The Generic Model of Psychotherapy After 25

Years: Evolution of a Research-Based Metatheory

David E. Orlinsky

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University of Chicago

The Generic Model of Psychotherapy was initially presented 25 years ago

(Orlinsky & Howard, 1984) and was conceived as a transtheoretical frame for
integrating the varied empirical findings of hundreds of studies relating therapeutic process to outcome that had appeared during the previous 3 decades into
a coherent body of knowledge (Orlinsky & Howard, 1986). This article briefly
reviews the conceptual model as an integrative metatheory for research and
practice and traces its continued growth based on subsequent innovations in
process outcome research, reflections on the human contexts of psychotherapy,
and current limitations in the field of psychotherapy research.
psychotherapy integration, Generic Model of Psychotherapy, processoutcome research, outcome variable domains

Keywords:

The Generic Model of Psychotherapy was initially presented 25 years

ago at the first meeting of the Society for the Exploration of Psychotherapy
Integration (SEPI) in Annapolis, MD, and celebrated its silver anniversary
with SEPI in Seattle.1 The interest this conceptual model should hold for
SEPI members in particular stems from the fact that it offers a comprehensive framework in which various clinical theories of psychotherapy can
David Orlinsky, Department of Comparative Human Development, The University of
Chicago.
Correspondence concerning this article should be addressed to David E. Orlinsky,
Department of Comparative Human Development, The University of Chicago, 5730 South
Woodlawn Avenue, Chicago, IL 60637. E-mail: d-orlinsky@uchicago.edu

1
Presented at the 25th annual conference of the Society for the Exploration of Psychotherapy Integration in Seattle on May 15, 2009; revised from an earlier version delivered on
November 3, 2008, at a symposium celebrating the 50th anniversary of the School of Psychology at the Catholic University of Chile in Santiago, Chile.

319
Journal of Psychotherapy Integration
2009, Vol. 19, No. 4, 319 339

2009 American Psychological Association

1053-0479/09/$12.00 DOI: 10.1037/a0017973

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Orlinsky

be systematically compared and combined. The Generic Model is not itself

a clinical practice theory but might be described instead as a researchbased metatheory of psychotherapythe implication of the term metatheory being that the model is formulated at a taxonomically higher level,
and stands in the same hierarchical relation to clinical practice theories that
a taxonomic genus has to species within it (e.g., within genus Homo such
related species as Homo habilis, Homo erectus, Homo neantherthalis, and
Homo sapiens sapiens).2
Figure 1 illustrates this hierarchical relation between the Generic
Model as a research-based metatheory of therapy and the clinical practice
theories that it comprehends. By standing a step beyond clinical practice
theories or treatment models (as genus to species), the Generic Model links
them in a way that allows one to draw on each as a source of guidance in
practice without needing to reconcile the frequently conflicting visions of
human nature and personality that the clinical theories espouse, and make
some theoretical hybrids appear to be gargoyles full of contradictory
features.
This use of the Generic Model as a means to the integration of clinical
practice theories is actually incidental to its initial purpose, which was to
provide a coherent account of research findings in a large number of
studies on the relation of varied aspects of therapeutic process to the
clinical outcomes attained by patients, published in the third edition of
Bergin and Garfields Handbook of Psychotherapy and Behavior Change
(Orlinsky & Howard, 1986). This initial goal led to the formation of a
research theory of therapy that took as its subject matter the variables that
researchers had studied and the results they had found, and sought to
connect these in a coherent and parsimonious framework. By contrast,
clinical practice theories take patients problems, personalities, and circumstances at their subject matter, and propose ways to understand those
problems, define feasible goals for treating those problems, and provide
technical interventions (i.e., useful procedures) to attain those goals.3
2
Taxonomically, the class of modern psychotherapies can be viewed as part of a larger
family of helping relationships that includes other specialized professional helping relationships (e.g., education, social work, medicine, nursing, and the new practice called
coaching) as well as the basic social helping relationships from which they derive (e.g.,
parenthood, mentoring, friendship, and communal solidarity).
3
The value of a clinical practice theory is tested by how well it empowers therapists to
help their patients. On the other hand, the value of a research theory of therapy is tested by
its ability to suggest interesting research questions, guide researchers in designing studies to
answer those questions, make sense of their findings, and knit them into a comprehensive
body of knowledge. Even though the subject matter (i.e., psychotherapy) is ostensibly the
same, the very different functions of research theories and clinical practice theories suggest
that they be clearly distinguished.

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Generic Model of Psychotherapy After 25 Years

321

Figure 1. Two modes of theoretical integration in psychotherapy.

Research theories and clinical practice theories of psychotherapy

differ so greatly in their respective functions that they are not really
comparable, despite the fact that all are theories and all are about
therapy. However, a research theory of therapy becomes taxonomically
superordinate to clinical practice theories of therapy when the latter are
viewed as variables in a study (e.g., when different treatment models are
compared as aspects of therapeutic process). This is what happened in
the Generic Model of Psychotherapy and is the source of its ability to
serve as an integrative bridge between diverse clinical practice theories.
In what follows, I briefly describe the aspects of therapeutic process
distinguished in the Generic Model, and then I turn to recent extensions of
the model from its initial focus on process to the realm of outcomea
realm that heretofore has been rather poorly conceptualized.

ASPECTS OF THERAPEUTIC PROCESS

The Generic Model starts with a simple distinction between therapy
processincluding all the actions, events and experiences that occur in psy-

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Orlinsky

chotherapyand the individual and social contexts in which psychotherapy

occurs. For the most part, process refers to what transpires during therapy
sessions, in terms of the participants experiences and perceptions and their
behavioral interactions. However, the therapeutic process also includes the
patients thoughts, feelings, memories and actions relating to therapy and the
therapist in the time between sessionsas well as the therapists thoughts,
feelings, memories, and actions with respect to the patient between sessions.
Much research has been conducted on in-session processes, but only a little so
far on intersession processes (Hartmann, Orlinsky, Weber, Sandholz, &
Zeeck, 2010; Orlinsky, Geller, Tarragona, & Farber, 1993).
The Generic Model originally organized in-session process in terms of
five broad categories of variables that researchers had studied: therapeutic
contract, therapeutic operations, therapeutic bond, participants selfrelatedness, and in-session impacts. Later, after developments in therapy
research, temporal process patterns was added as a sixth category.

Therapeutic Contract
The therapeutic contract is the formal or organizational aspect of therapy
process, answering the question What business do these persons have with
each other? The therapeutic contract typically takes the form of a mutual
understanding between therapist and patient concerning the goals of their
clinical collaboration; the methods to be used in it; the site, schedule, duration,
and cost of this work; the treatment modality or form in which it is to be
conducted (e.g., as individual, couple, family, or group therapy); and the norms
governing the participants behavior in their roles as patient and therapist.
Without general agreement on these contractual issues, the therapeutic process cannot begin. If the terms of the contract are not implemented in good
faith, or if the norms are violated, a breach of contract will effectively cause
treatment to stop. Nowadays, the contract often also includes third parties who
have influence or control over the treatment (e.g., insurance payers, or parents
of a child or adolescent patient).
Figure 2 sketches the main features of the therapeutic contract, which
consists essentially of the application in particular cases of the clinical
theory or treatment model that the therapist has learned. The therapists
treatment theory influences the therapeutic contract primarily by determining how the roles of patient and therapist are defined, which treatment
goals are viewed as desirable and attainable, what methods are best used to
reach those goals, and what manner of relationship with patients is optimal
when employing those methods. The therapeutic contract sets standards
that guide and limit therapists actions, and parallel expectations for how

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Generic Model of Psychotherapy After 25 Years

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Figure 2. Generic model of psychotherapy process components: Therapeutic contract.

patients ought to act. Viewing treatment models instrumentally, as a guide

and road map rather than a sacrosanct ideology, one can see the advantage
in a therapists gaining mastery of several (e.g., being well equipped to
effectively treat a broad range of patients).

Therapeutic Operations
Once there is a mutual understanding on basic contractual issues, the
actual work or business of therapy can proceed; that is, the therapeutic
operations performed in their interactions by patient and therapist, respectively. This is the technical, or instrumental, aspect of process.
Figure 3 illustrates a continuous cycle of work that can be distinguished
into four steps, starting with (1) the patients verbal and nonverbal presentation
of complaints and information to the therapist about problematic feelings,
symptoms, or life situations. (2) The therapist, drawing on one or more
treatment model, constructs an expert understanding of what she takes to be
the real problem underlying the patients complaints, and then (3) offers an

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Orlinsky

Figure 3. Generic model of psychotherapy process components: Therapeutic operations.

appropriate treatment intervention. This evokes (4) some form of co-operation,

which may be compliant and cooperative or resistant and uncooperative.
Whatever it is, this provides further information to the therapist about the
patient and thus becomes the starting point for a new turn of the cycle. In
Figure 3, the dotted arrow on the left indicates that the patients response can
lead beyond these proceedings to become an in-session impact and make a
positive or negative contribution to patient outcome.

Therapeutic Bond
The therapeutic contract, and the technical operations based on it,
concern the formal roles of therapist and patient in psychotherapy. However, the individuals who enact those roles are actual, flesh-and-blood

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Generic Model of Psychotherapy After 25 Years

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persons who have characteristics and qualities that go beyond their roles in
therapy, and these personal characteristics influence how they interpret
and perform their roles. As individuals, they may be of the same or
opposite gender; may be of similar or widely differing ages; may come from
the same or different social classes and subcultures; may be physically
attractive or unattractive; may dress conservatively or provocatively, and in
or out of fashion. Their social manners may be friendly and outgoing,
assertive and challenging, or shy and sensitive; their speech and movements
may be awkward or graceful. All these characteristics are extrinsic to
their roles in therapy but will influence the quality and dynamic of the
human connection or therapeutic bond that they form. This bond is the
interpersonal aspect of therapy process, and it has been consistently shown
by an impressive range of research to be importantly related to therapy
outcome (Orlinsky, Rnnestad, & Willutzki, 2004).
Figure 4 reflects the fact that analysis of research variables suggests that
two aspects of the therapeutic bond can be distinguished. One may be called
task-teamwork, the quality of which is determined by how much personal
investment the individuals have in their respective roles and how well the

Figure 4. Generic model of psychotherapy process components: Therapeutic bond.

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typical leadership stance of each mesh with one another with respect to
initiative and control (i.e., do they dance well together, or step on each
others toes). The other side of the bond consists of the personal rapport that
develops between the individuals, determined by their empathic resonance
reflecting their expressive attunement to one another, and the emotional
climate determined by their affective response to one another. Accordingly,
they may be on the same wavelength when communicating, or may just talk
past each other; and may feel liking and respect, disliking or mistrust, or be
emotionally neutral or indifferent toward one another. It is easy to see how the
task-teamwork and personal rapport between those who occupy patient and
therapist roles would make a difference both in how effectively they work
together and how effectively the therapeutic relationship itself would serve to
restore the patients morale.

Self-Relatedness
A fourth category of process variables that researchers have studied
includes the patients psychological openness or defensiveness as manifested in
therapy. This intrapersonal aspect of process refers to the cognitive and
emotional controls that govern self-awareness, self-direction, self-discipline
and self-esteem, and was first described as patient self-relatedness. Eventually, it was realized that therapist variables, such as measures of Rogerss
concept of self-congruence, also fit this category and thus we now refer to this
process aspect as participant self-relatedness, or the way in which persons
perceive and respond to themselves while interacting with those around them.
Figure 5 suggests that the patients self-relatedness has a major influence
on how much what happens in therapy is effective. Self-relatedness functions
as a gate or variably permeable filter through which therapeutic operations,
and the qualities of the therapeutic bond, are taken in by the patient to
become in-session impacts and, eventually, contributions to clinical outcome.

In-Session Impacts
The process variables classified as in-session impacts were initially
called therapeutic realizations because the emphasis was on positive
results attained during sessions such as insight, emotional relief, and a
sense of courage and hope for the future; but it was soon recognized that
negative impacts in sessions also occur, resulting in confusion instead of
insight, anxiety rather than relief, or discouragement in place of hope
impacts that, if sustained, can lead to deterioration effects (e.g., Bergin &

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Generic Model of Psychotherapy After 25 Years

327

Figure 5. Generic model of psychotherapy process components: Participant self-relatedness.

PT patient; TH therapist.

Lambert, 1978; Lambert & Ogles, 2004). More recently, the category of
in-session impacts has expanded to include studies that focus on the impacts of
therapeutic work on therapists (e.g., Orlinsky & Rnnestad, 2005)for example, positive impacts such as intrinsically rewarding flow experiences
(Csikszentmihalyi, 1990) and negative impacts such as burnout.
Figure 6 represents in-session impacts as the pot of gold (or lead,
in the case of negative impacts) at the end of the rainbow where the clinical
aspects of therapeutic process collect and are carried forward into the life
situation of the patient (which is most important) but also into the therapists life. I will return shortly to consider the life contexts in terms of which
outcomes of therapy may be reckoned, but first I will briefly mention a new
aspect of therapeutic process and consider the way that the different
process aspects function together.

Temporal Patterns
The Generic Model was initially designed to take account of the kinds
of variables that were included in process-outcome research, and has added

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Figure 6. Generic model of psychotherapy process components: In-session impacts. PT

patient.

new elements as researchers have expanded the topics they study. As

researchers began to investigate the temporal sequence of events within
and between therapy sessions, a new category, temporal patterns, was introduced to the Generic Model in 1994 (Orlinsky, Grawe, & Parks, 1994). The
five process aspects previously mentioned must be viewed as coexisting at each
moment, all being always present together in one or another configuration.
Variables in the temporal patterns category represent these configurations as
they change over time as microevents within therapy sessions and macroevents
over the course of treatment. Adding the model of change stages proposed by
Prochaska and colleagues extends the scope of temporal patterns even further
(e.g., Prochaska, Rossi, & Wilcox, 1991) These show that the nature of events
in therapy is partly determined by whether they occur early, middle, or late in
a session or early, middle, or late in the course of treatment.

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Interrelations of Process Components

The Generic Model of Psychotherapy envisions process as a complex
system in which the various aspects of process function in a unified way,
each aspect influencing and being influenced by all the others.
Figure 7 illustrates the systemic nature of process and uses arrows to
suggest some of the principal paths of influence. To review briefly, the
therapists clinical theory or treatment model defines the terms of the
therapeutic contract, including patient and therapist roles and the aims and
methods that guide and set boundaries on their interactions. The patient
role guides those who enter therapy in how to present themselves and their

Figure 7. Generic model of psychotherapy: Interrelated aspects of therapy process. PT

patient; TH therapist.

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problems to the therapist, as their part in therapeutic operations. The

therapists treatment model, enacted through the therapist role, provides a
diagnostic scheme of disorders or problem types as an aid to understanding
what the patient presents, and a repertory of appropriate interventions. In
addition, the therapists treatment model usually specifies an optimal manner of relating to patients that contributes to forming a therapeutic bond,
but the bond is also influenced by the personalities of the individual who
participate as patient and therapist (not shown in this diagram).
The therapeutic bond occupies a central place in therapy process, as it
does in the diagram. The personal rapport and teamwork of the
patient and therapist have an influence on therapeutic operations; for
example, by encouraging or discouraging patient self-disclosure, or helping
the therapist judge when and how to intervene in response to the patient.
Patient cooperation with therapist interventions will also be influenced by
in the bond; for example, by the degree of the patients trust in the
therapist.
When a therapists intervention is appropriate, and a patients cooperation engages positively with it, chances are good that the patient will
learn something useful (using the term learn in its broadest sense). Thus
therapeutic operations may have an influence that registers, hopefully
favorably, as an in-session impactif the patients state of self-relatedness
is sufficiently open, although not if the patient is cognitively and emotionally closed. These states are a situational expression of personality traits
such as psychological mindedness and ego-strength or defensiveness and
fragility; along with the support that the patient feels from the therapeutic
bond, they determine how much the patient can take in. This explains why
well-disposed, high-functioning persons can benefit from almost any sort of
therapeutic intervention, giving rise to the so-called Dodo Bird effect
(Luborsky, Singer, & Luborsky, 1975), yet even very skillful and experienced therapists find it difficult to succeed with patients (e.g., borderlines
or psychotics) who have difficulty forming a secure therapeutic bond.
The therapeutic bond can also have a direct positive influence on
patient in-session impacts, as a strong therapeutic bond helps to counteract
a patients sense of demoralization (Frank, 1974) and increase feelings of
confidence, hope for the future, and courage to approach previously
avoided feelings, memories, or behaviors. The therapeutic bond nonverbally communicates emotional messages to the patient containing information highly relevant to the patients self-evaluationso that the therapists
interest, warmth, and committed involvement tacitly convey that the patient is someone who is interesting, likable, and worthwhile, if the patient
is not too self-preoccupied to receive the message or too self-deprecating to
find the message believable.

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Finally, I would also note a feedback effect by which in-session impacts

influence other process aspects. Positive in-session impacts tend to
strengthen the therapeutic bond by enhancing a patients personal investment and increasing trust, respect, and liking for the therapist. In therapy
as elsewhere, nothing succeeds like success. By contrast, negative or
psychonoxious in-session impacts normally have the opposite effect.
Patients who feel shamed, demeaned, or criticized by their therapists are
likely to become defensive or withdraw from the bond.
These varied aspects of therapy process are implemented in different
ways in different treatment models, but all therapies involve some form of
therapeutic contract, some type of therapeutic operation, some sort of
therapeutic bond, some degree of self-relatedness, and some kind of insession impact. The relative salience of the different aspects also varies
over time, both within sessions and across the whole course of treatment.
For example, the therapeutic contract is bound to be a prominent concern
in the first phase of treatment, at the end of therapy (if there is a review of
the progress made with respect to treatment goals), and on occasions over
the course of therapy when the bounds of patient and therapist roles are
seriously challenged or transgressed. The first phase of treatment is also the
time when a positive therapeutic bond must be formed and when therapeutic operations typically concentrate on the patients presentation and
the therapists assessment of the problems that brought the patient to
treatment. After that, therapy typically enters a main working phase in
which therapeutic operations and in-session impacts are the most salient
process aspects. If treatment is not interrupted or does not stop unexpectedly, a valedictory termination phase will typically follow in which the
therapeutic bond is salient and the therapeutic contract is mutually dissolved. However, as these process aspects may shift in salience over time in
specific cases, it is essential to see that all of the aspects are always present,
like the facets of a jewel viewed one way or another.

THE HUMAN CONTEXTS OF PSYCHOTHERAPY

Now we need to look beyond the therapeutic process to the even more
complex human contexts in which therapy takes place and consider the
question of outcome. Traditionally, measures of outcome have assessed the
impact of therapy on the patients life and personality outside of therapy,
most often after therapy has ended but the features of patients lives and
personalities focused on have been limited for the most part to (a) psychological or psychosomatic symptoms, (b) the maladaptive or psychopathological personality traits presumed to underlie symptom formation,

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(c) patients general subjective sense of well-being, and sometimes also (d)
their ability to perform in basic social roles, at work or school or in family
relations. This selection of features reflects the dominance of the medical
model in thinking about psychotherapy and the utilitarian concerns of
health care insurance providers and their corporate customers. My only
objection to this (but, I think, an important one) is that it is too narrow and
does not fairly reflect the nature of psychotherapy or the range of uses that
patients make of it. It has also unfortunately transformed the field of
psychotherapy research into an applied science obsessed by the question
what works? and away from the potential it holds for basic research on
personality and interpersonal relations, group dynamics and psychocultural
process.
In response to this, the conceptual domain framing outcome assessment has been the area of most significant development in the Generic
Model of Psychotherapy during the past decade. Initially, the Generic
Model differentiated outcome measures only in terms of their results
(positive, neutral, or negative) and the observational perspectives from
which the results were judged (patients, therapists, external clinical observers, or psychometric measures). More recently, developments in the Generic Model regarding outcomes have come from concepts in related fields
of social science as well as new research studies of psychotherapists.4
The first step in broadening this conceptual domain recalls the distinction initially made between therapy process and the human contexts in
which it occurs. Therapy process, viewed as a system of distinct but
interacting aspects, is influenced by prior conditions in these contexts, and
in turn has some influence on subsequent conditions in these contexts. If
one were to make a flowchart of this, the relevant functional influences of
the contexts on therapy process would be called inputs (or determinants)
and the functional influences of therapy process on these contexts would be
called outputs (or consequences).
Here, an important distinction must be made between outcome and
output. Outcome refers to the clinical result of therapy for patients; output
refers to all of the consequences that result from engagement in psychotherapy, including but not limited to outcomes for patients. Clearly questions of outcome will always be an important concern: Do patients
thoughts, emotions, and behaviors become less distressing, less symptomatic, more efficient and adaptive, as a result of their participation in
therapy? However, important as these practical issues may be, it is also
important to recognize that therapy has consequences for the patients
life-situation and developmental life-trajectory. Are patients current rela4
I have explored diverse approaches to the conceptualization of context domains in the
past few years (e.g., Orlinsky, 2004a, 2004b, 2008; Orlinsky & Rnnestad, 2005).

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Generic Model of Psychotherapy After 25 Years

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tionships and current life situations improved by their experiences in

therapy? Do their lives become more satisfying, more meaningful, more
personally fulfilled and socially productive?
Questions about outcome are basically questions about the relation of
therapy process to one specific portion of its human contextthe quality
and character of the patients life outside of therapy before, during, and
after having experienced therapy. The human contexts of therapy are more
extensive than this. They include the life and personality of the therapist
outside and beyond their involvement in therapeutic work, which (like
their patients) are also influenced by what occurs in therapy. The human
contexts of therapy also include the offices, counseling centers and clinics
where therapy is provided, as well as the settings, organizations and institutions in which psychotherapists are trained. Even more generally, the
human contexts of therapy include the civic, economic, political, and
cultural institutions of society that ultimately authorize and support the
psychotherapeutic professions and that are influenced in turn by the cumulative impact of there being so many individuals who have sought and
experienced psychotherapy.
Figure 8 reflects recent efforts to broaden the Generic Model with
respect to output contexts in general. First, a distinction is made between
the individual and collective aspects of context. The individual aspect
consists of the patient as a person and the therapist as a personnot in
their roles as patient and therapist in therapy, but as persons in their lives
outside of and apart from therapy. Figure 8 shows these at the right and left
sides of the bottom panel. The center of the bottom panel refers to the
collective contexts of therapy, which consist of the treatment milieu, the
community that supports it, and, ultimately, the society in which community exists.
Figure 9 provides a more detailed representation of the most proximal
aspects of the individual and collective contexts of therapy. The circles
represent patient and therapist as whole fully rounded persons, with their
respective roles in therapy as wedge-shaped slices of life for them. As
persons, they can be described in terms of their clinically relevant characteristics (e.g., diagnosis and ego strength), their personal demographics
(e.g., age, gender, family status, and occupation), and their personal presence (appearance, energy, and demeanor), which reflects their personalities and lifestyles. Convergently, the treatment milieu they meet and work
in is the proximal aspect of the collective context, providing the roles that
patient and therapist take as participants in therapy (e.g., viewed as elements in the organizational chart of the treatment setting).
Focusing further on the individual contexts of therapy on patients
and therapists as personsFigure 10 distinguishes between the person
viewed as an individual organism and the person viewed as a life in

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Figure 8. Generic model of psychotherapy: Influences of process on context (output).

progress. Persons can be described in terms of who they areas separate

human beings, each one a living, adapting psychosomatic unityand also
in terms of what they doas active incumbents of an unfolding life
situation, facing and responding to opportunities and challenges as they
arise, and seeking in these a secure, satisfying, and meaningful life experience.
As living organisms, individuals can be described biologically or biopsychologically (e.g., as being at a particular level of maturation) and
psycho-biologically (e.g., as complex systems with cognitive, affective, motivational, and behavioral characteristics). These complementary modes of
description address two basic aspects of the living person and are not
meant to imply a philosophical separation of mind and body.
Individuals can also be viewed in terms of their lives, rather than just
as psychological well or ill-functioning organisms. We recognize person as
lives when reading memoirs and biographies, or in eulogies and obituaries.
Here, a useful distinction can be drawn between the persons current life
situation (i.e., a network of relationships and groups in which the individual
takes part) and the ongoing life history of the individual as it extends over
time, from one life situation to another. A persons life situation can be

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Generic Model of Psychotherapy After 25 Years

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Figure 9. Proximal individual and social contexts of psychotherapy: Persons and treatment
setting.

further divided into a personal life of involvements with family, friends,

and intimates and a public life of dealings with teachers, employers, colleagues, and officials in varied organizations. A persons life history consists of a developmental trajectory that emerges successively through a
series of prior life situations and tends toward a more or less predictable
future.
The virtue of these distinctions is that they suggest areas of research
that have not been studied to date, one directed toward patients and the
other toward therapists. Researchers might consider the influence that
participation in therapy process has on the patients life situation and life
history. How much does therapy improve the patients current life situation
with respect to personal life (e.g., finding or improving a marital relationship) and public life (e.g., less delinquent behavior)? How much does a
course of therapy alter a patients life trajectory for the better (e.g.,
enhancing social mobility or reducing self-limiting or potentially selfdestructive behavior)? Similar questions arise about influences that work in
therapy may have on the life and personality of psychotherapists, as well as
influences that the therapists life and personality have on their work with
patients.
I conclude with a few words about the collective context of therapy,
which consists most proximally of the treatment setting (as noted earlier).
The treatment setting provides the organizational milieu in which therapy

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Figure 10. Individual contexts of psychotherapy: Persons as psychobiological organisms and as

ongoing lives. Pt patient; Th therapist.

occurs, within which the roles of patient and therapist are key elements,
and the organizational culture or dominant ideas and values that define its
collective identity (e.g., as a psychoanalytic clinic for children and adolescents).
The organization and culture of the treatment setting in turn is part of
a larger local community that supports it and that uses it to benefit
emotionally distressed or normatively deviant members. The fact that
patient and therapist have therapy together in a given treatment setting
implies that they are members of the same local community, sharing at
least the language through which they communicate (which is no small
thing). Figure 11 suggest that they are likely to have other indirect contacts
in their communal lives (e.g., as fans of the same ball club), and even direct
contacts, such as those that might occur in a small local or occupational
community (e.g., when the patient is a therapist having personal therapy).
It is less likely that the private lives of patient and therapist would intersect,
and of course there is a general taboo in the profession against that
happening.
The lower central panel of Figure 11 indicates connections beyond
those between treatment settings and the indigenous or professional mental health service delivery systems they serve. These include connections

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Generic Model of Psychotherapy After 25 Years

337

Figure 11. Collective contexts of psychotherapy: Existential, communal, and societal. Pt

patient; Th therapist.

between treatment settings and the social support and regulatory institutions that depend on mental health services such as schools, churches and
synagogues, welfare agencies, law courts, and family networks in the general population.
These, in turn, depend ultimately on the wider social, economic, political, and cultural systems of society at-large. Local communities are
integral parts of a national community in which large-scale political and
economic trends affect the lives of patients and therapists alike. This may
be most evident in countries that have experienced significant political
disruption or economic instability, or in relatively stable countries for
persons in the unstable, impoverished, and oppressed strata. Among the
middle classes in stable societies, patients private lives and personal relationships are typically the main focus and target of psychotherapy: family
relationships with parents, siblings, spouses, children, or in-laws; friendship

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338

Orlinsky

or loneliness; and the never-ending story of finding, fostering, or failing

in intimate relationships.
Society at-large must also be viewed as an important context of therapy
because the very ability to engage the satisfactions and struggles of private
life depends on the adequacy and predictability of support from the economic, political, and social structures that support communal life. These
factors do not often intrude on the private lives of patients and therapists
in the protected upper and middle strata of stable societies, so they have
not been much noticed in research on therapy; but the current economic
crisis, with its disruptive impact on so many individual lives, is a reminder
that the big world out there isnt always someone elses problem somewhere else.

PAST AND FUTURE

The Generic Model of Psychotherapy has proved to be useful over the
past 25 years as a basis for integrating the findings of the ever-increasing
number of studies reported in the research literature (e.g., Kolden, 1991;
Kolden & Howard, 1992; Saunders, Howard, & Orlinsky, 1989). It has also
stimulated a number of research studies and has been used successfully to
deconstruct, demystify, and integrate various clinical practice theories of
psychotherapy for students. I hope that it will continue to serve as a useful
framework that can expand to encompass new aspects of therapeutic
process that researchers may explore, and that it will also stimulate researchers to take a broader view of the questions that research can ask
about the impacts of psychotherapy on the psychological, social, and
cultural contexts in which it occurs.

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