Establishing and Maintaining Engagement As referenced above the therapeutic relationship has been shown to be critical in determining good outcomes for patients It has been said that common factors play a key role in the therapeutic relationship and the more a practitioner invests in common factors skills the better their therapeutic relationship will be with patients Cahill et al 2008 They can account for a significant amount of client improvement Lambert Barley 2002 with some suggesting as much as 30 of the outcome Lambert 1992 Examples of common factors include a clear introduction the establishment of relevant expertise displaying a positive non judgmental attitude and demonstrating verbal non verbal competencies Richards and Whyte 2011 Rosenzweig 1936 first proposed the concept of common factors He observed that all forms of psychotherapy could point to notable successes He concluded that these successes could be explained by implicit common factors that exist across the seemingly diverse approaches which are perhaps more important than the specific factors To the contrary specific factors are defined as being unique to the particular therapy Katzow Safran 2007 e g problem statement or 5 areas conceptualization in CBT and there is some evidence that they have a greater effect compared to common factors on treatment outcomes Blow et al 2007
In terms of establishing and maintaining engagement the common factors skills specified in the assessment competency scale were as follows maintaining a collaborative approach the use of complex simple reflections as well as capsule major summaries and having a balanced ratio of questions to feedback During the simulation it felt as though I had to demonstrate these skills at any given opportunity due to the significance placed on them throughout the training thus far I believe as a result there is evidence of all them throughout the assessment That said I wonder whether because of my eagerness I overused certain elements to the detriment of others One example being simple reflections over complex seeing as the former were much simpler to demonstrate The reflection of feelings through the use of complex reflections can help the interviewee uncover blind spots in their perceptions and assessment of a situation and assists both the interviewer and interviewee in coming to a shared understanding of what's going on for that person Egan 2001 For that reason it would be reasonable to assume there is a benefit to applying the full range of common factor skills proportionally In future I plan to practice using complex reflections in role play with fellow trainees and team members with the aim of becoming more comfortable and fluent in using them
This will help me to translate them into interviews with real life patients which should improve my therapeutic alliance leading to better outcomes and recovery rates for my service and me In spite of that I must be mindful that I do not prioritize the application and practice of common factors skills over specific CBT processes as both have been shown to be vital in determining positive outcomes Interpersonal Skills Common factors also comprise of Interpersonal skills such as displaying empathy through verbal communication normalizing maintaining a non judgmental stance showing warmth compassion and demonstrating good non verbal skills in communication e g eye contact and body language Upon review of the recording I felt I had good interpersonal skills particularly in warmth which can be described as a type of softness and gentleness that conveys caring concern Gilbert 2007 as well as maintaining a non judgmental stance which has been identified as a characteristic of a good listener Myles Rushforth 2007 Unfortunately in regards to normalization and empathy through verbal communication I felt as though there were some missed opportunities and I appeared to be repeating the same statements for each e g It can be quite common for people that must be quite difficult Carlat 2005 advises that normalization is the most useful technique for eliciting sensitive or embarrassing material Likewise it has been proposed that empathic communication one of the key elements in development of therapeutic empathy fulfills a variety of functions within CBT Thwaites Bennett Levy 2007 This would suggest that to use them inconsistently and in an inauthentic manner might be disadvantageous Be that as it may it is possible I may be biased in my perception and this might not be congruous with the patient experience So to test this in future I will ask patients whilst completing their patient experience feedback form whether they felt as though I understood their situation as a measure of empathy Papworth et al 2013 and whether they felt they weren't alone in their problem as a measure of normalization I can use these findings as a metric of competency in delivering the above skills and reflect on them in clinical case management
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