Relations of the alliance with psychotherapy outcome: findings in the Second Sheffield Psychotherapy Project

Clients (n = 79) and therapists (n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pretreatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.     

Measuring the outcomes of psychotherapy: Findings of the Penn Psychotherapy Project.

Reports analyses of outcome measures obtained from patients, therapists, and clinical observers in the Penn Psychotherapy Project, a 5-yr study of factors that predict outcome in outpatient psychotherapy. The data from the "method factors" study by D. S. Cartwright et al (see record 1963-06833-001) were also reanalyzed. Results in both studies were very similar. Substantial agreement was found among viewpoints about broadly defined treatment outcomes, although distinct viewpoints did clearly exist. Contrary to a common opinion, consensus measures of psychotherapy outcome could be meaningfully defined. Relationships among posttreatment ratings of benefits from therapy and measures of adjustment obtained before and after treatment were explored. A strong relationship was found between the residual gain score and ratings of benefits, suggesting that posttreatment ratings of outcome take account of the fact that the amount of change to be expected depends on the initial level of functioning. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring adherence in time-limited dynamic psychotherapy.

Reports the development of the Vanderbilt Therapeutic Strategies Scale (VTSS), a measure of adherence to the tenets of time limited dynamic psychotherapy (TDLP). The VTSS comprises 2 subscales, 1 intended to assess the extent to which therapist's in-session behaviors are consistent with the approach outlined in the TDLP manual and the other rating the presence and quality of general psychodynamic techniques. Results from 64 patients (aged 24–64 yrs) and 16 therapists (aged 27–48 yrs) suggest the VTSS subscales have acceptable psychometric properties and provide good discriminant validity between pre- and post-training conditions. VTSS ratings were also compared with ratings of the therapist's contribution to the therapy process and ratings of "overall competence" made by the therapists' supervisors. The relationship between technical adherence, competence, interpersonal manner, and therapeutic skill is examined and discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic focusing in time-limited group psychotherapy.

The degree to which treatment outcome is related to therapeutic focusing, leader skill, and positive aspects of the therapeutic relationship was examined in time-limited group psychotherapy. Measures tapping each of these domains were assessed at Sessions 3, 8, and 14 in 15-week therapy groups led by 4 expert professional group therapists and 4 "natural-helper" nonprofessionals. Significant differences were found on process measures for both the leader skill condition and time factors. In addition, both the quality of the therapeutic relationship and the degree of therapeutic focusing independently predicted client improvement. Specifically, the results indicate that therapist focusing occurs differentially and is only predictive of improvement in professional groups, whereas a positive therapeutic relationship is only predictive of early positive improvement in nonprofessional groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Following the trail of the focus in time-limited psychotherapy.

Studied 47 short-term psychotherapy cases (aged 18–33 yrs) from a college counseling center that followed the evolution of the focus from the patient's presenting problem, through the formulation of the focus during the consultation, to the stated focus at termination. Findings suggest that the presenting complaint was not the same as the consultation or the termination focus and that the consultation focus was not the same as the termination focus. The longer the time-limited therapy progressed, the more likely it was that the focus was revised between the time of the initial consultation and termination. Clinical examples of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalization of interpersonal process in time-limited dynamic psychotherapy.

[Correction Notice: An erratum for this article was reported in Vol 31(3) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-17141-002). This article contained, as Figure 1, an SASB model. The authorship and copyrights for the model were not acknowledged. The following acknowledgement should have been included: "Adapted from Benjamin (1984). Principles of Prediction using Structural Analysis of Social Behavior (SASB). In R. A. Zucker, J. Aronoff, and A. J. Rabin (Eds.), Personality and the Prediction of Behavior (pp. 121- 174). New York: Academic." An apology is offered to the author, Dr. Lorna Smith Benjamin. The particular version used in the article was developed in collaboration with Clinton W. McLemore.] Investigated the internalization of positive aspects of therapist–patient (TP) interactions among 70 patients and their 16 therapists who participated in a 5-yr study (H. H. Strupp et al, unpublished) of time-limited dynamic psychotherapy. Patients sought help for anxiety, depression, or other problems with a clear interpersonal component and qualified for an Axis I or Axis II diagnosis on the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III). Instruments included the Structural Analysis of Social Behavior and outcome measures of depression, anxiety, and psychological functioning. Patients' intrapsychic functioning became more similar to interpersonal activity in the TP relationship over the course of psychotherapy. Intrapsychic movement toward interpersonal activity in the TP relationship was associated with positive outcome on measures of depression, anxiety, and on independent clinician ratings of patient psychological functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on the training of therapists in time-limited dynamic psychotherapy.

Suggests that "manualized training" is most effective at increasing adherence to the technical procedures characterizing the treatment under scrutiny. There is minimal evidence that other skills associated with therapeutic competence are acquired or enhanced to the extent found with technical adherence. Drawing on findings from a study of manual-guided training of therapists in the techniques of brief therapy (H. H. Strupp and J. L. Binder, 1984), the author offers recommendations for improving therapy training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior.

16 therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant–observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose–effect relations in time-limited psychotherapy for depression.

Criteria for reliable and clinically significant improvement were applied to standard and individually tailored outcome measures data from 212 depressed clients who had been randomly assigned to receive either 8 or 16 sessions of time-limited psychotherapy. The data were used to address 2 questions: (a) Is the dose-effect curve for psychological symptoms negatively accelerated? and (b) is there a differential rate of response for acute, chronic, and characterological/interpersonal components of depression? The results supported the differential rate of response of different components of depression and suggested qualifications to the acute, chronic, and characterological/interpersonal components and evidence that both supported and qualified previous suggestions that the dose effect curve is negatively accelerated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of patient and therapist evaluations of time-limited psychotherapy.

Obtained empirical data regarding the degree of congruence between therapists' and patients' evaluations of brief psychotherapy on a session-by-session basis and posttreatment and compared these data with predictions derived from J. Mann's (1973) model of the process of brief psychotherapy. 28 17–34 yr old students who were seen in brief psychotherapy (6–22 sessions) by 6 university mental health staff served as Ss. Patients and therapists completed an evaluative questionnaire at the conclusion of each session and at 1–4 wks posttreatment. Sessions were treated as falling into the early, middle or final phase of treatment by dividing the total number of sessions into equal thirds. Without exception, patients' evaluations were higher than those of therapists, both session-by-session and posttreatment. Therapists gave evidence of appreciating this discrepancy but underestimated its magnitude. Results are viewed as largely consistent with predictions derived from Mann's model of brief psychotherapy and as lending support to the model's validity. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early memories: A technical aid to focusing in time-limited dynamic psychotherapy.

The key to successful time-limited therapy, whatever model is being used, is to rapidly develop a problem focus. A focus makes the work meaningful to the patient and guides the therapist's interventions. A technical aid to focusing involves the therapist collecting a small number of early memories during the evaluation. The psychological function of these memories is similar to that of dreams in that they express important feelings, fantasies, and defenses. However, early memories more purely reflect central and enduring life themes. In addition, it is proposed that the particular memories patients choose to share with their therapist reflect their experience of present needs and stresses. Early memories can be used during the course of treatment to reinforce interpretations of maladaptive relationship patterns and their genetic antecedents. Vignettes are presented to illustrate this use. Clinical implications developing from the use of early memories in time-limited psychotherapy are discussed, and a proposal is made for greater emphasis on the systematic teaching of time-limited therapy in the training of psychotherapists. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of dropping out in time-limited, interpretive individual psychotherapy.

Predictors of dropping out were investigated for patients who participated in time-limited, interpretive individual psychotherapy in a randomized clinical trial. A sample of 22 dropouts was compared with a sample of 22 matched completers on pretherapy and therapy process variables. A modified Vanderbilt Psychotherapy Process Scale was used to assess patient hostility and patient and therapist exploration and focus on transference. Pretherapy predictors, which included demographic, diagnostic, and initial disturbance outcome variables, did not significantly differentiate the two groups. Therapeutic alliance, dynamic and supportive work, patient exploration, and focus on transference significantly differentiated dropouts from completers. For dropouts, there was a weaker alliance, less work, less exploration, and greater focus on transference. Examination of the last session of dropouts revealed a nonproductive pattern characterized by resistance and transference interpretation. Implications and limitations associated with the study are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in clients' attachment styles over the course of time-limited dynamic psychotherapy.

This study utilized a theory-specific measure to examine client relational change over the course of time-limited dynamic psychotherapy in 84 Ss (aged 26–64 yrs). Specifically, this study examined change and stability in clients' attachment style. Categorical and dimensional ratings attachment styles were obtained. Pretreatment and posttreatment measures of attachment styles were then examined in association with Global Assessment Scale (GAS) scores and symptoms. Results show that at posttreatment, a significant number of clients were evaluated as having changed from an insecure to a secure attachment style. Additionally, the sample as a whole demonstrated significant changes toward increased secure attachment. Significant relationships were also found among changes in attachment style, GAS scores, and symptom levels. Implications for psychodynamic/interpersonal psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of Loevinger's theory of ego development for time-limited psychotherapy.

Examines the implications of J. Loevinger's (1976) stages of ego development, which are characterized by psychic structures that determine the form in which self and other are experienced, for psychotherapy. The stages of ego development are described, and their association with specific symptoms of psychopathology is discussed. An important distinction in applying developmental concepts to clinical work is the difference between internal developmental stages and external challenges of the life cycle. Case examples of a 42-yr-old woman with an adjustment disorder and a 17-yr-old girl with school and family problems illustrate the use of developmental concepts in time-limited psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled outcome and follow-up study of Mann's time-limited psychotherapy.

Thirty-three patients were assessed for suitability for time-limited psychotherapy (TLP). A battery of outcome measures was composed of Ss self-report measurements and objective judgments by external ("masked") raters. Ss were randomly assigned to either the experimental group, which received TLP immediately, or the control group, whose TLP was delayed for 3 months. Ss were evaluated on outcome measures at TLP termination and again at 6 and 12 months after termination. Significant improvement was observed in the experimental group after TLP, but the control Ss did not show any systematic changes after waiting. However, after TLP, the control Ss improved significantly. The gains achieved after therapy were stable in both groups after 6- and 12-month follow-ups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counselor trainee achievement goal orientation and the acquisition of time-limited dynamic psychotherapy skills.

The relationship between trainee achievement goal orientation and acquisition of time-limited dynamic psychotherapy (TLDP; H. H. Strupp & J. L. Binder, 1984) skills was examined. Counselor trainees (n?=?28) completed the Achievement Goal Tendencies Scale (T. Hayamizu & B. Weiner, see record 1991-34655-001) and saw a recruited client for 4 counseling sessions. The sessions were rated for trainee adherence to TLDP. Growth-curve analyses revealed a significant relationship between trainee learning goal orientation and pattern of TLDP skill acquisition. A relatively higher trainee learning goal orientation was related to a linear increase in use of TLDP specific strategies and to less midtraining decline in trainees' adherence to the psychodynamic interviewing style aspects of the TLDP model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An empirical study of the natural history of time-limited psychotherapy for stress response syndromes.

30 White female patients (aged 21–53 yrs) received individual, time-limited (12 sessions), dynamic psychotherapy following the death of a parent. Treatment followed the principles for the treatment of stress response syndromes and included focused use of suggestion, interpretation, clarification, abreaction, and work to resolve impending defenses and transference reactions. The patients' 11 therapists completed the 34-item Therapist Action Scale to indicate actions used in therapy. Results show that of the 6 dimensions that varied significantly over the course of the 12 sessions, Transference and Termination showed the most dramatic change across time, changing from a relatively low emphasis early in psychotherapy to the 2nd highest action in the final session. Findings indicate systematic variation in therapist actions. The way changes occurred across sessions depended on the kind of actions the therapist took. The last session was not representative of other sessions in the treatment. (30 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)     

Some characteristics of research in applied settings.

Some of the ways in which "applied settings influence the research they support" are described. Major headings are: Origin of Applied-Sponsored Research ("Show me" empiricism, Minimum research, Steps toward basic research, The climate of basic research); Situational Nuisances (Cost per yield, Time pressure, Overt signs of activity, Approximation and error, Correlation as a tradition; Prefabricated variables, Excessive reassurance of sponsors); and The Course of Research (Choice of area, Research design, Standards of Accomplishment). (PsycINFO Database Record (c) 2010 APA, all rights reserved)