Evaluation of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) as a measure of treatment effectiveness in an outpatient training clinic.

This study evaluated the validity of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER), a system that identifies target problems and monitors treatment outcomes. Pre- and posttreatment data were obtained from 78 clients and their therapists in an outpatient training clinic. CASPER scales were significantly correlated with the Brief Symptom Inventory (BSI) and with therapist ratings on the Global Assessment Scale (GAS) at both intake and posttreatment. These measures also showed significant pre- to posttreatment changes. The largest effect sizes were found on CASPER individualized outcome measures. Residual change scores and posttreatment improvement ratings derived from CASPER were significantly correlated with BSI and GAS change scores. There was moderate agreement between clients' and therapists' ratings; clients tended to rate their functioning higher than did therapists on several CASPER scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session impact, working alliance, and treatment outcome in brief counseling.

Examined associations among working alliance, session evaluations over the course of brief counseling, and counseling outcome. At a training clinic, 61 clients and student counselors from 41 dyads completed ratings of session depth, smoothness, positivity, and arousal after their 1st 12 sessions. Alliance ratings were completed after the 4th session and at termination. Clients and counselors also provided 5 measures of counseling outcome. Results indicated that session evaluations were significantly related to later alliance ratings, and positive alliance ratings predicted subsequent session evaluations. Both linear and curvilinear session effects were suggested. Associations for client ratings were generally stronger than for counselor ratings. Both alliance and session evaluations were significant unique predictors of client-related outcome, but only alliance predicted counselor-rated outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of success in emotionally focused marital therapy

This study examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated form of marital therapy after the behavioral approaches. The relationship of attachment quality, level of emotional self-disclosure, level of interpersonal trust, and traditionality to the therapy outcome variables, marital adjustment, intimacy, and therapist ratings of improvement, was examined. These variables were chosen for their relevance to the theory and practice of EFT and to intimate relationships in general. Overall, therapeutic alliance predicted successful outcome; the task dimension of the alliance in particular predicted couples' satisfaction. More specifically, one dimension of female partners' trust, their faith in their partner, predicted couples' satisfaction at follow-up. Females' faith also significantly predicted males' level of intimacy at follow-up. Males who were most likely to be nondistressed at termination indicated higher levels of proximity seeking on an attachment measure at intake, and older males and males whose partners had higher levels of faith in them were more likely to be nondistressed at follow-up. Traditionality was not found to be significantly related to outcome. Couples who made the most gains at follow-up also indicated lower initial marital satisfaction and included males who indicated lower levels of use of attachment figure on the attachment measure at intake. Males who made the largest gains at termination were older and were rated as less expressive by their partner on self-disclosure measures at intake. Age was the only variable significantly related to males' gains in satisfaction at follow-up. Implications for the practice of marital therapy and future research are delineated.     

Treatment outcome and follow-up evaluation based on client case records in a mental health center.

Assessed the outcome of treatment of 121 mental health center clients (11–70 yrs of age), using therapist and independent global improvement ratings and independent ratings of notes in case records based on a client-specific goal-oriented outcome technique (Goal Attainment Scaling; GAS). Telephone follow-up of 50 clients provided a 2nd GAS assessment, client global improvement ratings, and 3 consumer satisfaction ratings. Findings indicate that (a) independently determined GAS scores and therapist and independent global ratings converged significantly, (b) the GAS procedure provided some increase in accuracy as well as an increase in specificity of outcome, and (c) client global ratings may reflect satisfaction with treatment rather than outcome. In view of the intercorrelations among measures and the relationship between GAS scores determined from case records and telephone interviews, case records may provide for accurate assessment of client problems and treatment success. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminating variables among psychotherapy dropouts from a psychological training clinic.

In contrast to most previous research on psychotherapy dropout, this study hypothesized that significant differences would be found among clients who terminate prematurely during the 3 major phases of therapy: intake, evaluation, and therapy proper. For 624 clients receiving individual, dynamically oriented therapy at a psychological training clinic, discriminant function analyses revealed that each of the 3 phases of therapy can be significantly distinguished with regard to the client characteristics related to dropout. Discriminating variables included demographics, psychiatric ratings, and diagnostic ratings. Compared with completers, intake dropouts were categorized with 77.06% accuracy (p?p?p?     

Disability, psychopathology, and vocational adjustment.

Examined the relationship among rehabilitation clients' preservice psychological status, type of disability, severity of disability, and vocational adjustment at follow-up using MMPI configural decision rules. 286 rehabilitation center clients (aged 16–62 yrs) who completed a Mini-Mult developed by J. C. Kincannon (see record 1968-12987-001) were sorted by sex into 3 groups: adjusted, possibly maladjusted, and probably maladjusted. Selected findings reveal that type and severity of physical disability were not related to adjustment group membership. Psychological disability was related to psychopathology, although the strength of the relationship was less than expected. Male self-ratings and work evaluators' ratings of male psychological adjustment were significantly related to adjustment group membership. Female psychological group membership was a more accurate predictor of center outcome than was either the naturally occurring base rate or the work evaluators' client ratings. There was no relationship between adjustment group membership and vocational adjustment at follow-up, thus supporting previous assertions that psychological and vocational adjustment are coeffects and are not causally linked. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome.

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients’ and therapists’ perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists’ ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists’ ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process ratings forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy Outcome and Satisfaction: Methods Applied to Intensive Outpatient Programming in a Private Practice Setting.

This study evaluated an Intensive Outpatient Program (IOP) in a private practice setting. Patients received the Symptom Checklist-90--Revised pre- and posttreatment and the Client Satisfaction Questionnaire-8 posttreatment, which were used to measure symptom change and client satisfaction. Reliable Change Indices and Clinically Significant change scores were calculated for each individual (N=225) using several variables from therapist and clinician perspectives. Highly significant improvement rates on client symptom ratings were also validated by clinician global assessment of functioning ratings, client satisfaction, and discharge rates to lower levels of care. This IOP was demonstrated to be more effective than psychotherapy in clinically representative studies, randomized clinical trials, and controlled clinical trials as well as comparable to many widely used medical interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing clinical significance: Does it matter which method we use?

Measures of clinical significance are frequently used to evaluate client change during therapy. Several alternatives to the original method devised by N. S. Jacobson, W. C. Follette, & D. Revenstorf (1984) have been proposed, each purporting to increase accuracy. However, researchers have had little systematic guidance in choosing among alternatives. In this simulation study, the authors systematically explored data parameters (e.g., reliability of measurement, pre-post effect size, and pre-post correlation) that might yield differing results among the most widely considered clinical significance methods. Results indicated that classification across methods was far more similar than different, especially at greater levels of reliability. As such, the existing methods of clinical significance appear highly comparable; future directions for clinical significance use and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of a client pretherapy orientation videotape.

Examined the effects of a videotaped psychotherapy orientation on clients' response to therapy, knowledge about therapy, utilization of services, and satisfaction with services and on therapist ratings of client attractiveness. 62 psychotherapy clients (mean age 29 yrs) at an urban community mental health center were randomly assigned to an oriented group, which viewed a pretherapy orientation videotape at admission, or to a control group. 14 therapists participated. The 11-min videotape described the relationship between client and therapist, encouraged clients to attend appointments, and stated that, although progress is rarely immediate, most clients find that therapy can lead to a reduction in anxiety and depression. Clients and therapists completed questionnaire and rating scales at intake and at 1-mo follow-up. It was found that oriented clients were able to understand and recall the information in the videotape, and the oriented group showed a greater decrease in self-reported symptoms than the control group after 1 mo. Client feedback regarding the videotape was favorable. In general, the 2 groups did not differ in their satisfaction with services, service utilization, or therapist ratings of client symptoms and functioning. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of race and socioeconomic status on the perception of process variables in counseling.

Analyzed the effects of race and socioeconomic status (SES) on the perception of process variables in counseling, including judged counselor empathy, judged counselor–client cognitive similarity, and attraction. The study used a 2?×?12?×?2?×?6 design (race of S, tape order, SES of client, race of counselor and client) with repeated measures on the SES of client variable and the race of counselor and client variable. Following empathy training, 12 Black and 12 White undergraduate middle-class males listened to 12 specially prepared counselor–client taped dialogs and rated the counselor and client on each tape on the process variables being researched. All hypotheses were confirmed. Both Black and White Ss gave highest counselor empathy ratings, client–counselor attraction and cognitive similarity ratings, and client improvement ratings to matchings in which the counselor and client were similar over race and social class, and they gave lowest ratings when the counselor and client were dissimilar over race and social class. Effects of client accent were generally not significant. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multiperspective, multivariable evaluation of reliable change

N. S. Jacobson and P. Truax's (1991) method for evaluating the clinical significance of client change has gained some prominence in psychotherapy outcome research. However, little has been done to investigate the validity of this methodology. This study addresses this limitation by comparing (a) the perceived level of change (as subjectively reported from 3 distinct perspectives) across outcome groupings based on Jacobson and Truax's reliable change index (RCI) and (b) subjective reports of therapeutic alliance and satisfaction across outcome groupings. The results of these comparisons indicate that the RCI is effective in identifying those who make reliable improvement in therapy but is less effective in differentiating between no-changers and deteriorators. In addition, the relationship between treatment outcome and satisfaction with service is questioned.     

Therapeutic expectations, premorbid adjustment, and manifest distress level as predictors of improvement in hospitalized patients.

Evaluated voluntary admissions to an open psychiatric ward (N = 49) at intake and discharge in order to determine whether improvement had occurred in faulty coping styles (ego weakness). Self-report, therapists', and supervisory staff ratings were used to assess change. 26 Ss were rated by consensus to be improved, and 23 were rated to be unchanged. 3 sets of variables were used to predict favorable outcome: (a) minimal patient expectations that the therapist would be uncaring, unstructuring, and insensitive; (b) staff ratings of good premorbid social adjustment; and (c) high initial level of manifest distress as judged by self-report, therapist, nurse, and staff evaluations. The multiple correlation for these predictors associated with favorable outcome was .59 (p     

Counseling session impact as viewed by novice counselors and their clients.

The Session Evaluation Questionnaire (SEQ) was used to measure the perspectives of 17 graduate-student counselors and their 72 17–39 yr old clients on 942 individual counseling sessions along 2 evaluative dimensions—depth and smoothness—and 2 dimensions of postsession mood—positivity and arousal. A components-of-variance analysis showed that, from both perspectives, SEQ ratings varied greatly from session to session; ratings were only modestly predictable from differences among counselors or among counselor–client dyads. However, averages across 6–20 sessions permitted adequately reliable differentiation among dyads, for example, for comparisons with outcome measures. Correlations between corresponding counselor and client dimensions ranged from moderate to negligible, whether calulated across sessions, across clients, or across counselors, Novice counselors' judgments of session depth and value may have had little relation to their clients' evaluations. On the other hand, counselors' comfort in sessions and postsession positive mood were moderately predictive of client reactions. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cost/benefit analysis of the interpersonal process recall technique.

Examined interpersonal process recall (IPR), a supervisory technique, by a cost-benefit analysis. Cost was defined as the possible inhibitory effects on client self-exploration of the use of IPR; benefit was defined as client satisfaction, increased supervisor ratings, and increased counselor empathy levels. Counselors were 36 master's level trainees, clients were 36 undergraduate psychology students, and supervisors were 6 doctoral students in counseling. The IPR treatment consisted of 3 videotaped interviews followed by client, counselor, or mutual recall. The comparison treatment consisted of 3 audiotaped interviews followed by traditional supervision. Results indicate that IPR, when compared to traditional supervision, did not produce differential effects on counselors' empathy level, client satisfaction, supervisor ratings, or clients' self-reported inhibition. Method of supervision, however, did effect significant change in clients' level of self-exploration over time. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prediction of child psychotherapy outcome: Factors specific to treatment.

Examined the prediction of child psychotherapy outcome from client, parent, and process factors specific to the therapeutic relationship. 31 children (mean age 11 yrs) were assessed by some independent and therapist ratings, as were parental behaviors, at admission and at discharge from a community mental health center. The primary diagnoses were adjustment disorder (89%) and functional enuresis (11%). Process was evaluated by therapist ratings on the Psychotherapy Process Inventory by P. E. Baer et al (see record 1981-11629-001). Results support the importance of treatment dosage and client participation to global change in impairment and are consistent with findings of B. Gomes-Schwartz (see record 1979-26509-001). Change (decrease) in the severity of Ss' primary problem through treatment was predicted by less frequent parental psychological punishment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of single therapists versus cotherapy teams in sex therapy.

Assigned 65 sexually dysfunctional couples to treatment by a single male therapist, a single female therapist, or a dual-sex cotherapy team. The male Ss in age ranged from 21 to 69 yrs; female Ss were aged 20 to 65 yrs. Mean duration of the Ss' relationships was 12.7 yrs. Treated dysfunctions included male erectile failure and premature ejaculation and female primary and secondary orgasmic dysfunction. Assessments of marital and sexual satisfaction and functioning were made at initial intake, at the start of therapy, immediately following therapy, and at a 3-mo follow-up. The assessment battery included the Sexual Interaction Inventory, a marriage inventory, patient global ratings, and measures of symptom remission. Repeated measures ANOVA and post hoc comparisons failed to reveal any differences in effectiveness of single therapists vs cotherapy teams. Furthermore, in cases treated by single therapists, a matching of sex of therapist with sex of the dysfunctional member of the couple did not lead to better outcome than for nonmatched cases. Overall, sex therapy was generally effective, although greater gains were shown in Ss' global ratings of satisfaction and in the psychometric measures of adjustment than in actual symptom remission. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of puberty: Adolescent, parent, and health care personnel.

This study was designed (a) to examine relations among ratings of pubertal stage by adolescents, parents, and health care personnel, and (b) to determine if accuracy of adolescent and parent ratings varied with stage of puberty. Ss were 90 healthy adolescents: 46 boys, ages 10–15, and 44 girls, ages 9–15, and their parents. Ss were shown photos of the 5 stages of puberty (Tanner criteria). Ss rated the adolescents" pubertal stage, and a nurse practioner completed an examination to rate the adolescents" stage. Correlations between adolescent and examiner ratings ranged from r?=?.77 to r?=?.91 (p?≤?.001, κ?=?.33 to .50), and between parent and examiner from r?=?.75 to r?=?.87 (p?≤?.001, κ?=?.13 to .55). When inaccurate, Ss ratings were lower than examiner ratings and less accurate at later stages of puberty. Use of adolescent and parent ratings is limited if precise ratings of stage are necessary to answer a research question. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multiperspective comparison of satisfaction, symptomatic change, perceived change, and end-point functioning.

Measures of satisfaction have become increasingly popular as indications of psychotherapy outcome both in research and in practice. Several studies have explored the relationship between satisfaction and symptomatic change, with mixed results. The present study examines the relationship among satisfaction, symptomatic improvement, perceived change, and end-point functioning from multiple perspectives. Sixty-six clients from 2 Midwestern community mental health centers, 48 of their spouses and significant others, and their therapists participated in the study. Results indicated that satisfaction was not significantly related to symptomatic change. Satisfaction and perceived change were significantly related from all 3 perspectives. Satisfaction was also significantly related to end-point functioning from the client and significant other perspectives. The unique contribution of satisfaction data to a comprehensive outcome evaluation strategy is discussed. Researchers, administrators, and practitioners are encouraged to use satisfaction measures with a greater awareness of both their strengths and their limitations as outcome indicators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)