scholarly journals Psychotherapy, placebos, and informed consent

2020 ◽  
pp. medethics-2020-106453 ◽  
Author(s):  
Garson Leder
Keyword(s):  
Informed Consent ◽  
Common Factors ◽  
Sufficient Information ◽  
Expectancy Effects ◽  
Psychotherapeutic Interventions ◽  
Consent To Treatment ◽  
Informed Treatment ◽  
The Common ◽  
Common Factors In Psychotherapy

Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients’ ability to give informed consent to treatment. This ‘deception’ claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments (eg, expectancy effects and therapist effects), rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of psychotherapy have a duty to ‘go open’ to patients about the role of common factors in therapy (even if this risks negatively affecting the efficacy of treatment); to not ‘go open’ is supposed to unjustly restrict patients’ autonomy. This paper makes two related arguments against the ‘go open’ claim. (1) While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners ‘go open’ about therapeutic common factors in psychotherapy, and (2) clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to ‘go open’ should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works.

How to obtain informed consent for psychotherapy: a reply to criticism

2021 ◽  
pp. medethics-2020-107138
Author(s):  
Garson Leder
Keyword(s):  
Informed Consent ◽  
Common Factor ◽  
Common Factors ◽  
Behavioural Therapy ◽  
Expectancy Effects ◽  
Cognitive Behavioural ◽  
Core Set ◽  
The Common ◽  
Theoretical Foundations

In ‘Psychotherapy, Placebos and Informed Consent’, I argued that the minimal standard for informed consent in psychotherapy requires that ‘patients understand that there is currently no consensus about the mechanisms of change in psychotherapy, and that the therapy on offer…is based on disputed theoretical foundations’, and that the dissemination of this information is compatible with the delivery of many theory-specific forms of psychotherapy (including cognitive behavioural therapy (CBT)). I also argued that the minimal requirements for informed consent do not include information about the role of therapeutic common factors in healing (eg, expectancy effects and therapist effects); practitioners may discuss the common factors with patients, but they are not part of the ‘core set’ of information necessary to obtain informed consent.In a recent reply, Charlotte Blease criticises these two arguments by claiming they are not supported by empirical findings about the therapeutic common factors. Blease’s response is based on serious misunderstandings of both CBT and what the common factor findings actually find. Nevertheless, addressing the reasons for these misunderstandings is instructive and gives us an opportunity to clarify what, exactly, needs to be explained to patients in order to obtain informed consent for psychotherapy.

scholarly journals The Role of Common Factors in Psychotherapy Outcomes

2019 ◽  
Vol 15 (1) ◽  
pp. 207-231 ◽  
Author(s):  
Pim Cuijpers ◽  
Mirjam Reijnders ◽  
Marcus J.H. Huibers
Keyword(s):  
Common Factors ◽  
Recovery Process ◽  
Specific Factor ◽  
Working Mechanism ◽  
Specific Factors ◽  
Methodological Problems ◽  
The Common ◽  
Meta Analyses ◽  
Common Factors In Psychotherapy

Psychotherapies may work through techniques that are specific to each therapy or through factors that all therapies have in common. Proponents of the common factors model often point to meta-analyses of comparative outcome studies that show all therapies have comparable effects. However, not all meta-analyses support the common factors model; the included studies often have several methodological problems; and there are alternative explanations for finding comparable outcomes. To date, research on the working mechanisms and mediators of therapies has always been correlational, and in order to establish that a mediator is indeed a causal factor in the recovery process of a patient, studies must show a temporal relationship between the mediator and an outcome, a dose–response association, evidence that no third variable causes changes in the mediator and the outcome, supportive experimental research, and have a strong theoretical framework. Currently, no common or specific factor meets these criteria and can be considered an empirically validated working mechanism. Therefore, it is still unknown whether therapies work through common or specific factors, or both.

Common Factors in Psychotherapy

2013 ◽  
Author(s):  
James W. Drisko
Keyword(s):  
Social Work ◽  
Social Services ◽  
Research Policy ◽  
Common Factors ◽  
Policy And Practice ◽  
Conceptual Base ◽  
History Of ◽  
The Common ◽  
Common Factors In Psychotherapy

This entry examines the common factors approach in social work and in related professions. The term “common factors” refers to a set of features that are shared across different specific models of psychotherapy and social services, but may not always be conceptualized as being curative influences. The common factors approach broadens the conceptual base of potentially curative variables for practice and research. The history of common factors, the research designs and statistical methods that have led to the approach’s elaboration, the approach’s empirical base, and its fit with social work’s person-in-environment perspective are each explored. The intersection of the common factors approach with the evidence-based practice movement is examined. The role of common factors in the psychotherapy integration movement is also discussed. The implications of the common factors approach for research, policy, and practice in social work are identified.

scholarly journals In Architecture Inference The role of inference in the development of creative abilities of architecture student

2017 ◽  
Vol 5 (2) ◽  
pp. 64-79
Author(s):  
Basim Hasan Almajedi ◽  
Aymen Abdul hussein Jawad
Keyword(s):  
Architectural Design ◽  
Common Factors ◽  
New Product ◽  
Research Problem ◽  
The Other ◽  
Product Architecture ◽  
Inference Process ◽  
The Common ◽  
The Individual

Inference process is an important part in the architectural design process as well as to realize the different aspects of the product architecture, and plays an important role in bringing new products of an innovator and contrary to traditional productions, through the investment of available data and linking them with the individual and previous expertise and experience for getting creative output in architecture. The research  Inference in the architecture field in addition to the other importance of cognitive fields, And the in architecture Special through students from them problems in the weak evidentiary have a base, from here the research problem of (Ambiguity of available knowledge about the role of inference Resources in the development of creative ability with the architecture students), to achieve the goal of research in architectural directed toward investment sources inference in generating solutions to creative problems of design to get into creative output in architecture, to highlight the research hypotheses, was where the hypothesis key b (Whenever inventories increased in the architecture students memory, increased his capabilities and creative skills in design), to be then test these hypotheses through questionnaire to a group of students, where it was found that (The multiplicity of views and reasoning process by the architecture students help him to produce and give many and varied images of processors design solutions, which may contain the common factors that contribute to the formation of a new product of an architect and has a unique and iconic properties).

Psychotherapy is still failing patients: revisiting informed consent—a response to Garson Leder

2020 ◽  
pp. medethics-2020-106865
Author(s):  
Charlotte Blease
Keyword(s):  
Informed Consent ◽  
Recent Literature ◽  
Common Factors ◽  
Patient Characteristics ◽  
Therapist Characteristics ◽  
Complementary And Alternative Therapies ◽  
Mainstream Medicine ◽  
Detailed List ◽  
Patient Work ◽  
The Common

Compared with mainstream medicine and complementary and alternative therapies, the practice of psychotherapy has enjoyed a relative pass when it comes to ethical evaluation. Therefore, contributions to the, although slowly growing, body of literature on psychotherapy ethics are to be welcomed. In his paper ‘Psychotherapy, placebos, and informed consent’, Garson Leder takes issue with what he calls the ‘go open’ project in psychotherapy ethics—the idea that the so-called ‘common factors’ in therapy should be disclosed to prospective patients. Although Leder does not give a detailed list, the common factors include therapist characteristics (empathy, positive regard, positive expectations that therapy will succeed), patient characteristics (expectations about therapy including its plausibility, confidence in the therapist), and the working alliance (how well both therapist and patient work well together during sessions). He argues that the project advocating disclosure of these factors is flawed on two grounds: (1) that information about common factors is not necessary for informed consent; and (2) clarity about specific mechanisms of change in therapy is consistent with ‘many theory-specific forms of psychotherapy’. There are multiple serious problems with Leder’s critique of the recent literature, including how he represents the contours of the debate, which I list, and address in this response.

Success Factors for Public Access Computing

2011 ◽  
pp. 82-94
Author(s):  
Ricardo Gomez
Keyword(s):  
Success Factors ◽  
Critical Role ◽  
Common Factors ◽  
Public Access ◽  
Underserved Communities ◽  
The Common ◽  
Barriers To Use ◽  
Venue Staff

Throughout this book, we have detailed the profile of a public access venue user, discussed the role of venue staff in public access venues, identified the critical role that trust plays in use of public access venues, and demonstrated some barriers to use of venues, as well as explored how gender is situated in the ICT world. In this chapter, we will explore and seek to answer the question: what are the common factors that contribute to the success of public access ICT centers, especially in underserved communities?

scholarly journals Informed Consent and Adolescents

2005 ◽  
Vol 50 (9) ◽  
pp. 534-540 ◽  
Author(s):  
Debbie Schachter ◽  
Irwin Kleinman ◽  
William Harvey
Keyword(s):  
Informed Consent ◽  
Ethical Issues ◽  
Relevant Literature ◽  
Individual Case ◽  
Medical Decision ◽  
Ability To Consent ◽  
Consent To Treatment ◽  
Minimum Age ◽  
Consent To Medical Treatment

Objective: To explore the doctrine of informed consent and the development of capacity in adolescents with psychiatric problems to help clinicians better reflect on the relevant ethical issues. Method: We discuss the relevant literature and explore the role of psychiatric impairment in adolescents' ability to consent. Results: In common law, there is no minimum age at which individuals are able to consent to medical treatment and no age below which they are unable to consent. Adolescents' right to self-determination is based on their ability to understand and appreciate the information relevant to the medical decision and on their ability to consent voluntarily and freely. There is a consensus in the literature that, around age 14 years, adolescents have the cognitive ability to understand information necessary for consent. However, there are limited empirical data regarding adolescents' ability to appreciate the information and to make a voluntary decision. Conclusion: Clinicians need to involve adolescents in the consent process to the extent possible and assess the elements of capacity to consent to treatment on an individual case basis, recognizing that capacity may evolve as adolescents' cognitive capacities and values mature.

Asset or burden? Informed consent and the role of the family: law and practice

Legal Studies ◽  
2012 ◽  
Vol 32 (4) ◽  
pp. 525-550 ◽  
Author(s):  
Roy Gilbar
Keyword(s):  
Informed Consent ◽  
Family Involvement ◽  
Negative Impact ◽  
Significant Shift ◽  
Substantial Impact ◽  
Partnership Model ◽  
Consent To Treatment ◽  
Patient Partnership ◽  
Duty To Inform

The paper discusses the issue of family involvement in the process of obtaining consent to treatment. Legally, doctors have a duty to inform the patient, and the patient has a right to be informed before making a decision. In this context, however, there is no requirement to involve relatives or to take into account their interests or requests. Yet, findings from in-depth interviews with NHS general practitioners presented in the paper indicate that in reality relatives have a substantial impact on the process of informed consent. Their presence may lead the doctor to provide more information to the patient and help the patient better understand the information conveyed by the doctor. Ultimately, the relatives' involvement enhances the patient's ability to make an informed decision, even though in some cases – when the relative is dominant – this may have a negative impact on the channel of communication between doctor and patient. These findings reflect a relational approach to patient autonomy. They lead the author to suggest that the current doctor-patient partnership model in English medical law would benefit by the addition of relatives as an integral component of the decision making team. Such a significant shift in the legal approach requires changes in the type of information conveyed by the doctor to the patient; in the means to increase the patient's understanding; and lastly at the point when decisions are actually made.

Lessons from the nursery: The role of childcare in a cognitive behavioral treatment intervention for Latinas

2020 ◽  
pp. 147332502093116
Author(s):  
Shinwoo Choi ◽  
Lissette M Piedra ◽  
Soo-Jung Byoun
Keyword(s):  
Behavioral Treatment ◽  
Participant Observation ◽  
Common Factors ◽  
Cognitive Behavioral ◽  
Cognitive Behavioral Treatment ◽  
Community Settings ◽  
Field Notes ◽  
The Common ◽  
Social Work Interventions

Providing childcare along with interventions for disadvantaged mothers increases the benefit. However, program designers rarely focus on the implementation of that care and how it affects program participants. Using the common factors model as a lens, this paper explores the challenges that arose in the third year of an intervention that provided childcare to Spanish-speaking immigrant mothers enrolled in a Cognitive Behavioral Treatment (CBT) group when the socioeconomic status of beneficiaries and the population of children needing care changed. We used data collected by the childcare coordinator—participant observation, field notes, and administrative documentation—to examine the meanings participants assigned to problems in the childcare program, their resolution, and how it affected the therapeutic alliance. Data analysis focuses on the extent emerging themes were consistent with the concepts from the common factors approach. Four lessons for providers of interventions with similar supports emerge: attend to the physical environment, anticipate that learning from and rectifying mistakes can improve the therapeutic relationship, select and train childcare providers to understand they are clinical helpers, and recognize that participants view the childcare service as an extension of the intervention. Findings underscore the importance of support services in fostering the success of social work interventions in community settings.

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