Table 2:

Brief descriptions of common factors identified across number (%) of manuals (n=16)

Common factor	Brief description	Number of Manuals, n (%)
Promoting hope and realistic expectancy for change	Building the client’s positive and realistic expectancy for change by outlining what can and cannot be achieved through treatment, and encouraging the client that change is possible	15 (94)
Explaining and assuring confidentiality	Building trust with the client by clearly explaining confidentiality, as well as disclosing when confidentiality may be broken to assure client’s safety (e.g., confidentiality exceptions for harm to self and others); and, adjusts topics based on private or non-private settings to maintain confidentiality	15 (94)
Giving praise	Praising the client for mental health-promoting behaviors, e.g., participating in the therapy, expressing emotions during therapy, completing homework and practice assignments	14 (88)
Psychoeducation	Explaining psychological distress and how the treatment works by incorporating the client’s explanatory model, local concepts and terms; provides information about the client’s problem and related treatment plan; checks that the client understands	14 (88)
Rapport building and self-disclosure	Using strategies that increase the quality of the relationship between the provider and client through socially appropriate interactions, making the client feel comfortable, and offering appropriate disclosure in the service of the client’s needs	13 (81)
Empathy	Portraying a deep understanding of the client’s perspectives by showing warmth, genuineness, and respect; the ability to understand psychological distress within the context of the client’s worldview and experiences	12 (75)
Incorporating client’s coping mechanisms	Identifying and incorporating the client’s prior mental health-promoting behaviors; collaborative discussion with the client to re-evaluate potential unhelpful or harmful coping mechanisms	12 (75)
Collaborative goal setting	Supporting the client’s autonomy, control, and ability to make choices; jointly selects treatment targets and path to achieve that objective; checks-in on goals throughout treatment, to see if the client has adjusted or redefined them	12 (75)
Family engagement	Involving family members and significant others; encouraging interaction between client and significant others when appropriate during the treatment process; promoting skills and strategies to facilitate the family’s positive engagement in treatment	11 (69)
Eliciting feedback	Routinely checking for client’s experiences of and perspectives on treatment progress, clinical decisions, and expectations	11 (69)
Normalization and validation of emotions	Showing acknowledgment of emotional responses, and when appropriate, explains that the client’s feelings are expected for a person in her/his situation	11 (69)
Assessment of harm	Taking an assessment of harm to self, harm to others, and developing a collaborative response plan	10 (63)
Non-verbal communication	Showing culturally appropriate body language to communicate engagement, e.g., eye contact, facial expression, nodding head, sits at appropriate angle from the client and leans in to show interest, uses communications such as ‘uh-huh,’ ‘hmm,’ ‘I see,’ etc.	10 (63)
Verbal communication	Using open-ended questions, paraphrasing, reflective listening, and summary reflections	10 (63)
Connecting daily functioning and mental health	Connecting symptoms to functioning and impact on life, as well as pathway from functioning to symptoms; exploring with the client how to improve functioning when symptoms take time for abatement	7 (44)