Psychotherapy Research

ISSN: 1050-3307 (Print) 1468-4381 (Online) Journal homepage: http://www.tandfonline.com/loi/tpsr20

The motivational foundations of different therapeutic orientations as indicated by therapists' value preferences Eugene Tartakovsky To cite this article: Eugene Tartakovsky (2014): The motivational foundations of different therapeutic orientations as indicated by therapists' value preferences, Psychotherapy Research, DOI: 10.1080/10503307.2014.989289 To link to this article: http://dx.doi.org/10.1080/10503307.2014.989289

Published online: 17 Dec 2014.

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Date: 05 November 2015, At: 18:11

Psychotherapy Research, 2014 http://dx.doi.org/10.1080/10503307.2014.989289

EMPIRICAL PAPER

The motivational foundations of different therapeutic orientations as indicated by therapists’ value preferences

EUGENE TARTAKOVSKY The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel

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(Received 18 March 2014; revised 19 September 2014; accepted 12 November 2014)

Abstract Objective: The present study investigates the relationships between therapists’ value preferences and their beliefs in the efficacy of the four main therapeutic orientations (cognitive behavior, psychodynamic, client-centered, and eco-systemic). Method: The study was conducted in Israel. Social workers practicing individual therapy in different psychosocial services participated in the study (n = 528). Results: Personal value preferences explained a significant proportion of the variance in the social workers’ beliefs in the efficacy of different therapeutic orientations. Each therapeutic orientation was associated with a specific pattern of value preferences, thus indicating that different therapeutic orientations promote or impede the attainment of the therapists’ specific motivational goals. Conclusions: The study results’ implications for understanding the motivational foundations of different therapeutic orientations are discussed, as well as their possible application for therapist training and practice. Keywords: therapeutic orientations; psychodynamic therapy; cognitive behavioral therapy; client-centered therapy; ecosystemic therapy; personal value preferences

Introduction Therapeutic orientations are important in that they influence the therapist’s understanding of their patient’s problems, direct their interventions, and thus affect the efficacy of therapy (Boswell et al., 2009; Buckman & Barker, 2010; Tartakovsky & Kovardinsky, 2013). Examining various factors affecting the choice of therapeutic orientation may help understand the commonalities and specifics of the different psychotherapies, while also informing choices regarding university-level education and onthe-job training for psychotherapists (Buckman & Barker, 2010). The present study focused on the relationships between therapists’ value preferences and their beliefs in the efficacy of different therapeutic orientations. A number of studies have investigated the effects of different personality variables (e.g., personality traits, epistemological orientations, and philosophical assumptions) on therapists’ choice of therapeutic orientation (e.g., Buckman & Barker, 2010; Heffler & Sandell, 2009; Scandell, Wlazelek,

& Scandell, 1997; Tremblay, Herron, & Shultz, 1986). However, this is the first study to examine the connection between the personal value preferences of therapists and their therapeutic orientations. Personal value preferences reflect an individual’s general motivational goals (Schwartz, 2006); therefore, understanding the connection between the therapists’ value preferences and their therapeutic orientations may shed light on the motivational foundations of different therapeutic orientations.

Therapeutic Orientations According to Poznanski and McLennan (1995, p. 412): therapeutic orientation refers to an organized set of assumptions, which provides a counselor with a theory-based framework for (a) generating hypotheses about a client’s experience and behavior, (b) formulating a rationale for specific treatment interventions, and (c) evaluating the ongoing therapeutic process.

Correspondence concerning this article should be addressed to Eugene Tartakovsky, The Bob Shapell School of Social Work, Tel-Aviv University, P.O.B. 39040, Tel-Aviv 69978, Israel. Email: [email protected] © 2014 Society for Psychotherapy Research

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Therapists’ orientations form the basis of their therapeutic practice; however, the particular therapeutic behaviors actually implemented may be a function of a variety of other factors, including the agency’s policies and procedures, client needs, and the counselor’s experience (Coleman, 2004; Poznanski & McLennan, 1995). In the present study, the therapeutic orientations were operationalized as the therapists’ beliefs in the efficacy of the curative factors associated with each therapeutic orientation. Separate scores reflecting the therapists’ belief in the efficacy of each therapeutic orientation were calculated and used in the analysis (for a similar approach see Coleman, 2004, 2007; Sandell et al., 2004; Tartakovsky & Kovardinsky, 2013). This approach enabled assessing each therapeutic orientation separately, even though in their actual practice, therapists may endorse several therapeutic orientations simultaneously or interchangeably. The present study focuses on the four therapeutic orientations which are most widely used in counseling, clinical psychology, and social work: cognitive behavioral therapy (CBT), psychodynamic therapy (PDT), client-centered therapy (CCT), and ecosystemic therapy (EST; Boswell et al., 2009; Buckman & Barker, 2010; Coleman, 2004; Guy, Poelstra, & Stark, 1989; Poznanski & McLennan, 1995; Prochaska & Norcross, 2007; Stiles et al., 2006). The present study does not include the integrative (or eclectic) approach, despite its popularity in psychotherapy practice (Prochaska & Norcross, 2007). Two reasons guided this decision. First, the integrative approach is not a distinctive therapeutic orientation, but is rather a combination of several orientations. Second, the main goal of this research was to investigate the motivational basis of the four main therapeutic orientations; therefore, the therapists’ beliefs in the efficacy of each therapeutic orientation had to be measured separately. In what follows, a brief description of the four therapeutic orientations investigated in the present study is provided. Psychodynamic psychotherapy. PDT refers to a range of treatments based on psychoanalytic concepts and methods. The essence of PDT is exploring those aspects of the self that are unconscious, especially as they manifest in and are influenced by the therapy relationship (Coleman, 2004; Shedler, 2010). The goals of PDT extend far beyond symptom remission. Successful psychodynamic treatment aims to engage the psychological resources of the client and facilitate positive changes in their underlying intrapsychic processes (Shedler, 2010). Seven features distinguish PDT (Blagys, & Hilsenroth, 2000, p. 168): (1) a focus on affect and the patient’s

emotional expression; (2) an exploration of the patient’s attempts to avoid certain issues or engage in activities that hinder the progress of therapy; (3) identifying patterns in the patient’s actions, thoughts, feelings, experiences, and relationships; (4) an emphasis on past experiences; (5) a focus on the patient’s interpersonal experiences; (6) an emphasis on the therapeutic relationship; and (7) an exploration of the patient’s wishes, dreams, and fantasies.” PDT is usually long-term and consists of dozens or even hundreds of sessions (Leichsenring et al., 2006). Cognitive behavioral therapy. CBT focuses on a specific problem; it directly targets symptoms, reevaluates thinking, and promotes helpful behavioral responses (Leichsenring et al., 2006). Cognitive-behavioral therapists actively structure the interaction and introduce topics; they offer the clients explicit guidance and advice and explain the rationale behind the treatment and technique (Beck, 2005; Masters et al., 1987). CBT focuses on the cognitive and behavioral aspects of the presented issues, and it views emotions as a phenomenon to be controlled rather than experienced and deepened (Boswell et al., 2009; Shedler, 2010). Trusting therapeutic relations are viewed as an essential component of CBT, but not as the main vehicle of change; therefore, the therapist–client relationship is usually less close and less emotionally intense than in PDT. Finally, CBT is usually much shorter than PDT; CBT treatment usually lasts between 10 and 20 sessions (Leichsenring et al., 2006). Client-centered therapy. CCT has its roots in the work of Carl Rogers (1963); however, today, CCT incorporates a broad range of ideas that are related to the humanistic and existential traditions (Schneider & Längle, 2012). The philosophical core of CCT is humanism, which emphasizes the highest value of human being, dignity, and self-actualization (Elkins, 2009). As a therapeutic practice, CCT emphasizes the therapeutic alliance, empathy, genuineness, receptivity to client feedback, and a search for meaning (Schneider & Längle, 2012). Eco-systemic therapy. PDT, CBT, and CCT focus on the client’s intrapsychic processes. However, many social workers, as well as some psychologists, intervene on both the intrapsychic level and through different social systems in which the individual is embedded (IASW, 1994; National Association of Social Workers [NASW], 2008; Weiss-Gal, 2008); therefore, they practice what may be termed EST (Coleman, 2007). EST strives to improve the client’s adjustment to different social systems; however, it also aims to change the social systems

Psychotherapy Research themselves so as to reduce inequality and advance social justice (IASW, 1994; NASW, 2008). EST includes interventions at the family and/or couple level, case management, mediation, advocacy, social action, and policy formation (Coleman, 2004; Hare, 2004; Tartakovsky & Kovardinsky, 2013; WeissGal, 2008).

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Personality Characteristics Affecting the Practitioners’ Choice of Therapeutic Orientation Among various personality characteristics that may be related to the practitioners’ choice of therapeutic orientation, previous studies have focused on religious beliefs, philosophical assumptions, epistemological orientations, and personality traits. The therapists’ religious beliefs, or lack thereof, have been found to be related to their choice of therapeutic orientations. A study by Bilgrave and Deluty (1998) found that a higher commitment to Christianity was associated with a stronger adherence to CBT. At the same time, a stronger adherence to CCT was associated with a commitment to Eastern and other unorthodox religious beliefs, and was negatively related to a commitment to Christianity. PDT was not related to religiosity, and the authors assumed that the antireligious zeal of early psychoanalysis has been abandoned in modern psychodynamic therapies. However, when considering the therapists’ cultural roots and not their religiosity, Langman (1997) claims that among American psychotherapists, adherence to CBT was associated with the traditional WASP culture, while PDT was associated with Jewish mysticism. Considering the philosophical assumptions and epistemological orientations of psychotherapists, Buckman and Barker (2010) found that adherence to CBT was associated with mechanicism, empiricism, and rationalism, while therapists’ adherence to PDT was associated with intuitivism. Several studies have focused on the relationship between personality traits and choice of therapeutic orientations. It was found that practitioners of PDT and CCT had significantly higher scores on the Openness scale than practitioners of CBT and EST (Arthur, 2000; Buckman, & Barker, 2010; Poznanski & McLennan, 2003; Scandell et al., 1997; Scragg, Bor, & Watts, 1999; Topolinsky & Hertel, 2007). In addition, a stronger adherence to CBT was associated with higher scores on the Conscientiousness scale, with an opposite pattern for PDT. The CBT practitioners also scored significantly higher than other therapists on the Agreeableness scale, which may be understood in terms of different modes of planning, organizing, and carrying out therapeutic

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interventions in different therapeutic orientations; CBT practitioners may appear more purposeful and determined, whereas PDT and CCT practitioners may appear less directive (Buckman & Barker, 2010). It should be noted that in previous studies, personality factors have explained only a small proportion of the variance (5–20%) in therapists’ preferences for different therapeutic orientations (Bilgrave & Deluty, 1998; Buckman & Barker, 2010; Topolinsky & Hertel, 2007). Several researchers have suggested that psychotherapists’ values may influence their therapeutic goals and guide their interventions (Bilgrave & Deluty, 1998; Kelly, 1995; Vasco & Dryden, 1997); however, this topic has not been sufficiently conceptualized theoretically or empirically investigated. Research on the connection between personal value preferences and adherence to different therapeutic orientations is important, because personal values reflect general motivational goals and predict social cognition and behavior (Schwartz, 2006); therefore, such research may shed light on the motivational foundation of therapists’ choice of different therapeutic orientations. Theory of Values The present study is based on Schwartz’s theory of values (Schwartz, 2004, 2006; Schwartz et al., 2012), which defines values as desirable trans-situational goals that serve as guiding principles in people’s lives. Individual value preferences reflect one’s general motivations; they affect one’s perception of reality and direct behavior (Schwartz, 2006). In its latest formulation (Schwartz et al., 2012), the theory specifies a comprehensive set of 12 motivationally distinct values: power, achievement, hedonism, stimulation, self-direction, universalism, benevolence, humility, conformity, tradition, security, and face (see Table I for definitions of the values in terms of their motivational goals). The theory assumes the existence of dynamic relations between these values: pursuit of each value has consequences that may conflict or may be congruent with the pursuit of other values. The conflicts and congruities among all 12 values yield an integrated structure of four higher order value types arrayed along two orthogonal dimensions: self-enhancement vs. selftranscendence and openness to change vs. conservation (Figure 1). Previous studies have established connections between personal value preferences and other personality characteristics, such as personality traits, religious beliefs, and political orientations (Schwartz, 2006). Regarding personality traits, positive correlations were found between Agreeableness and the

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Table I. Definitions of the 12 basic values in terms of their motivational goals. Values Universalism Benevolence Humility Conformity Tradition Security Face Power Achievement Hedonism Stimulation Self-direction

Definitions in terms of motivational goals Understanding, appreciation, tolerance, and protection of the welfare of all people and of nature Caring for the welfare of the others with whom one is in frequent social contact Recognizing one’s insignificance in the larger scheme of things Limiting actions and urges that might violate rules, laws, social expectations, and norms Maintaining and preserving cultural, family, or religious traditions Preserving safety, harmony, and stability of the self, immediate environment, and the wider social structure Obtaining a sense of security and power through maintaining one’s public image and avoiding humiliation Aspiration for social status through gaining control and dominance over other people and resources Acquiring personal success through demonstrating competence according to social standards Pursuit of pleasure and sensual gratification Striving for excitement, novelty, and change Freedom to cultivate one’s own ideas and abilities and to determine one’s own actions

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Adopted from Knafo, Daniel, and Khoury-Kassabri (2008); Schwartz et al. (2012).

benevolence and tradition values, between Openness and the self-direction and universalism values, between Extroversion and the achievement and stimulation values, and between Conscientiousness and the achievement and conformity values (Roccas et al., 2002). The openness to change values (hedonism, stimulation, and self-direction) was associated with weaker religious beliefs, while the conservation values (conformity and tradition) were associated with stronger religious beliefs. In addition, benevolence was associated with stronger religious beliefs, while universalism and achievement were associated with weaker beliefs (Roccas et al., 2002). Regarding political orientations, the selfenhancement and conservation values were associated with a right-wing voting orientation, while the openness to change and the self-transcendence

values were associated with a left-wing voting orientation (Schwartz, 2006). Main Hypotheses of the Present Study Based on the theoretical considerations and the results of previous studies, the following hypotheses were formulated: (1)

(2)

(3)

A stronger belief in the efficacy of PDT will be associated with a higher preference for the openness to change values and with a lower preference for the conservation values. CBT will have a pattern of relationships with value preferences opposite to that of PDT: A stronger belief in the efficacy of CBT will be associated with a higher preference for the conservation values and a lower preference for the openness to change values. A stronger belief in the efficacy of CCT and EST will be associated with a higher preference for the self-transcendence and openness to change values and with a lower preference for the self-enhancement and conservation values. Method

Sample

Figure 1. Theoretical model of relations among basic values and higher order value types. Source: Adopted from Schwartz et al. (2012).

Five hundred and twenty-eight social workers participated in the study. The study participants lived across Israel, worked in different psychosocial services, and provided individual psychotherapy to different types of clients. Table II presents the socio-demographic characteristics of the sample, comparing them with the characteristics of social workers as revealed in the most recent existing survey of all social workers in Israel (Bar-Zuri, 2004). The results obtained indicate that the study sample is representative of the population of social

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Table II. Socio-demographic characteristics of the sample compared to the population of social workers in Israel. Socio-demographic characteristic

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Age Gender (% of females) Family status (% of married or living with a partner) Ethnicity (% of Jews) Immigration status (% of foreign born) Education (% with a MSW or higher) Average work hours per week Have a private practice (%)

workers in Israel regarding most of the socio-demographic characteristics: age, gender, family status, immigration status, and workload. However, among the study participants there was a higher proportion of social workers with a MSW degree and those with a private practice.1 On average, the study participants worked 12 years as social workers (SD = 9.72, range 0–40); 23% of them occupied a managerial position, and 39% were supervisors. Among the study participants, there were graduates of all five universities as well as colleges that teach social work in Israel. Since the Jewish and non-Jewish populations in Israel differ significantly in their sociodemographic characteristics, values, and social norms (Fefferman, 2011; Gabarin, 2010; Haj-Yahia, Bargal, & Guterman, 2000; Schwartz, 2004), the present study included only Jewish social workers.

Procedure The study used self-report anonymous questionnaires. The questionnaires were distributed by students participating in a senior thesis seminar at the Tel Aviv University School of Social Work as part of their course requirements. The students distributed most of the questionnaires in their workplaces, which included dozens of organizations focusing on different fields of social work across Israel. In addition, the questionnaires were distributed through professional Internet forums and social networks. The goals of the study were explained and a signed informed consent was obtained from all the participants. Study participants completed the questionnaires during their work hours or at home and returned them directly to the students in a sealed envelope or by email. The return rate was about 70%. The study was approved by the Tel Aviv University Research Board.

Instruments Therapeutic orientations. Social workers’ beliefs in the efficacy of different therapeutic orientations were measured using a revised version of the

Population

Sample

40.2 90% 66% 96% 15% 37% 35.6 5%

38.9 (SD = 9.76; range 24–66) 91% 68% 100% 13% 62% 32.2 (SD = 9.64; range 4–65) 11%

Therapeutic Orientations Questionnaire (TOQ-R; Tartakovsky & Kovardinsky, 2013). The revised questionnaire consists of 40 items describing curative factors (i.e., therapeutic beliefs, techniques, and interventions) related to the four therapeutic orientations. The participants were asked to evaluate to what degree they believed each curative factor contributes to long-term and stable therapeutic changes in their clients, on a scale from 1 (not at all) to 5 (very much). The items constitute four scales measuring the degree of the therapists’ belief in the efficacy of the four therapeutic orientations: psychodynamic (10 items), cognitive behavior (11 items), client-centered (10), and eco-systemic (9 items). Higher scores on each scale indicate a stronger belief in the efficacy of that particular therapeutic orientation. A factor analysis (Extraction method: Principal Component Analysis; Rotation method: Oblimin with Kaiser Normalization) confirmed the hypothesized questionnaire’s structure (see Appendix 1). All scales demonstrated high internal consistency (Cronbach’s α = .79–.90). Personal value preferences. The personal value preferences of the social workers were measured using the latest version of the Portrait Values Questionnaire (PVQ57; Schwartz et al., 2012). This questionnaire consists of 57 items. Each item portrays a person’s goals, aspirations, or wishes that indicate the importance of a specific value. For each item, respondents indicate how similar the described person is to them on a 6-point scale, from 1 (not like me at all) to 6 (very much like me). Scores for 12 basic values are calculated as means of the relevant items. As recommended by Schwartz et al. (2012), to correct for individual differences in use of the response scales, each participant’s responses were centered on his or her own mean, i.e., from each value score the average of all 57 values was subtracted. This converts the absolute value scores into scores that indicate the relative importance of each value to the individual, i.e., the person’s value preferences. The questionnaire was tested in 10

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countries including Israel and demonstrated good psychometric properties (Schwartz et al., 2012). Item examples: “It is important to him to avoid upsetting other people” (conformity); “Being creative is important to her” (self-direction). Internal consistency of the scales obtained in the present study was satisfactory and similar to those reported in previous studies (Cronbach’s α = .69–.85). Higher scores indicated a higher importance of the value for the person.

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Results The statistical analysis was conducted in several stages. First, Pearson correlation coefficients were calculated between the 12 personal value preferences and beliefs in the efficacy of the four therapeutic orientations (Table III). A stronger belief in the efficacy of CBT was significantly correlated with selfdirection (–.13), security (.12), benevolence (–.10), and universalism (–16). A stronger belief in the efficacy of PDT was significantly correlated with stimulation (.11), hedonism (.10), face (.12), security (.09), tradition (–10), conformity (–.12), and humility (–.12). A stronger belief in the efficacy of CCT was significantly correlated with power (–.17), humility (–.11), benevolence (.14), and universalism (.11). Finally, a stronger belief in the efficacy of EST was significantly correlated with conformity (–.15), humility (–.14), and universalism (.20). Second, Pearson correlation coefficients were calculated between the 12 socio-demographic characteristics measured in the present study and the therapists’ beliefs in the efficacy of the four therapeutic orientations (Table IV). The results demonstrated that no socio-demographic characteristic was significantly correlated with the social workers’ belief in the efficacy of CBT. A stronger belief in the efficacy of PDT was significantly correlated with age Table III. Pearson correlation coefficients between the personal value preferences and the four therapeutic orientations. Values Self-direction Stimulation Hedonism Achievement Power Face Security Tradition Conformity Humility Benevolence Universalism

CBT

PDT

CCT

EST

–.13** .07 .05 –.08 .08 .08 .12** .04 .01 .02 –.10* –.16***

.04 .11* .10* .06 –.01 .12** .09* –.10* –.12** –.12** –.04 –.04

.08 .06 .01 –.02 –.17*** .01 –.03 –.04 –.07 –.11* .14** .11*

.03 .02 –.03 –.04 –.07 –.05 –.05 .01 –.15** –.14** .03 .20***

N = 528. *p < .05; **p < .01; ***p < .001.

Table IV. Pearson correlation coefficients between the sociodemographic characteristics and the four therapeutic orientations. Variables

CBT

PDT

CCT

EST

Age Gender Education Religiosity Immigration status Professional experience Work hours in the public services Number of clients in the public workplace Have a private practice Salary Managerial position Supervisory role

–.03 –.07 –.02 .00 –.03 .00 .05

.10* –.10* .11* –.08 –.03 .06 .01

.01 .01 .03 –.05 –.04 –.02 –.06

–.11* .07 –.06 –.03 .04 –.10* –.02

.04

–.14**

–.17**

–.01

–.08 .05 .05 .07

.17** .08 .04 .10*

.09* .08 .09* .11*

–.14** –.02 .04 .02

CBT, Cognitive-Behavior Therapy; PDT, Psychodynamic Therapy; CCT, Client-Centered Therapy; EST, Eco-Systemic Therapy. Variable codes: Gender: 1-male, 2-female; Education: 1-BA, 2-MA or higher; Immigration status: 1-Israeli-born, 2-immigrant; Private practice: 1-no private practice, 2-has a private practice; Managerial position: 1-no managerial position, 2-managerial position; Supervisory role: 1-no supervisory role, 2-supervisory role. N = 528. *p < .05, **p < .01.

(.10), gender (–.10), education (.11), number of clients in the public services (–.14), having a private practice (.17), and being a supervisor (.10). A stronger belief in the efficacy of CCT was significantly correlated with the number of clients in the public services (–.17), having a private practice (.09), occupying a managerial position (.09), and a supervisory role (.11). Finally, a stronger belief in the efficacy of EST was significantly correlated with age (–.11), professional experience (–.10) and having a private practice (–.14). Third, to examine whether therapists’ value preferences predict beliefs in the efficacy of the different therapeutic orientations beyond the effect of sociodemographic characteristics, two-step hierarchical regression analyses were conducted for PDT, CCT, and EST. In the first step of the analysis, the sociodemographic variables that significantly correlated with the specific therapeutic orientation were included as predictors; in the second step of the analysis, the values that significantly correlated with the therapeutic orientation were added as predictors. No socio-demographic characteristic was significantly correlated with CBT; therefore, a simple regression analysis was conducted for this therapeutic orientation. The results of the regression analysis for CBT (Table V) indicated that only the regression coefficient for universalism was significant (β = .12). For PDT, the regression coefficients for two socio-demographic variables were significant (Table VI): the number of clients (β = –.09) and having a private practice

Psychotherapy Research Table V. Summary of regression analysis for personal value preferences predicting belief in the efficacy of CBT. Predictors

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Table VII. Summary of hierarchical regression analysis for sociodemographic variables and personal value preferences predicting belief in the efficacy of CCT.

CBT CCT

Values Self-direction Security Benevolence Universalism R2 Adjusted R2 F

–.09 .04 –.06 –.12* .04 .03 F(4;523) = 5.52; p = .000

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*p < .05.

(β = .12). In addition, the regression coefficients for two values were significant: face (β = .15) and security (β = .09). For CCT, the regression coefficients for two socio-demographic variables were significant (Table VII): the number of clients (β = –.15) and having a supervisory role (β = .12). In addition, the regression coefficients for two values were significant: benevolence (β = .17) and universalism (β = .14). For EST, the regression coefficient for only one sociodemographic variable was significant (Table VIII): having a private practice (β = –.12). In addition, the regression coefficients for three values were significant: conformity (β = –.09), humility (β = –.14), and universalism (β = .22). For all therapeutic orientations, when personal values were added to the analysis, the prediction significantly improved. Together with Table VI. Summary of hierarchical regression analysis for sociodemographic variables and personal value preferences predicting belief in the efficacy of PDT. PDT Predictors

Step I

Socio-demographic variables Age .03 Gender –.07 Education .06 Number of clients –.09* Private practice .12** Supervisory role .05 Values Stimulation Hedonism Face Security Tradition Conformity Humility .05 R2 Adjusted R2 .04 F F(6;521) = 4.83; p = .000 F for change in R2

*p < .05, **p < .01.

Predictors

Step I

Step II

Socio-demographic variables: Number of clients –.15** Private practice .07 Managerial position Supervisory role .12* Values Power Humility Benevolence Universalism .04 R2 Adjusted R2 .03 F F(4;523) = 5.46; p = .000 F for change in R2

–.11** .06 .10* –.04 –.02 .17** .14* .09 .08 F(8;519) = 6.43; p = .000 F(4;519) = 7.14; p = .000

*p < .05, **p < .01.

socio-demographic characteristics, values predicted 4–11% of the variance in the therapists’ beliefs in the efficacy of the four therapeutic orientations.

Discussion In the present study, personal value preferences explained a significant proportion of the variance in the therapists’ beliefs in the efficacies of the four therapeutic orientations, beyond the therapists’ sociodemographic characteristics. Although bivariate correlations between the value preferences and the belief

Step II

.05 –.06 .07 –.09* .12** .04 .08 .07 .15** .09* –.06 –.08 –.03 .11 .09 F(13;514) = 5.06; p = .000 F(7;514) = 5.03; p = .000

Table VIII. Summary of hierarchical regression analysis for sociodemographic variables and personal value preferences predicting belief in the efficacy of EST. EST Predictors

Step I

Socio-demographic variables: Age –.07 Professional experience –.02 Private practice –.12** Values Conformity Humility Universalism .03 R2 .02 Adjusted R2 F F(3;524) = 4.54; p = .004 F for change in R2

*p < .05, ** p < .01, ***p < .001.

Step II

–.06 –.02 –.14** –.09* –.14** .22*** .10 .09 F(6;521) = 10.1; p = .000 F(3;521) = 15.3; p = .000

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in the efficacy of the four therapeutic orientations were small, and only a small proportion of the variance was explained, each orientation was associated with a specific pattern of personal value preferences. Cognitive behavioral therapy. A stronger belief in the efficacy of CBT was associated with a higher preference for the security values and a lower preference for the self-direction, universalism, and benevolence values. Therefore, according to the values’ theory (Schwartz et al., 2012), CBT is compatible with the motivational goals of preserving safety and stability of the self and the wider social structure. At the same time, CBT contradicts the motivational goals related to tolerance, protection, and care for the welfare of others, as well as with cultivating one’s own ideas and determining one’s own actions. Several aspects of CBT may explain its motivational foundations as revealed in the present study. CBT emphasizes the therapists’ task of helping clients adapt to the existing social conditions; it does not focus on issues related to social justice and does not call for social change (Ellis & Dryden, 1997), which may explain its perceived contradiction to the universalism and self-direction values. In addition, therapists who apply CBT often work according to instructions written in a manual (Beck, 2005; Masters et al., 1987). This procedure may appeal to those therapists who highly value security and have a relatively low preference for the self-direction values. Finally, CBT, more than the other therapeutic orientations, uses confrontation, rewards, punishments, and direct instructions (Masters et al., 1987; Safran, 1996), which may explain its contradiction to the benevolence values. The pattern of value preferences associated with CBT found in the present study may explain the findings of some previous studies, which demonstrated that therapists who had a stronger adherence to CBT tended to be more religious and belong to the right political spectrum (Bilgrave & Deluty, 1998). Research by Schwartz (2006) has demonstrated that religiosity and right-wing voting are related to a higher preference for the security values and a lower preference for the benevolence and universalism values—the same pattern of value preferences characterizing the therapists who strongly believe in the efficacy of CBT, as found in the present study. Psychodynamic therapy. A stronger belief in the efficacy of PDT was associated with a higher preference for the openness to change values (stimulation and hedonism) and a lower preference for the conservation values (humility, conformity, and

tradition). However, it was associated with a high preference for two other conservation values (face and security). The results obtained indicate that PDT is compatible with the motivational goals related to excitement, novelty, and change, as well as the pursuit of pleasure and sensual gratification. At the same time, PDT contradicts the motivational goals related to maintaining the existing order of things, following the existing rules and societal norms, and belittling oneself. However, PDT is compatible with the motivational goals of obtaining a sense of security and power through maintaining one’s public image as well as the safety and stability of the self, the immediate environment, and the wider social structure. The association of PDT with the values of stimulation and hedonism and its contradiction to the values of tradition, conformity, and humility may be explained by the emphasis of PDT on exploring unconscious drives and their conflicts with the superego (Blagys, & Hilsenroth, 2000; Shedler, 2010). In addition, PDT has been traditionally associated with an emphasis on nonconformity and secular worldviews (Bilgrave & Deluty, 1998; Langman, 1997). Finally, the association between the stimulation and hedonism values and the belief in the efficacy of PDT obtained in the present study is congruent with the results of previous studies, which have demonstrated that practitioners of PDT have higher scores on the personality trait of openness, and that adherence to PDT is associated with the epistemological orientation of intuitivism (Buckman, & Barker, 2010; McLennan & Poznanski, 2004; Topolinsky & Hertel, 2007). The association of PDT with the face and security values was unexpected. This finding may perhaps be explained by the high status of the psychodynamic therapist, who is positioned as an expert in explaining and interpreting the clients’ thoughts, emotions, and behavior (Blagys, & Hilsenroth, 2000). It is probable that the psychodynamic therapist’s position provides him or her with a sense of respect, safety, and stability (including financial stability), which is sought by individuals with a high preference for the face and security values. In addition, the important role of the face and security values in predicting the therapists’ beliefs in the efficacy of PDT found in the current study may be related to the traditional dominance of PDT in the Israeli therapy community (Gal & Weiss, 2000; Moses, 1998). Finally, it may be related to some socio-demographic factors and their association with certain value preferences. Thus, in the present study, the older therapists, with a higher education, and who have a private practice, reported a higher belief in the efficacy of PDT, and these socio-demographic characteristics

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may be associated with a higher preference for the face and security values (Schwartz, 2006; Schwartz et al., 2012). Client-centered therapy. A stronger belief in the efficacy of CCT was associated with a higher preference for the benevolence and universalism values and with a lower preference for the power and humility values. The results indicated that CCT is compatible with the motivational goals related to tolerance, protection, and care for the welfare of others. At the same time, CCT contradicts the motivational goals of gaining control and dominance over other people and resources. This pattern of general motivational goals associated with CCT is consistent with the principles of humanism that constitute the philosophical base of CCT. Therapists for whom the values of self-transcendence are important and the values of self-enhancement are not important perhaps fulfill their motivational goals through belief in the efficacy of CCT, because this therapeutic orientation emphasizes respect for the client’s human dignity, empathy, genuineness, and therapist-client equality (Rogers, 1963; Schneider & Längle, 2012). Therapists who emphasize the humility values tend to believe less in the efficacy of CCT, probably because the humanist principles constituting the philosophical foundation of this orientation contrast the notion of human insignificance reflected in the humility values. Eco-systemic therapy. A stronger belief in the efficacy of EST was associated with a higher preference for the universalism values and with a lower preference for the conformity and humility values. The results indicated that EST is compatible with the motivational goals of appreciation, tolerance, and protection of the welfare of all people, while it contradicts the motivational goals of belittling others and refraining from actions that may violate existing social norms and expectations. The association between EST and the universalism values is explained by the strong emphasis of EST on justice and equality, and on making society a better place for human development (Coleman, 2004; Tartakovsky & Kovardinsky, 2013; Weiss-Gal, 2008)— the motivational goals emphasized by the universalism values. EST stresses human dignity, which is perhaps why this orientation contradicts the humility values. Finally, the negative connection between EST and the conformity values may indicate that EST is associated with working in a manner which differs from the practice of most social services (Weiss-Gal, 2008).

9

The Role of Socio-demographic Characteristics Similar to the results obtained in studies conducted among psychologists (Arthur, 2000; Bilgrave & Deluty, 1998; Poznanski & McLennan, 2003; Sandell et al., 2004), the present study found that among social workers, therapeutic orientations were only weakly related to the therapists’ socio-demographic characteristics. The most profound effect of sociodemographic variables was found for PDT. Social workers who demonstrated a greater belief in the efficacy of PDT tended to be male; they also tended to be older, hold a MSW degree, have a smaller number of clients at their public workplace, work as supervisors, and have a private practice. As mentioned above, these results may be explained by the fact that PDT was for many years the leading therapeutic orientation in Israel, and has only recently been challenged by other therapeutic orientations (Dorfman, 2013; Gal & Weiss, 2000; Hovev et al., 2013). Social workers who demonstrated a greater belief in the efficacy of CCT tended to have less clients, to hold managerial positions, work as supervisors, and have a private practice. Two factors may explain these findings. First, having a large caseload may hamper the therapists’ ability to focus on their client’s needs and remain empathic and supportive, which are the key features of CCT. Second, the ability to be empathic and supportive, and to focus on the client’s needs are key requirements of the profession (IASW, 1994; NASW, 2008); therefore, those social workers who have these abilities to a greater degree are perhaps more frequently promoted to supervisory and managerial positions. Social workers who demonstrated a greater belief in the efficacy of EST tended to be younger, have less professional experience, and fewer of them had a private practice. It may be assumed that younger social workers, as well as younger people in general, have a stronger inclination to change society and encourage others to do so as well (Gal & Weiss, 2000; Schwartz, 2006). In addition, younger people tend to have a higher preference for the values of universalism (Schwartz, 2006), which in the present study was associated with a stronger believe in the efficacy of EST.

Limitations of the Present Study and Suggestions for Further Research The most serious limitation of the present study is related to the studied population, which consisted of members of only one psychotherapeutic profession— social workers. As is known from previous studies, social workers have a specific values profile, which includes a relatively high preference for the

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E. Tartakovsky

benevolence, universalism, and self-direction values, and a relatively low preference for the hedonism, achievement, power, and security values (Knafo & Sagiv, 2004). Therefore, the variance of the values may have been rather limited, which may explain the relatively low correlations obtained in the present study. Further studies should try to replicate the results obtained in other groups of psychotherapists, such as psychologists, psychiatrists, nurses, etc. Another limitation of the present study relates to the fact that it was conducted in only one country. Countries differ in their system of value preferences, as well as in the specific circumstances of developing their psychotherapy services, psychotherapy education, and training. Therefore, the results of the present study conducted in Israel should be replicated in other countries. Finally, the present study was a cross-sectional one, which prevents conclusions regarding causality in the relationships between personal values and therapeutic orientations. Further longitudinal studies may resolve this problem. Relatively low correlation coefficients, as well as a low proportion of variance explained by the personal value preferences and socio-demographic characteristics of the therapists probably indicate that there are many other factors that may affect the beliefs in the efficacy of different therapeutic orientations. Further studies should continue testing the effects of different individual-level and organizational-level variables on the therapeutic orientations.

Conclusion The results of the present study are important for both theory and practice. The main theoretical contribution of the study is the enhanced understanding of the motivational foundations of the four therapeutic orientations. The present study revealed that the different therapeutic orientations are associated with specific patterns of value preferences. This finding indicates that different therapeutic orientations promote the attainment of certain motivational goals among therapists while they hamper the attainment of other motivational goals. Therefore, therapists tend to have a greater belief in the efficacy of those therapeutic orientations that enable the attainment of their important motivational goals, as reflected in their pattern of value preferences. As studies on cross-cultural psychology have demonstrated, specific patterns of value preferences constitute a motivational basis for different cultures (Hofstede, 2001; Schwartz, 2004). Therefore, the different therapeutic orientations may be viewed as separate cultures, and psychotherapists who strongly believe in the efficacy of a particular orientation may

be considered members of that specific culture. Considering different therapeutic orientations as separate cultures which fulfill the specific needs of its members may explain the simultaneous existence of many therapeutic orientations, as well as the fact that the continuous efforts to integrate these different orientations have been only partially successful (Neumann & Hirschhorn, 1999; Patterson, 1989). The main practical contribution of the present study is the discovered ability of personal value preferences to predict belief in the efficacies of the different therapeutic orientations. The results obtained indicate that during their career, psychotherapists may tend to gravitate toward those therapeutic orientations which are congruent with their value system. This finding highlights the potential importance of focusing on the personal value preferences of psychotherapists during their university-level education and on-the-job training. An important part of the therapist’s training should be to ensure a sense of congruence between their system of value preferences and what the training course offers. To achieve this goal, the value system of the psychotherapists should be assessed during selection for training. Moreover, therapists themselves should strive to achieve a better understanding of their personal value preferences and motivational goals. In addition, the university departments and the supervisors responsible for on-the-job training should be explicit about their value preferences and their corresponding theoretical allegiance. Finally, during training, as was previously suggested by Buckman and Barker (2010), it would be beneficial for institutions to help trainees become more aware of the links between their value preferences and the various therapeutic orientations, and explore the implications therein. When discussing how to choose the best therapeutic approach for their clients, psychotherapists have been known to say, “Different kinds of folks need different kinds of strokes” (Blatt & Felsen, 1993). The results of the present study indicate that the same may be said for psychotherapists as well. Acknowledgments I thank all students who participated in a senior thesis seminar at the Tel Aviv University School of Social Work and helped to distribute the research questionnaires. I also thank the social workers who completed the questionnaires. Finally, I thank the two reviewers for their thoughtful comments that significantly improved my article.

Psychotherapy Research Note 1

Since 2004, when the last survey of all social workers in Israel was conducted, the number of social workers with a MSW degree substantially increased. Similarly, the number of social workers in private practice may have also increased over the last decade (Hovev, Lontel, & Katan, 2013).

Psychotherapy Research

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Appendix 1. Table A1. Factor analysis results of the TOQ-R.

Psychotherapy Research

Curative factors Psychodynamic therapy 1. Helping the client understand that he or she repeats old behaviors and relations in new situations. 2. Helping the client understand that old reactions and relations are being repeated with the therapist. 3. Encouraging the client to reflect on early emotionally painful experiences. 4. Helping the client see the connections between his or her present problems and childhood. 5. Interpreting the client’s dreams. 6. Analyzing the psychosexual history of the client. 7. Working with the client’s childhood memories. 8. Working with the client’s defenses. 9. Helping the client remember and confront possible physical and sexual abuse. 10. Interpreting the client’s body language. Cognitive behavioral therapy 1. Helping the client to adjust to the existing social circumstances. 2. Giving advice to the client. 3. Assigning homework to the client. 4. Helping the client adapt or adjust to his/her symptoms. 5. Educating the client about his/her symptoms and psychological problems. 6. Focusing on the client’s symptoms. 7. Helping the client to become more reality-oriented. 8. Helping the client to understand how his or her thinking is related to the problematic behavior. 9. Helping the client avoid the mistakes made in the past. 10. Helping the client control his or her emotions. 11. Helping the client to think about himself or herself in a more positive way. Client-centered therapy 1. Being a warm and kind therapist. 2. Conveying unconditional positive regard to the client. 3. Providing the client with emotional support. 4. Making the client feel well liked by the therapist. 5. Encouraging the client’s personal growth and development. 6. Showing compassion and consideration for the client. 7. Helping the client to fulfill his or her potential. 8. Letting the client get things off his or her chest. 9. Encouraging the client to take initiatives in the sessions. 10. Satisfying the client’s emotional needs that have not been satisfied in the past. Eco-systemic therapy 1. Working toward changing laws to make them more benign for clients. 2. Supporting and encouraging the client to join social pressure groups or start a new one. 3. Supporting and encouraging the client to join self-help groups or start a new one. 4. Encouraging the client to live a more active social and community life. 5. Influencing public opinion by presenting your views in the mass media or participating in public protests. 6. Inviting the client’s family and other significant persons in his or her life to take part in the therapy. 7. Helping the client establish contact with different organizations in order to find a job, caretaking facilities for children, or public housing. 8. Helping the client understand his or her sociocultural environment. 9. Helping the client understand and assert his or her cultural values. Eigenvalue Variance explained Cronbach’s α

PDT

CBT

CCT

EST

.801 .799 .792 .742 .736 .717 .703 .690 .551 .537

.031 .040 –.079 .103 –.117 –.196 .023 .014 .036 .082

.035 –.149 .080 .036 –.095 .000 .142 –.070 –.133 .194

.001 –.167 .019 –.034 .124 .006 –.100 –.038 .050 .106

–.048 –.155 –.290 .198 .239 .138 –.127 .269 –.013 –.097 –.168

.697 .658 .652 .632 .631 .598 .592 .560 .528 .483 .463

.147 –.133 –.079 –.013 –.055 –.069 .052 .005 .153 –.017 .202

–.088 –.023 –.018 –.041 .002 .116 –.026 .143 .210 .165 .187

–.178 .092 –.071 –.195 –.127 –.017 .383 .251 .192 .402

–.026 –.121 .098 –.085 .161 –.054 .082 .067 .140 –.158

.714 .713 .709 .698 .611 .549 .542 .510 .464 .423

.065 –.068 –.125 .119 –.061 .033 .060 –.161 –.018 .090

.097 .295 –.038 –.167 .310

–.024 –.063 .136 .116 .073

–.141 –.266 –.001 .173 –.152

.709 .690 .672 .619 .600

–.328 –.126

–.060 .104

.130 –.139

.547 .521

–.090 .094 6.83 16.7% .90

.225 .046 6.01 14.7% .83

.248 .215 3.98 9.70% .81

.490 .429 2.24 5.46% .79