Luis Botella, Sílvia Urbano, & Josep Gallifa Ramon Llull University Barcelona

1. Cognitive Complexityand Case Formulation inPsychotherapy Experts vs. Novices:Implications forPsychotherapy Integration Luis Botella, Sílvia Urbano, & Josep Gallifa Ramon Llull University Barcelona

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3. One-third to one-half of American clinicians consider themselves to be either “eclectic” or “integrative” in theoretical orientation—Schottenbauer, Glass,& Arnkoff (2005).

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5. Psychotherapy integration is widely believed by experienced clinicians to improve the effectiveness of psychotherapy—Schottenbauer, Glass,& Arnkoff (2005).

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7. Expert psychotherapists converge in significant beliefs regardless of their preferred theoretical approach—Mahoney & Craine (1991).

8. Expertise entails an increasing acknowledgement of clients’ variables, therapists’ personality, and the quality of the therapeutic relationship as the most important factors in psychotherapy outcome.

9. Expertise entails also a decrease in novices preference for being directive (vs. reflective).

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11. Psychotherapy integration can be regarded as a product or a process—Schacht (1991).

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14. The development of expertise involves a progression from a superficial and literal understanding of problems (a qualitative mark of the cognition of novices) to an articulated, conceptual, and principled understanding (a qualitative mark of the cognition of experts).

15. What are the differences between novice and expert integrative psychotherapists in terms of their knowledge organization?

16. Participants--Novices Study 1 28 postgraduate students enrolled in an integrative Psychotherapy Master’s course

17. Participants--Novices Study 1 Mean Age = 25.7 Min = 22.2; Max = 29.9; SD = 2.2

18. Participants--Novices Study 1 14.29% Men 85.71% Women

19. Participants--Novices Study 1 Maximum 50 hs. of clinical experience

20. Participants--Novices Study 2 9 novices randomly selected among the ones in Study 1

21. Participants--Experts Study 1 20 practicing psychotherapists, accredited by professional societies belonging to the Spanish Federation of Psychotherapists’ Associations

22. Participants--Experts Study 1 All of them defining their practice and approach as integrative

23. Participants--Experts Study 1 Mean Age = 46.3 Min = 42.2; Max = 55; SD = 2.9

24. Participants--Experts Study 1 35% Men 65% Women

25. Participants--Experts Study 1

26. Participants--Experts Study 1 More than 15 years of clinical experience; More than 10 patients per week; Ph.D; Publications; Presentations in international conferences.

27. Participants--Experts Study 2 9 experts randomly selected among the ones in Study 1

28. Participants

29. Method--Instruments Study 1--CCN Case Conceptualization Narrative First person narrative including prototypical examples of 28 key psychotherapy concepts

30. Method--Instruments Study 1--CCN Behavior Therapies (e.g., positive reinforcement) Cognitive Therapies (e.g., overgeneralization) Humanistic Therapies (e.g., unconditional positive regard) Psychoanalytic Therapies (e.g., CCRT) Systemic Therapies (e.g., triangulation) Constructivist Therapies (e.g., rigid superordinate construct)

31. Method--Instruments Study 1--CCN I would really like to say a few things to my mother. I was left with so many things to say and so many feelings to express after she divorced! But now it’s too late… she’ll never understand me even if I try, so I’ve quit trying… but the truth is that it still hurts… UNFINISHED BUSSINESS

32. Method--Instruments Study 1--CCN There are no shades of grey with me; either you’re with me or against me. Love me or leave me, but what I do I do it 100% and 24/7, and if someone does not want to follow me, he’d better get out of my way. If you’re not part of the solution you’re part of the problem; and the last thing I need right now are problems. ABSOLUTISTIC THINKING

33. Method--Instruments Study 1--CCN Participants were asked to: • Identify the key concepts that the narrative illustrates, and • Identify the theoretical approach to which each concept belongs

34. Method--Instruments Study 2--TAG Therapeutic Approaches Grid Personal construct grid elicited by comparing and contrasting six main theoretical approaches

35. Method--Instruments Study 2--TAG Behavior Therapies Cognitive Therapies Humanistic Therapies Psychoanalytic Therapies Systemic Therapies Constructivist Therapies

36. Method--Instruments Study 2--TAG Participants were asked to: • Compare two approaches; • Elicit what do they have in common (or what makes them opposite if that was the case); • Elicit the opposite pole of the personal construct in (b); • Repeat the comparison with other two approaches (nine comparisons in total); • Score each approach in each bipolar construct.

37. Method--Instruments Study 2--TAG Example A (Novice) In my opinion cognitive and behavior therapies are similar because both of them are directive, and the opposite of “directive” would be “non-directive”

38. Method--Instruments Study 2--TAG Example B (Expert) Psychoanalytic psychotherapies require a quite serious and profound therapist’s attitude, while systemic therapies are far more playful and irreverent

39. Method--Instruments Study 2--TAG

40. Method--Instruments Study 2.1 Novices were also asked to: • Read six prototypical case studies (one of each of the main approaches already mentioned); • Rate them in a list of 19 common factors; • Rate them in a list of six specific factors (each one being the main “active ingredient” of each approach);

41. Results Study 1--Concepts Correctly Identified (mean)

42. Results Study 1--Concepts Correctly Attributed to their Theoretical Approach (mean)

43. Experts have more “declarative knowledge” than novices. They identify more techniques as well as their theoretical origins.

44. Being able to identify theoretical concepts in the patient’s narrative is not only “declarative”, it’s also procedural . So, experts are also more skillful—not only more knowledgeable.

45. A+ C

46. Results Study 2—Constructs Content Clusters (Novices)

47. Results Study 2—Constructs Content Clusters (Experts)

48. Experts use a more complex conceptual map than novices. They use more concepts and organize them in more clusters.

50. Results Study 2—Integrative vs. Non Integrative Construct Scorings (means)