Nonspecific treatment factors in psychotherapy outcome research.

Discusses salient issues raised by W. Wilkins (see record 1980-01498-001). The term nonspecific treatment factors usually refers to several, often unspecified, variables that may influence therapy outcome. The word nonspecific denotes that these factors may extend to many different techniques. Recent research has demonstrated that treatment and control conditions differing from each other in overall efficacy may also differ in such factors as their credibility to the client and in the expectancies for improvement they generate. Relatively high levels of credibility and expectancies for improvement may be inherent in most, if not all, treatments. The task for therapy research is not to demonstrate that treatment operates free from such factors. Rather, the task is to demonstrate that specific treatment techniques considered to carry the burden of client change go beyond the results that can be obtained by implementing procedures that produce change merely because of their relatively high levels of credibility and treatment-generated expectancies. The present article briefly examines the conceptual and methodological issues raised by nonspecific treatment factors and the interpretive problems these factors pose for selected outcome questions. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The outcome of psychotherapy: A selected analysis of research findings.

A selective review of outcome studies of psychotherapy with emphasis on the major methodological issues of spontaneous recovery and methods of experimental control. The results of 9 studies which used experimental controls were assessed in terms of their limitations and merits in demonstrating the effectiveness of psychotherapy. It is concluded that outcome research with available techniques could be fruitful even though conclusions based on present research must be carefully qualified. (30 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social relations model: A tool for group psychotherapy research.

The social relations model presented in this article provides a solution to some of the problems that plague group psychotherapy research. The model was designed to analyze nonindependent data and can be used to study the ways in which group members interrelate and influence one another. The components of the social relations model are the constant (i.e., group effect), the perceiver effect, the target effect, the relationship effect, and error. By providing estimates of the magnitude of these 5 factors and by examining the relationships among these factors, the social relations model allows investigators to examine a host of research questions that have been inaccessible. Examples of applications of the social relations model to issues of group leadership, interpersonal feedback, and process and outcome research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond the illusion of structural change: A process priming approach to psychotherapy outcome research.

Psychoanalytically oriented psychotherapy outcome research has yet to differentiate between a psychological structure that is present but temporarily inactive and genuine change in that underlying structure. Thus, a decrease in maladaptive responding following treatment may sometimes reflect illusory structural change, with the patient remaining vulnerable to relapse in situations that activate the underlying pathogenic structure. Genuine structural change would be better assessed by deliberately seeking and failing to find evidence of the enduring presence of a pathogenic structure under conditions that typically activate that structure, using both implicit (e.g., free response) and explicit (self-report) outcome measures. Because implicit and explicit measures are differentially affected by situational variables (e.g., mood, mindset priming), rigorous psychotherapy research must use experimental techniques and multimodal assessments to assess outcome under the conditions most likely to evoke a pathological reaction in a seemingly recovered individual. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relinquishing the placebo: Alternatives for psychotherapy outcome research.

Comments on the article by W. Wilkins (see record 1986-25162-001) on placebo problems in psychotherapy research and suggests a refinement of efficacy research strategies that will allow such comparisons while relinquishing the use of a placebo construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single-case methodology in psychotherapy process and outcome research.

Delineates and explains the essential characteristics of single-case research methodology applied within the domain of psychotherapy research. Single-case research is presented as a subclass of intrasubject research in which aggregation across Ss is avoided and the generality of one's findings is addressed through replication on a case-by-case basis. The basic ways in which single-case designs vary are also discussed, and 3 basic types of single-case research are differentiated: (1) single-case experiments, (2) single-case quantitative analyses, and (3) case studies. Furthermore, some of the major weaknesses in current single-case psychotherapy research are identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Thematic Apperception Test as an outcome measure in psychotherapy research.

Correlated 2 measures of the TAT—the presence of depressive themes and the ratings of story endings—with other indicators of depression (MMPI and Beck Depression Inventory) or with ratings of improvement. 129 psychiatric hospital patients, aged 20–65 yrs, served as Ss. Results support the potential use of the TAT as an outcome measure in the treatment of depressions. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An overview of psychotherapy outcome research: Implications for practice.

In the past 50 yrs, an extensive amount of research has examined the psychotherapy process. The empirical literature can be a valuable source of information for practitioners, but given the volume and complexity of the research, it is sometimes difficult to analyze the results as they relate to practice. This article provides an overview of major trends in psychotherapy outcome research and discusses implications for practice. It also examines the research in the areas of the therapeutic relationship, session factors, approaches and specific techniques, and client experiences. Implications for using the outcome research in working with clients are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contribution of group cohesion and group alliance to the outcome of group psychotherapy

The contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.     

Power to detect homework effects in psychotherapy outcome research.

Studies of homework effects in psychotherapy outcome have produced inconsistent results. Although these findings may reflect the comparability of psychotherapy with and without homework assignments, many of these studies may not have been sensitive enough to detect the effects sizes (ESs) likely to be found when examining homework effects. The present study evaluated the power of homework research and showed that, on average, current power levels are relatively weak in controlled studies ranging from 0.58 for large ESs to 0.09 for small ESs. Thus, inconsistent findings between studies may very well be due to low statistical power. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating outcome research and clinical reasoning in psychotherapy planning.

This article reviews the strengths and weaknesses of outcome research and clinical reasoning as bases of treatment planning and presents a synthesis in which these two types of information complement each other. The author proposes that therapy planning should begin with a review of the relevant outcome literature and also that divergence from research-based guidelines might be warranted under several conditions, including (a) when the client is demographically or culturally dissimilar to the study samples, (b) when assessment suggests a mismatch between the etiologies of the client's disturbance and the processes addressed by empirically supported treatments, and (c) when use of such treatments is followed by a lack of progress that signals the advisability of midcourse correction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A primer for conducting child psychotherapy outcome research.

Presents basic principles for conducting child psychotherapy outcome research and suggests that a multivariate framework is needed to illuminate important mechanisms of change in effective child psychotherapy. Issues related to type of treatment, therapist variables, child problems, context, research design, and statistical concerns are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In defense of the placebo group in psychotherapy research.

Comments on K. D. O'Leary and T. Borkovec's (see record 1979-24057-001) discussion of conceptual, methodological, and ethical problems with placebo groups in psychotherapy research, focusing on alternatives to placebo groups and differences between psychotherapy and analog research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The directions in psychotherapy research.

Examined the feasibility of conducting large-scale collaborative research projects in psychotherapy by: (a) an analysis of existing empirical literature, (b) formulation of research designs that appeared promising, and (c) visiting scholars and research centers to sample opinions and test motivations for conducting such studies. It is concluded that the expectable returns from any of the large-scale, multifactorial projects thus far proposed do not justify the large investment of manpower and funds that would be required. On the basis of the literature review and interviews with prominent researchers, it is suggested that promising directions for therapy research include: (a) focusing on the mechanisms of change via experimental case studies, (b) avoiding further investment in process and outcome studies of traditional therapy, and (c) building new techniques rather than testing old ones. (19 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A critical evaluation of the state-of-the-art in psychotherapy outcome research.

Results from recent large-scale psychotherapy outcome studies have prompted efforts to manualize clinical practice. To many, the use of empirically validated manualized treatments for clients with specific Diagnostic and Statistical Manual disorders represents the current state of the art in the field. Despite these efforts, it is argued that attempts to manualize clinical practice are premature. The current state of the art is reviewed, and the manualization movement is critiqued with a consideration of current clinical practices and recent findings from the field of psychotherapy process research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating research findings into the practice of group psychotherapy.

Reviewers of the group psychotherapy literature have repeatedly described a "gulf" between researchers and practitioners. The present authors' examination of the reasons for this rift shows that some of the difficulties are due to stereotypical thinking on both sides; others imply constructive criticisms. Suggestions designed to bridge the gap are made in the hope that more attention to available group therapy research can ultimately lead to improved services and to empirically sound theories that can provide guidance to the practitioner. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group psychotherapy.

Insight into the therapeutic relationship in group psychotherapy requires an understanding of the treatment context. Cohesion is defined as the therapeutic relationship in group psychotherapy emerging from the aggregate of member leader, member-member, and member-group relationships. Using this definition, evidence for the relationship between cohesion, patient outcome, an treatment processes is reviewed. Six empirically supported principles that undergird the development and maintenance of cohesion are presented touching on pregroup preparation, ear group structure, leader interaction, feedback, leader modeling, and member emotional expression. The limitations the present research are discussed; leading to opportunities for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The outcome of psychotherapy with children.

Examined 75 studies, published between 1952 and 1983, in which children who received psychotherapy were compared with controls or children receiving another form of treatment. Only those studies using Ss younger than a mean age of 13 yrs at the time of treatment were included. Exceptions to the age limitation were made only if separate analyses for younger children were reported or if individual data from older Ss could be eliminated. Results show that therapy with children was similar in effectiveness to therapy with adults; treated children achieved outcomes about two-thirds of a standard deviation better than untreated children. Although behavioral treatments appeared to be more effective than nonbehavioral treatments, this apparent superiority was due largely to the types of outcome and target problems included in behavioral studies. No differences in outcome were found to result from other treatment characteristics such as the use of play in therapy or the administration of treatment individually or in groups. The evidence suggests that previous doubts about the overall efficacy of psychotherapy with children can be laid to rest. A bibliography of the studies examined is appended. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapist-as-fixed-effect fallacy in psychotherapy research.

Studies of psychotherapy involve sampling 2 sets of Ss from 2 populations: patients and therapists. Conclusions about psychotherapy should thus be based on statistical evidence that results are reliable across both patients and therapists. In most published research concerning psychotherapy, no statistical evidence is provided that findings can be generalized beyond the particular sample of therapists studied. In spite of this, researchers tend to draw conclusions concerning psychotherapy and therapists in general. ANOVA designs that allow generalization of results across both therapists and patients are described. The serious problems with inappropriate analyses of variance—treating therapists as a fixed effect or ignoring the therapist factor altogether—are discussed. A review of recently published studies of psychotherapy reveals that most researchers have done one or the other of these inappropriate analyses. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)