Operationalization of therapist’s prescriptive interventions from the process-outcome literature in psychotherapy

Authors

  • Marcelo Carneiro Cardamoni Paradigma – Centro de Ciências e Tecnologia do Comportamento Author
  • Denis Zamignani Instituto Par Author

DOI:

https://doi.org/10.31505/rbtcc.v28i1.2091

Keywords:

Directive Interventions, process-outcome research, helping skills, recommendation, behavior-analytic psychotherapy

Abstract

Therapists from different approaches occasionally offer suggestions, advice, or recommendations. Such behaviors characterize prescriptive therapeutic interventions and fall under the therapist behavior category described by SiMCCIT as Recommendation. This study aimed to investigate the use of interventions analogous to Recommendation in clinical practice through an integrative review from 2007 to 2024, using the following databases: PubMed, PsycNET, ScienceDirect, Lilacs, MedLine, and Scielo. The search yielded eight selected scientific articles. The data obtained highlighted the characterization, properties, moderating factors of Recommendation, its relationship with the therapeutic alliance, functions, and effects on outcomes. The results identified Recommendation as a broad class of interventions that includes advice, homework, and in-session task requests. It can be used at different stages of the therapeutic process and is effective for various therapeutic and diagnostic client goals, potentially impacting the therapeutic alliance either positively or negatively.

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References

Beutler, L. E., Moleiro, C., & Talebi, H. (2002). Resistance in psychotherapy: What conclusions are supported by research. Journal of Clinical Psychology, 58(2), 207–217. https://doi.org/10.1002/jclp.1144 DOI: https://doi.org/10.1002/jclp.1144

Bischoff, M. M., & Tracey, T. J. G. (1995). Client resistance as predicted by therapist behavior: A study of sequential dependence. Journal of Counseling Psychology, 42(4), 487–495. https://doi.org/10.1037/0022-0167.42.4.487 DOI: https://doi.org/10.1037//0022-0167.42.4.487

Catania, A. C. (1999). Aprendizagem: Comportamento, linguagem e cognição (4ª ed., D. G. de Souza, Trad.). Artmed. (Obra original publicada em 1998)

Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2018). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15(1), 207–231. https://doi.org/10.1146/annurev-clinpsy-050718-095424 DOI: https://doi.org/10.1146/annurev-clinpsy-050718-095424

(*) Duan, C., Hill, C., Jiang, G., Hu, B., Chui, H., Hui, K., Jingqing, L., & Yu, L. (2012). Therapist directives: Use and outcomes in China. Psychotherapy Research, 22(4), 442–457. https://doi.org/10.1080/10503307.2012.664292 DOI: https://doi.org/10.1080/10503307.2012.664292

Edwards, C. J., Beutler, L. E., & Someah, K. (2019). Reactance levels. In J. C. Norcross & B. E. Wampold (Eds.), *Psychotherapy relationships that work: Volume 2: Evidence-based therapist responsiveness* (3rd ed., pp. 188–211). Oxford University Press. https://doi.org/10.1093/med-psych/9780190843960.003.0007 DOI: https://doi.org/10.1093/med-psych/9780190843960.003.0007

Elliott, R. (2010). Psychotherapy change process research: Realizing the promise. Psychotherapy Research, 20(2), 123–135. https://doi.org/10.1080/10503300903470743 DOI: https://doi.org/10.1080/10503300903470743

Ercole, F. F., Melo, L. S. de, & Alcoforado, C. L. G. C. (2014). Revisão integrativa versus revisão sistemática. Revista Mineira de Enfermagem, 18(1), 1–11. https://doi.org/10.5935/1415-2762.20140001 DOI: https://doi.org/10.5935/1415-2762.20140001

Hayes, S. C., Zettle, R. D., & Rosenfarb, I. (1989). Rule following. In S. C. Hayes (Ed.), Rule-governed behavior: Cognition, contingencies, and instructional control (pp. 191–220). Plenum Press. https://doi.org/10.1007/978-1-4757-0447-1_6 DOI: https://doi.org/10.1007/978-1-4757-0447-1_6

Hill, C. E. (2020). Helping skills: Facilitating exploration, insight, and action (5th ed.). American Psychological Association. https://doi.org/10.1037/0000147-000 DOI: https://doi.org/10.1037/0000147-000

Juliani, L. C. A. (2019). Investigação dos processos envolvidos no repertório de interpretar do terapeuta na terapia analítico-comportamental (TAC) [Qualificação de mestrado profissional não publicada]. Associação Paradigma – Centro de Ciências e Tecnologia do Comportamento.

Kanamota, P., Oliveira, A., Morais, W., Zamignani, D., Almeida, R. de, Ramos, A. C., Pantet, A., Oliveira, A. D. de, Andrade, L. M. de, Hayamizu, N., & Rodrigues, B. (2019). O conceito de responsividade na terapia analítico-comportamental e suas implicações para a pesquisa de processo-resultado. Perspectivas em Análise do Comportamento, 10(1), 114–128. https://doi.org/10.18761/PAC.TAC.2019.016 DOI: https://doi.org/10.18761/PAC.TAC.2019.016

Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432 DOI: https://doi.org/10.1146/annurev.clinpsy.3.022806.091432

(*) Kazantzis, N., & Dattilio, F. M. (2010). Definitions of homework, types of homework, and ratings of the importance of homework among psychologists with cognitive behavior therapy and psychoanalytic theoretical orientations. Journal of Clinical Psychology, 66(7), 758–773. https://doi.org/10.1002/jclp.20699 DOI: https://doi.org/10.1002/jclp.20699

Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7(2), 189–202. https://doi.org/10.1093/clipsy.7.2.189 DOI: https://doi.org/10.1093/clipsy.7.2.189

Klostermann, K., Mignone, T., Mahadeo, M., & Papagni, E. (2019). The truth about what works in psychotherapy. Journal of Psychology and Clinical Psychiatry, 10(1), 57–58. https://doi.org/10.15406/jpcpy.2019.10.00627 DOI: https://doi.org/10.15406/jpcpy.2019.10.00627

Llewelyn, S., Macdonald, J., & Aafjes-van Doorn, K. (2016). Process–outcome studies. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, & B. O. Olatunji (Eds.), APA handbook of clinical psychology: Theory and research (pp. 451–463). American Psychological Association. https://doi.org/10.1037/14773-020 DOI: https://doi.org/10.1037/14773-020

Matos, M. A. (2001). Comportamento governado por regras. Revista Brasileira de Terapia Comportamental e Cognitiva, 3(2), 51–66. https://doi.org/10.31505/rbtcc.v3i2.135 DOI: https://doi.org/10.31505/rbtcc.v3i2.135

(*) McAleavey, A. A., & Castonguay, L. G. (2013). Insight as a common and specific impact of psychotherapy: Therapist-reported exploratory, directive, and common factor interventions. Psychotherapy, 51(2), 283–294. https://doi.org/10.1037/a0032410 DOI: https://doi.org/10.1037/a0032410

Meyer, S. B. (2005). Regras e auto-regras no laboratório e na clínica. In J. Abreu-Rodrigues & M. R. Ribeiro (Orgs.), Análise do comportamento: Pesquisa, teoria e aplicação (pp. 211–227). Artmed.

Meyer, S. B., & Donadone, J. (2002). O emprego da orientação por terapeutas comportamentais. Revista Brasileira de Terapia Comportamental e Cognitiva, 4(2), 79–90. https://doi.org/10.31505/rbtcc.v4i2.108 DOI: https://doi.org/10.31505/rbtcc.v4i2.108

Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2013). The outcome of psychotherapy: Yesterday, today, and tomorrow. Psychotherapy, 50(1), 88–97. https://doi.org/10.1037/a0031097 DOI: https://doi.org/10.1037/a0031097

(*) Ng, C. T. C., & James, S. (2013). "Directive approach" for Chinese clients receiving psychotherapy: Is that really a priority? Frontiers in Psychology, 4, Article 49. https://doi.org/10.3389/fpsyg.2013.00049 DOI: https://doi.org/10.3389/fpsyg.2013.00049

(*) Pardo, M. B. L., & Carvalho, M. M. S. B. (2011). Grupo de orientação de mães no contexto de uma clínica-escola. Paidéia (Ribeirão Preto), 21(48), 93–100. https://doi.org/10.1590/S0103-863X2011000100011 DOI: https://doi.org/10.1590/S0103-863X2011000100011

(*) Prebianchi, B. H. (2011). Orientação de pais no processo de psicoterapia infantil de grupo. Psicologia em Revista, 17(1), 135–145. https://doi.org/10.5752/P.1678-9563.2011v17n1p135 DOI: https://doi.org/10.5752/P.1678-9563.2011v17n1p135

(*) Rautalinko, E. (2017). Directiveness in psychotherapy: A phenomenological-narrative study of therapist attitudes. Psychology and Psychotherapy: Theory, Research and Practice, 90(4), 600–616. https://doi.org/10.1111/papt.12128 DOI: https://doi.org/10.1111/papt.12128

Sidman, M. (2009). Coerção e suas implicações (M. A. Andery & T. M. Sérgio, Trad.). Editora Livro Pleno. (Obra original publicada em 1991)

Skinner, B. F. (1953). Science and human behavior. Macmillan.

Skinner, B. F. (1957). Verbal behavior. Appleton-Century-Crofts. DOI: https://doi.org/10.1037/11256-000

Skinner, B. F. (1969). Operant behavior. In B. F. Skinner, Contingencies of reinforcement: A theoretical analysis (pp. 105–132). Appleton-Century-Crofts. (Trabalho original publicado em 1963)

Skinner, B. F. (1982). Sobre o behaviorismo (M. P. Villalobos, Trad.). Cultrix. (Obra original publicada em 1974)

Souza, M. T. S., Silva, M. D., & Carvalho, R. (2010). Revisão integrativa: O que é e como fazer. Einstein (São Paulo), 8(1), 102–106. https://doi.org/10.1590/S1679-45082010RW1134 DOI: https://doi.org/10.1590/s1679-45082010rw1134

Stiles, W. B. (1999). Signs and voices in psychotherapy. Psychotherapy Research, 9(1), 1–21. https://doi.org/10.1080/10503309912331332561 DOI: https://doi.org/10.1093/ptr/9.1.1

Stiles, W. B. (2009). Responsiveness as an obstacle for psychotherapy outcome research: It's worse than you think. Clinical Psychology: Science and Practice, 16(1), 86–91. https://doi.org/10.1111/j.1468-2850.2009.01148.x DOI: https://doi.org/10.1111/j.1468-2850.2009.01148.x

Stiles, W. B., Honos-Webb, L., & Surko, M. (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice, 5(4), 439–458. https://doi.org/10.1111/j.1468-2850.1998.tb00166.x DOI: https://doi.org/10.1111/j.1468-2850.1998.tb00166.x

Zamignani, D. R. (2007). O desenvolvimento de um sistema multidimensional para a categorização de comportamentos na interação terapêutica [Tese de doutorado, Universidade de São Paulo]. Biblioteca Digital de Teses e Dissertações da USP. https://doi.org/10.11606/T.4.2008.tde-21052009-091808

Zamignani, D. R., & Banaco, R. A. (2017). Relação terapêutica no contexto da clínica: Um enfoque analítico-comportamental. In M. C. O. S. Miyazaki, M. L. M. Teodoro, & R. Gorayeb (Orgs.), PROPSICO Programa de Atualização em Psicologia Clínica e da Saúde: Ciclo 1 (Vol. 1, pp. 66–100). Artmed Panamericana.

Zamignani, D. R., & Meyer, S. B. (2014). A pesquisa de processo em psicoterapia: O desenvolvimento do SiMCCIT – sistema multidimensional para a categorização de comportamentos na interação terapêutica. Editora Paradigma.

Zamignani, D. R., Rabelo, L. Z., & Hayamizu, N. (2024). Nível de diretividade que terapeutas comportamentais devem exercer: Em defesa de uma terapia reflexiva. In A. Dittrich, J. L. Leonardi, & J. M. da Silveira (Orgs.), Valores nas terapias comportamentais: Relação terapêutica, ética e política (pp. 250-285). Sinopsys.

(*) Zemel, A. (2016). Embedded instruction: Proxy voicing in couples therapy. Journal of Pragmatics, 97, 21–36. https://doi.org/10.1016/j.pragma.2016.04.001 DOI: https://doi.org/10.1016/j.pragma.2016.04.001

Published

2026-08-14

Issue

Section

Review Articles

How to Cite

Carneiro Cardamoni, M., & Zamignani, D. (2026). Operationalization of therapist’s prescriptive interventions from the process-outcome literature in psychotherapy. Brazilian Journal of Behavioral and Cognitive Therapy, 28(1), e262091. https://doi.org/10.31505/rbtcc.v28i1.2091