Client and therapist session satisfaction over the course of psychotherapy.

Examined the patterns of therapist and client session-by-session satisfaction (SSS) over the course of psychotherapeutic treatment as they varied by eventual outcome. The theoretical literature proposes 1 of 2 models for SSS evaluation patterns over the course of therapy for successful dyads: either linear increase over time or a curvilinear pattern. These models were examined using 23 therapist–client dyads at a university counseling center. The highly successful dyads demonstrated the curvilinear pattern for both the client and therapist evaluations and the linear pattern for the therapist, while the least successful group did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of satisfaction to symptom change, follow-up adjustment, and clinical significance.

The relationship of client satisfaction to outcome was investigated for adult outpatients (N? = ?152) from 3 urban community mental health centers. Clients completed a problem self-rating and the Brief Symptom Inventory (BSI) at intake, 10 weeks later, and 5 months later. Therapists' ratings of client adjustment were obtained at intake and termination. Clients' ratings of satisfaction with treatment were obtained at 10-week and 5-month follow-up. Correlations between satisfaction and client measures of outcome (client rating and BSI) based on pre-post changes, posttreatment adjustment, and Jacobson and Truax's (1991) method of measuring clinical significance were not significant. Correlations between satisfaction and therapist outcome ratings were significant but low for pre-post changes and clinical significance. The utility of client satisfaction as an outcome measure is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of satisfaction to symptom change, follow-up adjustment, and clinical significance in private practice.

Consumer satisfaction is widely used as an indicator of treatment quality; however, recent research in public clinics has found very little relationship between satisfaction and problem change. No research on private practice satisfaction has been reported. The current study compared satisfaction with a variety of outcome measures for 93 adult private practice clients and found no significant relationships. Satisfaction is inappropriately construed as an outcome measure and may be of more limited value than widely held. Quality assurance standards should rely more on assessments of adjustment, perhaps using brief measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client initial disturbance and outcome in psychotherapy.

Evaluated 34 clients seen by 19 therapists in a counseling center by 6 different criteria of outcome, including pre- and posttherapy MMPI difference scores, and ratings by clients, therapists, and supervisors completed at the end of therapy. Measures of initial disturbance consisted of self-report inventories and ratings by therapists, supervisors, and judges. It was found that in general, none of the measures of rated disturbance were related to outcome criteria, but small to modest inverse relationships were obtained between the measures of subjective disturbance and global ratings of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client expression of hostility in psychotherapy.

Examined the expression of hostility in psychotherapy in 15 males and 25 females in an outpatient clinic. Results indicate an association between inward hostility and psychopathology for females at intake and for males at termination. Although there were no gender differences for outward hostility, females in comparison with males demonstrated greater inward hostility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrast, contradiction, and change in psychotherapy.

The experience of contrast not only plays a fundamental role in moment-to-moment construction of reality, but also may function as a common source of change across diverse forms of psychotherapy. This article (1) examines salient sources of contrast associated with psychodynamic, interpersonal, behavioral, cognitive–behavioral, and experiential psychotherapies and (2) proposes a developmental framework for understanding the role of contrast in the process of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward more meaningful clinical research: Taking context into account in coding psychotherapy interaction.

Examines the practical and theoretical problems of failing to take context into account in observational coding during the course of psychotherapy process research. Six content levels are considered: culture, the psychological situation, the therapist–client relationship, the event, immediate communicative context, and the private unconscious context. Phenomenological, objective-inferential, and objective-explicit strategies are described and evaluated for taking context into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malpractice liability in psychotherapy: Client and practitioner perspectives.

To successfully pursue a case of malpractice in psychotherapy, the plaintiff must prove that damages were suffered by the plaintiff and that the defendant/practitioner owed a "duty" to the plaintiff, breached this duty, and this breach "proximally caused" the plaintiff's injuries. The fact that few psychotherapy malpractice suits are filed reflects the difficulty in proving all these points, as well as the fact that the plaintiff will have to expose private and personal information to the public record. Frequent defenses to malpractice action include the contention that the client was "contributory negligent" or that the client's mental condition makes him/her an uncredible witness. Malpractice action may be taken when care deviates from professional standards, when confidentiality is breached, when there is a failure to obtain informed consent, or when the therapist fails to warn others of a potentially dangerous client. Recommendations for insurance coverage are presented. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment delay, outcome, and satisfaction in time-limited group and individual psychotherapy.

As part of a randomized clinical trial in which we compared outcome in time-limited individual and time-limited group psychotherapy, patients were interviewed and completed a battery of assessment measures. All participants in the study were then randomly assigned to one or the other treatment modality. There were inevitable delays before patients began their assigned therapies. Group treatment patients waited an appreciably longer period of time, on average, than did individual treatment patients (48 days vs. 31 days). Nonetheless, it was only for individual therapy patients that we found a highly significant relationship between this delay and treatment satisfaction at the completion of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client factors related to premature termination of psychotherapy.

Investigated client factors related to the premature termination of counseling or psychotherapy. A review of 287 mental health center client files revealed 3 variables that were found to be significantly related to premature termination: diagnosis, presenting problem, and previous psychiatric experience. Early terminators had less previous contact with psychiatric services, were usually not psychotic, and presented with problems in the area of interpersonal relationships. Results suggest that community education activities, informed consent procedures, therapist knowledge of the early terminator's profile, and a wider range of services, including more groups, may improve community mental health center service delivery to these clients. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive change processes in psychotherapy.

Several types of cognitive-behavioral therapy are now practiced that use different sets of theoretical concepts and propose different kinds of change mechanisms. None, however, is directly grounded in experimental research in cognitive and social psychology, and few address basic issues such as the relevance of conscious versus nonconscious cognitive processes and the validity of the self-report data on which therapy depends. Put forward in this article is a model that describes the conscious and nonconscious processing of emotional stimuli and distinguishes between knowledge that is verbally accessible and knowledge that can only be recovered by exposure to situational cues. Also proposed are three mechanisms of cognitive change that involve altering verbally accessible knowledge, the accessibility of nonconscious situational memories, and self-regulatory strategies. These mechanisms are related to the current practices of behavioral and cognitive-behavioral therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency of treatment and change in psychotherapy.

To test the hypothesis that frequency of weekly interview has a selective effect on psychological changes in patients in individual psychotherapy, 133 VA outpatients were randomly assigned to 3 schedules: twice, once, and bi-weekly. Changes were measured by tests based on objective evaluation of personality characteristics and assessed after 4 mo., 8 mo., and 12 mo. of therapy. The results failed to confirm that there was any major support for the hypothesis that frequency of contact produced differences in personality changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process, life events, and symptomatic change in brief eclectic psychotherapy.

Brief eclectic psychotherapy was intensively studied using a time series approach to interrelate intrasessional processes, life events, and intermediate outcomes. The alliance demonstrated large global effects on outcome whereas therapist-rated high quality sessions preceded decreases in intersessional symptom levels (intermediate outcomes). Negative life events and negative intrasessional emotional experiences (rejection and dysphoria) anteceded increases in intersessional symptoms. Changes in subjective life events were associated with preceding intrasessional processes. It appeared that process might partially exercise its outcome effects by influencing patients' experience of their daily lives, which in turn, influenced intersessional symptom levels. Insight apparently occurred at the culmination of a 3-step process that was not directly related to symptom reduction. It was speculated that insight may function to consolidate therapeutic change. Relationships among other process measures were also described. (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)     

Treatment duration prediction: Client accuracy and its relationship to dropout, outcome, and satisfaction.

The relationship of clients' expected and actual treatment duration was investigated for 230 clients in private practice settings. Clients both expected and attended a relatively low number of visits. These patterns were discrepant with therapists' duration expectations. A stepwise regression analysis indicated that clients' expected number of visits was the single best predictor of clients' actual number of visits and that history of eating disorder, therapist's degree, and client's years of education also contributed to actual number of visits. Clients who attended fewer sessions than expected had lower satisfaction, better outcome on two of six measures, and were more often identified as dropouts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived and actual change in job satisfaction.

Analysis of identified questionnaire data collected from 196 office employees at the start and end of a 6-mo period showed that change in overall job satisfaction as perceived at the end was a very poor, though statistically significant, proxy measure of change as computed from initial and terminal reports on levels of satisfaction. Perceived change in job satisfaction had zero regression on initial satisfaction but regressed very significantly on terminal satisfaction and on change in 14 job aspects as perceived at the end of the period. The findings cast serious doubts on the usefulness of the quasilongitudinal design in studies of the impact of technological and organizational changes upon job satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client stages of change and expectations about counseling.

The relation between client stages of change and client expectations about counseling was examined in a sample of 88 clients seeking services from a university-based outpatient clinic. Results of a canonical correlation indicated that the composite of the contemplation, action, and maintenance stages of change was significantly related to the expectation factors of Personal Commitment and Facilitative Conditions. The composite of the contemplation and maintenance stages of change accounted for additional variance in expectations for Facilitative Conditions, Counselor Expertise, and Nurturance. The significance and implications of these findings for counseling are briefly discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client–therapist value similarity and psychotherapy outcome: A microscopic analysis.

Examined the association between patient–therapist pretreatment value similarity and subsequent improvement in 45 nonpsychotic psychiatric outpatients (aged 19–54 yrs) who were randomly assigned to 22 therapists. Pre-assignment assessment of similarity in 36 value dimensions on the Rokeach Value Survey was investigated to determine how the dimensions influenced symptomatic and global changes in the therapy process. Treatment outcome was assessed both by patient and therapist reports, and the SCL-90 was used to evaluate pre- to posttreatment symptom change on 9 symptom dimensions. In addition, therapists were asked to complete a subjective rating of improvement at the end of treatment. The results indicate that a complex pattern of similarity and differences in specific values promoted maximal improvement. Moreover, specific improvement measures were influenced differently by various patient–therapist value patterns. Generally, therapist ratings of outcome were enhanced by pretreatment dissimilarities in value placed on social ascendance and achievement and similar value emphasis being placed on humanistic and philosophical concerns. Patient ratings of outcome were also enhanced if patient and therapist shared philosophical and humanistic concerns, but were further facilitated if values relating to social attachment and independence were ranked differently for patient and therapist. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical and clinical issues in involuntary psychotherapy.

Ethical and clinical issues related to psychotherapy with competent adults who have been ordered to treatment by the courts are considered. A paradigm of the psychotherapeutic relationship is postulated based on G. Kelly's (1963) "role relationship" and M. Buber's (1958) "I-Thou." The difficulties of developing such a relationship in the presence of coercion are examined, and approaches to addressing those difficulties are suggested. Implications for the role of the psychotherapist and the social role of psychotherapy as a system are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blind man's bluff: Effectiveness and significance of psychotherapy and pharmacotherapy blinding procedures in a clinical trial.

No study has reported on the comparative effectiveness of blinding procedures for psychotherapy and pharmacotherapy conditions in treatment efficacy studies or the potential impact of failure to maintain a psychotherapy blind. In a randomized clinical trial, the authors found, from the perspective of clinical evaluators who were unaware of the patient's treatment assignment, procedures intended to protect the psychotherapy blind were only modestly effective but comparable to standard procedures used to maintain pharmacotherapy blinds. Second, accuracy of guessing each form of treatment (psychotherapy or pharmacotherapy) was not independent of the other. Third, findings suggested the importance of maintaining both psychotherapy and pharmacotherapy blinds, as subjective ratings of treatment outcome were significantly different depending on whether the clinical evaluator had correctly guessed the patients' true treatment condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)