The Great Psychotherapy Debate: Models, Methods, and Findings

By Bruce E. Wampold | Go to book overview

7
Allegiance and Adherence:
Further Evidence for the Contextual Model

Allegiance to a treatment approach and adherence to the respective protocol are important concepts that differentiate the meaning model and the contextual model of psychotherapy. Allegiance refers to the degree to which the therapist delivering the treatment believes that the therapy is efficacious. One of the sacrosanct assumptions of a client is that their therapist believes in the treatment being delivered. Because psychotherapy is an endeavor based on trust, violation of this assumption would appear to undermine the tenets of the profession. For the most part, practicing therapists choose the approach to psychotherapy that is compatible with their understanding and conceptualization of psychological distress and health, the process of change, and the nature of the client and his or her issues.1 Consequently clients can rest assured that their therapist is committed to and believes in the therapy being delivered. Conceived in this way, therapist allegiance is a common factor that exists across therapies as they are typically delivered.

Adherence is defined as the “extent to which a therapist used interventions and approaches prescribed by the treatment manual, and avoided the use of interventions and procedures proscribed by the manual” (Waltz et al.,

____________________
1
It is fully recognized that managed care limits the freedom that therapists have to deliver treatments that they deem to be optimal. In a sense, such limitations result from the imposition of a medical model onto the practice of psychotherapy.

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