields. New York, NY: Springer.

Google Scholar

Haken, H. (1977). Synergetics—An Introduction. Nonequilibrium Phase-Transitions and Self-Organization in Physics, Chemistry and Biology. Berlin: Springer.

Haken, H. (2000). Information and Self-Organization: a Macroscopic Approach to Circuitous Systems. Berlin: Springer.

Google Scholar

Haken, H., and Tschacher, W. (2010). A theoretical model of intentionality with an application to neural dynamics. Heed Affair viii, vii–18.

Google Scholar

Hatfield, E., Cacioppo, J. T., and Rapson, R. 50. (1994). Emotional Contagion. Cambridge, MA: Cambridge University Press.

Google Scholar

Horowitz, L. Yard. (2004). Interpersonal Foundations of Psychopathology. Washington, DC: American Psychological Association. doi: x.1037/10727-000

CrossRef Full Text | Google Scholar

Horowitz, 50. Thousand., Rosenberg, S. E., Baer, B. A., Ureño, G., and Villaseñor, V. Due south. (1988). Inventory of interpersonal problems: psychometric properties and clinical applications. J. Consult. Clin. Psychol. 56, 885–892.

PubMed Abstract | Total Text | Google Scholar

James, West. (1890). Principles of Psychology. New York, NY: Holt. doi: 10.1037/11059-000

CrossRef Total Text

Leary, T. (1957). Interpersonal Diagnosis of Personality. New York, NY: Ronald Press.

Google Scholar

Lutz, W., Stulz, N., Martinovich, Z., Leon, S., and Saunders, S. M. (2009). Methodological groundwork of decision rules and feedback tools for outcomes management in psychotherapy. Psychother. Res. nineteen, 502–510. doi: 10.1080/10503300802688486

PubMed Abstract | Full Text | CrossRef Full Text | Google Scholar

Maturana, H. R., and Varela, F. J. (1980). Autopoiesis and Cognition. The Realization of the Living. Dordrecht: Reidel.

Google Scholar

Meichenbaum, D. (1977). Cerebral Behavior Modification—An Integrative Approach. New York, NY: Plenum Press. doi: 10.1007/978-1-4757-9739-8

CrossRef Full Text | Google Scholar

Norcross, J. C. (ed.). (2011). Psychotherapy Relationships that Work, 2nds Edn. New York, NY: Oxford Academy Press.

Google Scholar

Orlinsky, D. E., Ronnestad, M. H., and Willutzki, U. (2004). "50 years of psychotherapy procedure-upshot research: Continuity and Alter," in Bergin and Garfield's Handbook of Psychotherapy and Behavior Modify, 5th edn., ed Thou. J. Lambert (New York, NY: Wiley), 307–389.

Popper, K. (1972). Objective Noesis. Oxford: Oxford University Press.

Google Scholar

Ramseyer, F., and Tschacher, W. (2014). Nonverbal synchrony of head- and torso-movement in psychotherapy: different signals have dissimilar associations with upshot. Front. Psychol. five:979. doi: ten.3389/fpsyg.2014.00979

PubMed Abstract | Full Text | CrossRef Full Text | Google Scholar

Taubner, South., Zimmermann, J., Kächele, H., Möller, H., and Sell, C. (2013). The relationship of introject affiliation and personal therapy to trainee cocky-efficacy: a longitudinal study among psychotherapy trainees. Psychotherapy 50, 167–177. doi: x.1037/a0029819

PubMed Abstract | Full Text | CrossRef Total Text | Google Scholar

Thompson, E. (2007). Listen in Life: Biological science, Phenomenology and the Sciences of Mind. Cambridge, MA: Cambridge University Press.

Google Scholar

Tschacher, Due west., Ramseyer, F., and Grawe, K. (2007). Der Ordnungseffekt im Psychotherapieprozess: Replikation einer systemtheoretischen Vorhersage und Zusammenhang mit dem Therapieerfolg. Z. Klin. Psychol. Psychother. 36, 18–25. doi: 10.1026/1616-3443.36.i.18

CrossRef Full Text | Google Scholar

Tschacher, W., and Rössler, O. (1996). The self: a processual Gestalt. Chaos Solitons Fractals 7, 1011–1022. doi: 10.1016/0960-0779(95)00096-8

CrossRef Full Text | Google Scholar

Tschacher, Due west., Scheier, C., and Grawe, K. (1998). Club and pattern formation in psychotherapy. Nonlin. Dyn. Psychol. Life Sci. 2, 195–215. doi: 10.1023/A:1022324018097

CrossRef Full Text | Google Scholar

Wampold, B. East. (2001). The Great Psychotherapy Contend: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum Associates.

Google Scholar

Weber, A., and Varela, F. J. (2002). Life after Kant: natural purposes and the autopoietic foundations of biological individuality. Phenomenol. Cogn. Sci. one, 97–125. doi: 10.1023/A:1020368120174

CrossRef Total Text | Google Scholar

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