Using Common Factors Outcome Research to Guide a Strength Based Counseling Approach with Nursing Home Residents

Lambert and Bergin (1994) indicated there have been more than 40 years of empirical evidence supporting the effectiveness of psychotherapy and counseling. Luborsky, McClellan, Woody, O'Brien and Auerbach (1985) and later comprehensive reviews (Lambert & Bergin, 1994; Miller, Taylor, & West, 1980; Stubbs & Bozarth, 1994), highlighted the conclusion that studies comparing differences between specific therapy approaches found little significant differences in outcome. Meta-analytic studies (Wampold, Mondin, Moody, Stich, Benson, & Ahn, 1997) confirmed this conclusion, but it is still not accepted as a fact about psychotherapy (Tallman & Bohart, 2003). In contrast, the available evidence on common factors present in diverse counseling models makes different therapy approaches equally effective. Hubble, Duncan, and Miller (2003), citing Lambert (1992), identified four common factors accounting for improvement in therapy: 1) 40% due to the clients' strengths, supportive environmental elements and chance events; 2) 30% due to relationship factors; 3) 15% due to placebo, hope and expectancy, both the client and therapists' belief in the counseling; and 4) 15% due to model/technique factors. Based on Lambert's (1992) research Tallman and Bohart Lambert and Bergin (1994) indicated there have been more than 40 years of empirical evidence supporting the effectiveness of psychotherapy and counseling. Luborsky, McClellan, Woody, O'Brien and Auerbach (1985) and later comprehensive reviews (Lambert & Bergin, 1994; Miller, Taylor, & West, 1980; Stubbs & Bozarth, 1994), highlighted the conclusion that studies comparing differences between specific therapy approaches found little significant differences in outcome. Meta-analytic studies (Wampold, Mondin, Moody, Stich, Benson, & Ahn, 1997) confirmed this conclusion, but it is still not accepted as a fact about psychotherapy (Tallman & Bohart, 2003). In contrast, the available evidence on common factors present in diverse counseling models makes different therapy approaches equally effective. Hubble, Duncan, and Miller (2003), citing Lambert (1992), identified four common factors accounting for improvement in therapy: 1) 40% due to the clients' strengths, supportive environmental elements and chance events; 2) 30% due to relationship factors; 3) 15% due to placebo, hope and expectancy, both the client and therapists' belief in the counseling; and 4) 15% due to model/ technique factors. Based on Lambert's (1992) research Tallman and Bohart (2003) reviewed many studies investigating clients' influence in making therapy work. The experts concluded the client's capacity for self healing was the most powerful factor. The positive view of humans has been emphasized in counseling since the establishment of the profession. The works of Carl Rogers (1951, 1957) during the last half century supported focusing on the clients' strengths, especially the capacity for self-direction. Recently, this positive strength based approach has been emphasized by Seligman and Csikszentmihalyi (2000) and Synder and Lopez (2002). With this research evidence the authors of this article concluded that the common factors of client strengths, the therapeutic relationship, hope and expectancy, and model techniques could be used as a guide in maximizing the strengths of nursing home residents. The Aging Population In 1900, persons 65 years of age represented only 4% (3 million) of people in the country (Wilmouth & Longino, 2006). Currently the approximate number of older United States' residents is 35 million, and by 2030 the number is projected to be approximately 70 million (U.S. Census Bureau, 2006). The census bureau predicts one in nine baby boomers will survive into their late 90's (Crowley, 1999). Unfortunately, a number of these older persons become impaired and require care the family is unable to provide, and which ne cessitates nursing home placement. …