Enhancing Quality in
School Mental Health

Task Force Findings

A recent Task Force of the Clinical Psychology Division of the APA focused on the empirical support for the importance of the therapeutic relationship. The Task Force addressed two questions:
What works in general in therapeutic relationships?
How do you customize interventions to match specific client needs and characteristics so that it works best for the client?
In respect to question 1, What works...? they report that the following are Demonstrably effective elements:
Therapeutic alliance
Cohesion in group therapy
Empathy
Goal consensus and collaboration
Promising and probably effective elements are:
Positive regard
Congruence, genuineness
Feedback
Repair of alliance ruptures
Self-disclosure
Management of counter-transference
Quality of relational interpretations
In terms of question 2, How to customize interventions…? they report that the following are Demonstrably effective elements:
Matching therapeutic directiveness to level of resistance
Lengthier, more intensive intervention to address higher functional impairment
Promising and probably effective elements are:
Matching intervention to coping style
Stages of change
Personality style of the client
Client expectations
Client’s ability to assimilate problematic experiences
There was no evidence to support customizing therapy for the following client characteristics:
Attachment style
Gender
Ethnicity
Religion and spirituality
Preferences
Personality disorders
School mental health clinicians must keep in mind how the therapeutic relationship will be affected a hiatus during school breaks and address these issues in therapy.
Norcross, J.C. & Hill, C.E. (2004). Empirically supported therapy relationships. Clinical Psychologist, 57, 19-24.

Promoting empirically supported therapy
relationships

The Task Force (see p. 1) makes the following recommendations which can be applied to school-based mental health (SBMH) clinicians:
Clinicians are encouraged to make the creation and cultivation of a therapy relationship characterized by the elements found to be effective (see p.1) a primary aim in the treatment of students.
2. Clinicians are encouraged to adapt the therapy relationship to specific student characteristics in the ways shown to enhance therapeutic outcome (see p.1).
3. Clinicians are encouraged to routinely monitor students’ responses to the therapy relationship and ongoing treatment. Such monitoring leads to increased opportunities to repair alliance ruptures, to improve the relationship, to modify technical strategies, and to avoid premature termination.
4. The use of empirically supported relationships together with empirically supported treatments tailored to the student’s problem/disorder and characteristics is likely to generate the best outcomes.
Norcross, J.C. & Hill, C.E. (2004). Empirically supported therapy relationships. Clinical Psychologist, 57, 19-24.