Douglas H. Sprenkle, PhD, is Director of the Doctoral Program in Marriage and Family Therapy at Purdue University and Professor of Marriage and Family Therapy within the Department of Child Development and Family Studies. Widely published, Dr. Sprenkle is past Editor of the Journal of Marital and Family Therapy. He is the recipient of honors including the Osborne Award for outstanding teaching from the National Council on Family Relations and the Significant Contribution to Family Therapy Award from the American Association for Marriage and Family Therapy (AAMFT).

Sean D. Davis, PhD, is Associate Professor and Site Director of the Marriage and Family Therapy Program at Alliant International University’s campus in Sacramento, California, as well as an approved supervisor and clinical member of AAMFT. Dr. Davis serves on the editorial board of the Journal of Marital and Family Therapy. His research, clinical, and teaching interests focus on common factors and bridging the scientist-practitioner gap in marriage and family therapy. Dr. Davis has published several journal articles and books and maintains a private practice.

Jay L. Lebow, PhD, is Clinical Professor of Psychology at the Family Institute at Northwestern University. He has conducted clinical practice, supervision, and research on couple and family therapy for over 30 years. He is board certified in family psychology by the American Board of Professional Psychology and is an approved supervisor of AAMFT. Dr. Lebow is the author of numerous publications on the interface of research and practice and the practice of integrative couple and family therapy.

What Is Responsible for Therapeutic Change?: Two Paradigms	p. 1
Two Paradigms of Therapeutic Change	p. 3
The Broad and Narrow Conceptualizations of Common Factors	p. 9
Resistance to Common Factors among Relational Therapists	p. 10
The Plan for This Book	p. 11
A Brief History of Common Factors	p. 14
Early School-Based Theories	p. 15
First-Generation Family Therapies	p. 16
Beginnings in the Understanding of Common Factors: Early Stirrings	p. 18
Jerome Frank	p. 19
Carl Rogers	p. 19
The Generic Model	p. 21
Luborsky and the Dodo Bird Verdict	p. 23
Karasu, Gurman, and Goldfried's Classifications of Change Agents	p. 23
Results from Meta-Analyses of the Impact of Psychotherapy	p. 24
Lambert's Analysis	p. 26
The Great Psychotherapy Debate	p. 27
The Heart and Soul of Change	p. 27
The American Psychological Association Division of Psychotherapy Report	p. 29
The Integrative Movement in Psychotherapy and Family Therapy	p. 30
Sprenkle and Blow's Moderate Common Factors Approach	p. 32
Common Factors Unique to Couple and Family Therapy	p. 34
Conceptualizing Difficulties in Relational Terms	p. 35
Disrupting Dysfunctional Relational Patterns	p. 37
Expanding the Direct Treatment System	p. 38
Expanding the Therapeutic Alliance	p. 42
The Big-Picture View of Common Factors	p. 45
Client Characteristics as Common Factors	p. 46
Therapist Characteristics as Common Factors	p. 49
Dimensions of the Therapeutic Relationship as Common Factors	p. 53
Dimensions of Expectancy as Common Factors	p. 53
Nonspecific Mechanisms of Change as Common Factors	p. 54
Other Mediating and Moderating Variables as Common Factors	p. 55
A Moderate View of Common Factors	p. 60
Believes One Treatment Is as Good as Another versus Questions Claims about Relative Efficacy	p. 61
Disparages Effective Models versus Supports Them	p. 64
Sees the Therapeutic Relationship as All There Is versus Views the Relationship as Only One Aspect of Change	p. 65
Minimizes Clinical Trials Research versus Supports It	p. 66
Supports Either-Or versus Both-And in the Common Factors and Specific Factors Debate	p. 67
Getting Clients Fired Up for a Change: Matching Therapist Behavior with Client Motivation	p. 69
Clients as the Most Important Common Factor	p. 69
Transtheoretical Stages-of-Change Model	p. 73
Facilitating Client Engagement through Motivational Interviewing	p. 78
Facilitating Client Engagement and Motivation in Relational Therapy: Functional Family Therapy	p. 81
Applying Principles of Motivation to Relational Therapy: A Clinical Vignette	p. 82
A Strong Therapeutic Alliance	p. 87
Understanding the Therapeutic Alliance	p. 88
Establishing and Maintaining an Alliance in Couple or Family Therapy	p. 98
Intervention as a Method of Building Alliance	p. 105
The Significance of the Therapeutic Alliance	p. 105
Models: All Roads Lead to Rome	p. 107
Common Distressed Relational Processes and Treatment Goals: Interactional Cycles and Patterns	p. 110
Model-Specific Conceptualizations of Common Distressed Relationship Processes	p. 112
Additional Common Processes of Distressed and Healthy Relationships	p. 122
A Meta-Model of Change in Couple Therapy	p. 123
The Need for a Meta-Model of Change	p. 123
Empirical Development of the Model	p. 125
How Narrow and Broad Common Factors Interact to Produce Change in Couple Therapy: A Meta-Model	p. 126
Strengths and Limitations	p. 142
Special Considerations for Family Therapy	p. 142
The Case against Common Factors	p. 144
Common Factors Training and Supervision	p. 159
Assumptions Underlying Common-Factors-Driven and Model-Driven Change Training Approaches	p. 161
Components of a Common Factors Training Program	p. 163
Practical Examples of Our Common Factors Training Approach	p. 165
Implications for Supervision	p. 167
A Climate of Reflective Theoretical Inclusivity	p. 168
Implications for Clinicians and Researchers	p. 170
General Implications for Clinicians	p. 171
Specific Implications for Clinicians	p. 174
General Implications for Researchers	p. 177
Specific Implications for Researchers	p. 180
Moderate Common Factors Supervision Checklist	p. 183
Instruments from Other Authors Related to Common Factors	p. 192
References	p. 199
Index	p. 219
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