Capítulo8 - The Role of Therapist Skills in Therapist Effectiveness
Capítulo8 - The Role of Therapist Skills in Therapist Effectiveness
Capítulo8 - The Role of Therapist Skills in Therapist Effectiveness
The English word skill is derived from Old Norse skilja, meaning, “to
separate, divide.” In this chapter, we separate or divide therapist skills into
technical, relational, conceptualization, and cultural aspects.
! Technical skills are defined by the delivery of interventions, spe-
cific strategies, and techniques.
! Relational skills refer to emotional and interpersonal commu-
nication.
! Conceptual skills refer to cognitive and organizational ability to
understand the client.
! Cultural skills are defined by the therapist’s awareness of cultural
context.
After discussing each of these skills separately, we integrate them into a con-
textual model for explaining therapist effectiveness. Our overarching goal is
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How and Why Are Some Therapists Better Than Others? Understanding Therapist Effects, L. G. Castonguay
and C. E. Hill (Eds.)
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139
to derive an explanation for the finding that some therapists are better (or
worse) than others.
TECHNICAL SKILLS
Technical skills are the interventions the therapist uses to help clients.
In other words, these skills refer to what the therapist does in sessions. In this
section, we describe the three levels at which techniques can be conceptual-
ized and assessed, according to Stiles, Hill, and Elliott (2015): treatment,
session, and sentence.
At the session level, skills may involve such things as analyzing transfer-
ence or addressing cultural issues. Judges typically observe an entire research
or training session and determine how much of each skill is used.
Ackerman and Hilsenroth (2001, 2003) reviewed the literature on
in-session activities and techniques associated with good and poor therapeu-
tic alliance. Their reviews indicated that the quality of specific techniques
or technical activity matters most. Sometimes the overuse of certain tech-
niques (e.g., interpretation of client resistance, therapist silence, disclosure of
personal conflicts) had deleterious effects. In contrast, several studies found
positive influences for the accuracy and appropriateness of several techniques
(e.g., reflection, exploration, other techniques designed to encourage client
expression of emotion, and transference interpretations).
RELATIONAL SKILLS
CONCEPTUALIZATION SKILLS
CULTURAL SKILLS
Cultural
skills
Level of Abstraction (Specific vs. Broad)
Technical
skills
Figure 8.1. An integrated contextual model of therapist skill. Each of the boxes rep-
resents one of the four skill sets described in this chapter. Circles provide examples
of skills (many other examples are possible). Arrows illustrate that the optimal use
of any specific skill involves integration with skills from other skill sets.
Case Example1
1
Client identifiers have been disguised to protect patient confidentiality.
We propose that the use of any one of the therapy skills discussed here
will be more effective when consistently combined with the other three ther-
apy skills. Using the example of the therapist who implements behavioral
exposure to treat social anxiety, it is important that this technical skill be
integrated with relational, conceptual, and cultural skills. In other words, to
be effective, this therapist must responsively apply behavioral exposure in
Hill’s (2014) helping skills model serves as a good example for under-
standing how specifically defined interventions can be conceived narrowly
(as specific techniques that can be operationalized at the sentence level) and
applied broadly at session and treatment levels. Helping skills integrate these
operationalized techniques by organizing them within sequenced sets via which
many treatments are commonly organized: (a) exploratory skills (e.g., reflec-
tions), (b) insight skills (e.g., interpretations), and (c) action skills (e.g., giving
homework). Helping skills have clear definitions, but are not taught in a cook-
book approach or with an orthodoxy about which skills must always be used.
Skills are specifically taught within the context that they must be implemented
with empathy, compassion, self-awareness, and cultural awareness.
Furthermore, part of what makes helping skills useful within the contex-
tual model is that the skills can be combined in nearly unlimited combinations
and can be practically implemented within a wide variety of contexts. For
example, it is recognized that not all clients respond to empathy in the same
way, and, furthermore, clients have different needs (e.g., some like to focus
on feelings, others do not). This flexibility provides the building blocks for
therapists to gain expertise by flexibly combining helping skills in the inte-
grative manner that we have recommended in this chapter. As Ridley, Kelly,
and Mollen (2011) stated, Hill’s (2014) helping skills model, relative to other
models, has the most comprehensive coverage of skills, culture, theory, rela-
tionship of skills to therapeutic change, and integration of skills.
Research has shown that helping skills can be effectively taught (Hill
& Kellems, 2002; Hill et al., 2008; Hill, Spangler, Jackson, & Chui, 2014).
Use of helping skills not only increased after helping skills training, but were
judged as being associated with higher posttraining ratings of the therapeutic
relationship, and higher evaluations of the session quality (Hill et al., 2008).
Hill, Sullivan, Knox, and Schlosser (2007) found that as a result of train-
ing, master’s level trainees were better able to use exploration and insight
skills, felt better about themselves as therapists, were less anxious, had more
self-efficacy, were more comfortable in the role of therapist, were less self-
critical, and felt themselves better able to connect with clients. Furthermore,
self-efficacy ratings in application of helping skills progressively increased
CONCLUSION
REFERENCES