Value Attributed to the Therapist’s Directiveness and Support in the Psychotherapeutic Process

Abstract

Background: Research on therapeutic processes has explored the elements that enhance psychotherapy’s effectiveness, particularly the role of common factors across various models. The therapist’s use of directiveness and support, as common variables, is crucial for effective treatment. Effective therapists adapt their level of directiveness and support according to the treatment phase, the issue being addressed, and the patient’s characteristics. This study examines the importance therapists attribute to directiveness and support, as well as its relationship with theoretical orientation, access to research publications, and stance on the similar effectiveness of different psychotherapeutic models. It aims to determine whether therapists’ attributions regarding this variable are in line with the importance it is given in process research. Methods: Responses from 69 psychotherapists to the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12), which assesses the importance therapists place on key psychotherapeutic process variables, including the directiveness and support provided, were analyzed. Theoretical orientations, ages, and experience levels were considered. Non-parametric tests, contingency tables, χ2 tests, t-tests, and ANOVAs were used to assess the variation in responses. Results: Common factors were often identified as key contributors to therapeutic healing, though these differences were not statistically significant (χ2 (2, N = 67) = 3.701, p = 0.157). For the “directiveness and support from the therapist” variable, significant differences were observed: Cognitive-behavioral therapists valued directiveness and support more than psychodynamic therapists (t (20) = −3.569, p = 0.002; Cohen’s d = 1.18). Therapists who view cognitive-behavioral therapies as most effective also rated this variable higher (t (38) = 3.816, p < 0.001; Cohen’s d = 1.21). Those regularly accessing specialized psychotherapy research publications valued this variable less than those who do so occasionally (t (64) = −2.693, p = 0.009; Cohen’s d = 0.65). Therapists who support the similar effectiveness of different models tend to favor common factors, including directiveness and support (χ2 (2, N = 66) = 12.522, p = 0.002). Conclusions: Therapists express doubts about the factors influencing psychotherapy’s effectiveness, reflecting the ongoing debate. They align their views on the importance of directiveness and support with their theoretical orientation and positioning on the similar effectiveness of psychotherapies. The importance of analyzing therapists’ attributions about the factors responsible for therapeutic change is emphasized, which will impact clinical practice. Advocacy for therapist flexibility and adaptation of therapy to the patient’s needs, including the level of directiveness and support provided, has been shown to be essential for effective psychotherapy.