Cited by 168Psychotherapy Techniques and ApplicationsDigital Mental Health InterventionsPersonality Disorders and Psychopathology

What do psychotherapists really do in practice? An internet study of over 2,000 practitioners

Open access
Cook, Joan M., Biyanova, Tatyana, Elhai, Jon, Schnurr, Paula P., Coyne, James C.·2010·Psychotherapy: Theory, Research, Practice, Training

Abstract

Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques. Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation. The modal patient was a White female adult suffering from a mood or anxiety disorder and interpersonal problems. Individual psychotherapy was the preferred treatment modality. The most frequently endorsed techniques were relationship-oriented such as conveying warmth, acceptance, understanding, and empathy. The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy. Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques. © 2010 American Psychological Association.

Integrity signals

Registry

Crossref · 10.1037/a0019788

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Individual psychotherapy was the preferred treatment modality.

    “Individual psychotherapy was the preferred treatment modality.”
    • Also stated in: § Results · plain
      “Individual psychotherapy was the preferred treatment modality in 84% of clinicians”
    Quote in the paperNot a substantial claim
  • Findingown data

    Most clinicians in this study were masters-level clinicians.

    “In addition, most clinicians in this study were masters-level clinicians.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The trend of synthesis or merging of theoretical influences continues.

    “The trend of synthesis or merging of theoretical influences continues.”
    Quote in the paperSubstantial claim
  • Findingown data

    Cognitive-Behavior Therapy was the most popular theoretical approach when the percentages assigned to each model were combined across participants.

    “Cognitive-Behavior Therapy (CBT) was the most popular approach, that is, it constituted a larger percentage of the practitioners’ models when all the endorsed percentages were combined.”
    Quote in the paperSubstantial claim
  • Findingown data

    Techniques that likely fall under CBT, such as assigning homework, challenging thoughts, following a treatment manual, and assigning readings, also appear quite popular in use.

    “Techniques that likely fall under the rubric of CBT (e.g., assign homework or behavioral tasks outside of session; challenge clients’ thoughts or use other cognitive restructuring techniques; follow a treatment manual; and assign readings or self-help books) also appear quite popular in use.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 12
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 8
  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy.

    “The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy.”
    • Also stated in: § Results · plain
      “The following 10 practices were endorsed by less than five percent as used most or all of the time and included biofeedback, neurofeedback, body therapies, hypnotherapy, paradoxical techniques, Eye Movement Desensitization and Reprocessing (EMDR), psychological testing, energy therapies, dream analysis, and use of empty chair or roleplaying techniques.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Compared to Orlinsky et al.'s (2001) psychotherapists, this sample had a higher proportion of female therapists (77% vs. 53%) and therapists were about 17 years older (59 vs. 42).

    “Compared to Orlinsky et al.’s (2001) psychotherapists, this sample had a higher proportion of female therapists (77 vs. 53%), and therapists were about 17 years older (59 vs. 42).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Orlinsky et al., 2001 source
  • May combine two claims.

    Findingown data

    Only 2% of participants identified completely with one theoretical orientation; the rest endorsed an eclectic approach or specified percentages for multiple orientations.

    “Only 59 participants (2%) identified themselves completely with one orientation. The rest either endorsed “eclectic” approach or specified the exact percentages each orientation informs their practice.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Psychotherapeutic integration was common; most respondents identified with more than one theoretical orientation or as having an eclectic orientation.

    “Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation.”
    • Also stated in: § Results · plain
      “Only 59 participants (2%) identified themselves completely with one orientation. The rest either endorsed “eclectic” approach or specified the exact percentages each orientation informs their practice.”
    • Also stated in: § Discussion · plain
      “the majority of participants in this sample identified themselves with more than one theoretical orientation or as having an eclectic orientation.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Psychodynamic techniques were also used often; almost one in three therapists used them with most or all clients, and a similar number used them with some clients.

    “Psychodynamic techniques (e.g., relate current problems to childhood and family experiences; help clients explore unconscious processes) were also used often. Indeed, almost one in three therapists used them with most or all of their clients, and a similar number used them with some of their clients.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    When participants who mentioned using an approach were counted, CBT was the leading orientation (79%), followed by family systems (49%), mindfulness (41%), psychodynamic/analytic (36%), and Rogerian/client-centered/humanistic (31%).

    “When the participants were summed to include everyone who mentioned using a given approach in their practice, CBT was still the leading orientation (n = 1,940; 79%); family systems was the second (1,212; 49%), mindfulness was the third (1,013; 41%), psychodynamic/analytic was the fourth (885; 36%), and Rogerian/client-centered/humanistic the fifth (758; 31%).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    The top 10 therapeutic practices, endorsed by more than half of participants, were relationship-oriented, including conveying warmth and respect, communicating acceptance, communicating understanding, empathizing, promoting expression of feelings, making reflective comments, cultivating the therapeutic relationship, encouraging recreational activities, encouraging emotional processing, and raising

    “The top 10 practices were endorsed by more than half of participants: trying to convey warmth and respect with all or almost all of their clients, followed by communicating that client is accepted and prized, communicating understanding of client’s experience, empathizing with the client, promoting clear, direct expression of client’s feelings, making reflective or clarifying comments, focusing on”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    There is some overlap in the therapeutic technique categories, making it difficult to definitively determine use of particular techniques.

    “In addition, there is some overlap in the therapeutic technique categories (e.g., follow a treatment manual and EMDR) making it difficult to definitively determine use of particular techniques.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The least frequently endorsed techniques, such as hypnotherapy, seem to require specialization or certification beyond standard graduate education.

    “The least frequently endorsed techniques (e.g., hypnotherapy) seem to require specialization or certification beyond what is provided in standard graduate education.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The noninclusion of psychiatrists is another limitation.

    “Because of small numbers as well as likely practice differences, another limitation is the noninclusion of psychiatrists.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Study design and conductown data

    More than 2,200 North American psychotherapists completed a web-based survey covering their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques.

    “Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques.”
    • Also stated in: § Method · plain
      “Between September 2006 and April 2007, 2,739 participants registered and at least partially completed the survey.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A survey of over 300 psychologists working with adults over two decades ago found relational interventions were widely employed and specialized techniques such as flooding were rarely used.

    “Some data concerning what practitioners actually do in therapy comes from a survey of psychologists over two decades ago (Wogan & Norcross, 1985). Over 300 psychologists working with adults were asked about use of 99 techniques. Relational interventions were widely employed, whereas some highly specialized techniques such as flooding were rarely used.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wogan & Norcross, 1985 source
  • May combine two claims.

    Study design and conductreasoning

    The study's main strength and primary limitation is that it was conducted with a large group of therapists in diverse clinical settings across North America via a Web-based survey, and exact generalizability is unknown due to lack of data on nationally representative samples of psychotherapists and detailed information on Psychotherapy Networker subscribers.

    “The main strength of this study is also its primary limitation. It was conducted with a large group of therapists in diverse clinical settings across North America via a Web-based survey and exact generalizability is unknown for a number of reasons including lack of data on nationally representative samples of psychotherapists, and detailed information on Psychotherapy Networker subscribers with”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques.

    “Efforts to disseminate empirically based therapies require understanding and accommodating clinicians’ tendencies to integrate techniques.”
    • Also stated in: § Discussion · boosted
      “Clearly, any attempts to disseminate evidenced-based practices to community psychotherapists should understand and accommodate tendencies to integrate techniques.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    A 2006 investigation of UK Council of Psychotherapy members found that although analytically informed conceptualizations guided most treatments, only 39% actually used psychoanalytic techniques.

    “A more recent investigation examined the practice patterns of members of the United Kingdom Council of Psychotherapy (Tantam, 2006). Although analytically informed conceptualizations guided most treatments, only 39% actually used psychoanalytic techniques.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tantam, 2006 source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The data may reflect a trend in the field of continuing increase in the number of master's-level therapists.

    “Although there are currently no data on the proportion of masters- and doctoral-level clinicians in the mental health field as a whole to which study findings could compare, the data may reflect a trend in the field of the continuing increase in the number of master’s-level therapists (Norcross et al., 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Norcross et al., 2002 source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This limitation may particularly apply to relationship-oriented common-factor techniques.

    “This may particularly be true of relationship-oriented common-factor techniques.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    To aid dissemination of empirical evidence to frontline clinicians, researchers need to understand the patients being seen, their problems, and currently used treatments.

    “To aid in the dissemination of empirical evidence to frontline clinicians, researchers need to understand the patients being seen, their problems, and currently used treatments (Hohmann & Shear, 2002; Kazdin, Siegel, & Bass, 1990).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hohmann & Shear, 2002 source
    • cites Kazdin, Siegel, & Bass, 1990 source
18 of 18
  • The paper relies on this without support.

    There is limited information about what constitutes the routine conduct of psychotherapy in community settings.

    “There is limited information about what constitutes the routine conduct of psychotherapy in community settings.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a large survey among North American mental health workers, exposure ranked among the least frequently applied methods.

    “In a large survey among North American mental health workers exposure ranked among the least frequently applied methods (Cook, Biyanova, Elhai, Schnurr, & Coyne, 2010).”

    From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Cook, Biyanova, Elhai, Schnurr, & Coyne, 2010

    The Method section (page unavailable) describes a survey of 2,156 U.S. and Canadian practitioners. The Results section (page unavailable) ranks techniques by reported use, but its list of the least-used techniques does not include exposure. A search for “exposure” found no result establishing its rank, so the central claim is not supported by our copy. (LLM, conf=0.81)

    Experimental — accuracy not yet measured

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Authors
Cook, J. M., Biyanova, T., Elhai, J., Schnurr, P. P., & Coyne, J. C.
Affiliations
  • Yale University (US)
  • University of Toledo (US)
  • Dartmouth College (US)
  • University of Pennsylvania (US)
Venue
Psychotherapy: Theory, Research, Practice, Training
Published
2010
Volume
47
Issue
2
Pages
260-267
ISSN
  • 0033-3204 (ISSN-L)
  • 1939-1536
OpenAlex
W1986974888
Cited by
168
References
31
Citations by year
2026: 6 · 2025: 8 · 2024: 8 · 2023: 10 · 2022: 8 · 2021: 11 · 2020: 16 · 2019: 11 · 2018: 13 · 2017: 13 · 2016: 13 · 2015: 7 · 2014: 16 · 2013: 10 · 2012: 10
FWCI
8.46
Type
journal article
Language
en
Open access
Locations
  • Psychotherapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Mental Health (K01 MH070859)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
theoretical orientation, eclectic therapy, psychotherapy integration, psychotherapeutic interventions, individual psychotherapy, client characteristics, mood and anxiety disorders, interpersonal problems
MeSH terms
Adult, Mental Disorders, Canada, Career Choice, Data Collection, Female

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