Dose-effect relations and responsive regulation of treatment duration: The good enough level.

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N = 1,868; 73.1% female; 92.4% White; average age = 40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n = 1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r =-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients and therapists confidence and attendance at planned individual therapy sessions

85 of 217 clients who reported retrospectively that their intake therapist seemed confident of being helpful also reported cancelling and missing fewer follow-up sessions regardless of the length of treatment. Clients' reported confidence during the first session and clients' attendance at later sessions were also associated with three measures of satisfaction with individual therapy.     

Termination, appointment use, and outcome patterns associated with intake therapist discontinuity.

Psychotherapy clients often experience intake therapist discontinuity: meeting first with an intake therapist, then entering therapy with a different treating therapist. The authors compared such discontinuity clients at a university’s counseling center (55.6% of 15,137 clients) with continuity clients, who continued therapy with their intake therapists. Discontinuity clients were twice as likely as continuity clients to terminate by missing the appointment after intake. Improvement among discontinuity clients lagged behind improvement among continuity clients at Sessions 2 and 3. Though more likely to terminate by missing Session 2, discontinuity clients attended 2 sessions more than continuity clients, on average, making treatment of discontinuity clients 19% more expensive than treatment of continuity clients in terms of sessions attended. The extra sessions attended by discontinuity clients did not yield overall better outcomes. Intake therapist discontinuity appeared to disrupt the beginning of psychotherapy, dissuading some clients from returning after intake, slowing early improvement among those who did return, and unproductively lengthening their treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' expectancies and their relationship to pretreatment symptomatology and outcome of cognitive-behavioral group treatment for social phobia.

The present study examined the expectancies of clients with social phobia that they would benefit from cognitive-behavioral group treatment. Lower expectancies for positive outcome were related to greater severity of social phobia, duration of social phobia, and depression. Lower expectancies were also reported by individuals with the generalized subtype of social phobia, but expectancies were not further influenced by the presence of other Axis I disorders. Expectancy ratings did not differ between clients who dropped out of treatment and those who did not, but, after pretreatment severity of social phobia was accounted for, expectancies significantly predicted improvement among treatment completers. Clients' expectancy beliefs may be an important factor to address in the prediction of who will benefit from a cognitive-behavioral treatment, even when that treatment has demonstrated specific efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression.

This study compared process-experiential and cognitive-behavioral psychotherapy in the treatment of major depression in a researcher allegiance-balanced randomized clinical trial. Sixty-six clients participated in weekly sessions of psychotherapy for 16 weeks. Clients' level of depression, self-esteem, general symptom distress, and dysfunctional attitudes significantly improved in both therapy groups. Clients in both groups showed significantly lower levels of reactive and suppressive coping strategies and higher reflective coping at the end of treatment. Although outcomes were generally equivalent for the 2 treatments, there was a significantly greater decrease in clients' self-reports of their interpersonal problems in process-experiential than cognitive-behavioral therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does a continuous feedback system improve psychotherapy outcome?

Using outcome data on a continual basis to monitor treatment progress has been identified as a way to enhance psychotherapy outcome. The purpose of this study was to investigate the use of a continuous feedback assessment system, the Partners for Change Outcome Management System (PCOMS; Miller & Duncan, 2004). Findings from 2 client samples that attended individual therapy at a university counseling center (N = 74) or a graduate training clinic (N = 74) indicated that clients who used PCOMS with their therapists (feedback condition) demonstrated statistically significant treatment gains when compared to clients receiving treatment as usual (no-feedback condition). Clients using PCOMS were also more likely to experience reliable change and in fewer sessions. A survival analysis demonstrated that approximately 50% of the clients in the feedback condition demonstrated reliable change after the 7th (graduate training clinic) or 9th session (university counseling center). Further findings, limitations of the study and ideas for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting counseling center clients' response to counseling: A 1-year follow-up.

A follow-up survey mailed 10 months after termination to 542 clients who received counseling at a university counseling center resulted in 207 (43%) returned surveys. Of the 158 clients who received 1 or more sessions, 32% showed reliable improvement. Of the 106 who began in the dysfunctional range of scores on a computerized intake assessment (CASPER), 31% showed clinically significant (CS) change. Likelihood of CS change depended on the number of sessions received but not in a linear, "more is always better" fashion. Survival analysis indicated that 25% of clients who achieved CS change did so after receiving 8 sessions and that 50% did so after receiving 16 sessions. Likelihood of eventual reliable change within a given number of sessions depended on the precounseling configuration of some CASPER symptom dimensions, with higher Hyperactivated Attachment interpersonal problems associated with fewer sessions needed to achieve reliable change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Duration, satisfaction, and perceived effectiveness of cross-cultural counseling.

The relationship between cultural dissimilarity and the duration, satisfaction, and perceived effectiveness of counseling was studied in the context of 70 actual treatment dyads that varied as to the race of the counselor and the client (White or non-White). White counselors provided fewer sessions than non-White counselors, and non-White clients expressed lower levels of overall satisfaction with counseling, regardless of counselor race. No differences in counseling effectiveness were observed as measured by counselor and client ratings of perceived relief, understanding, and coping. Relative to other treatment dyads, however, White clients seeing White counselors attributed their change more to counseling than to other, outside factors. (16 ref) (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)     

Successful outcome and number of sessions: When do counselors think enough is enough?

60 counselors rated 166 female and 97 male clients seen at a university counseling center over a 3-yr period on 4 outcome measures: psychic distress, interpersonal relations, performance, and overall severity of client's problem. Improvement was studied as a function of the number of weekly sessions for which clients were seen. Results reveal that through 20 sessions there was a strong and consistent (across all outcome measures) positive linear relationship between treatment length and counselor-assessed outcome. After 20 sessions, however, additional counseling was no longer associated with further increases in the rate of improvement. The "failure zone" reported in some earlier studies was not observed. The implications of these findings for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlations of male college students' verbal response mode use in psychotherapy with measures of psychological disturbance and psychotherapy outcome.

Compared verbal response mode use by 31 male college student clients in 3 sessions of time-limited psychotherapy (selected from an average of 17.2 sessions) with measures of clients' psychological distress, disturbance, and change, which were gathered at intake, termination, and 1-yr follow-up as part of the Vanderbilt Psychotherapy Project. Results show that (a) clients who were more distressed tended to use a higher percentage of Disclosures (revealing subjective information) and a lower percentage of Edifications (conveying objective information), perhaps reflecting greater preoccupation with inner troubles; and (b) clients who improved more were those who participated more, as measured by their estimated total number of utterances, a product of talking more in each session and remaining in therapy for more sessions; but (c) there was no relationship between clients' percentage of Disclosures and their improvement in psychotherapy, as hypothesized, even though percentage of Disclosures was correlated with process ratings of intrapsychic exploration. (58 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of length of treatment on weight loss.

In this study we tested whether the efficacy of behavior therapy for obesity might be improved by lengthening the duration of treatment. Forty-eight obese clients were randomly assigned to either a standard treatment of 20 weekly sessions or to an extended treatment of 40 weekly sessions. The content of each program was identical, but the treatment procedures were introduced in a more gradual manner in the extended condition. At Week 20, the conditions showed equivalent weight losses. At 40- and 72-week evaluations, however, the extended treatment produced significantly greater mean weight losses than did the standard treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice.

Client-focused research systems have been developed to monitor and provide feedback information about clients' progress in psychotherapy as a method of enhancing outcome for those who are predicted to be treatment failures. In the current study, the authors examined whether feedback regarding client progress and the use of clinical support tools (CSTs) affected client outcome and number of sessions attended. Results showed that clients in the feedback plus CST group stayed in therapy longer and had superior outcomes. Nearly twice as many clients in the feedback plus CST group achieved clinically significant or reliable change, and fewer were classified as deteriorated by the time treatment ended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with dropouts.

Discusses the deleterious clinical and administrative effects of the high dropout rate among psychotherapy outpatients. The dropout literature is reviewed, and it is suggested that discrepant expectations of clients and therapists regarding the duration and goals of treatment could account for much of the dropout rate and associated problems. Many clients expect to attend few sessions, want interventions to focus on the resolution of immediate emotional upset as opposed to changing basic personality or behavioral patterns, and may be willing to settle for a modest level of improvement. Two approaches for coping with the dropout problem are presented: (a) procedures designed to increase the duration of treatment, and (b) use of treatments designed for short duration—that is, for crisis therapy. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rhythmic external compression of the limbs: a method for healing cutaneous ulcers in systemic sclerosis

OBJECTIVE: To evaluate the usefulness of rhythmic external compression (REC) of the limbs on the healing of ischemic cutaneous ulcers in systemic sclerosis (SSc). METHODS: A prospective study analyzing 17 patients with SSc with symptomatic ischemic cutaneous ulcers in the limbs of more than 4 weeks' duration, who submitted to 20 sessions of REC, each session of one hour duration, 3 times a week. Patients were assessed at study entry, at the end of REC sessions, and at 30, 60, and 90 days after treatment. We also conducted a retrospective analysis of the outcome of ischemic vascular ulcers in a group of 20 patients with SSc who did not undergo REC. RESULTS: Twenty-eight ischemic vascular ulcers were submitted to REC. There was complete healing of 20 ulcers (71%) at the end of REC sessions. The healing was statistically more frequent in the distal ulcers (fingers and toes) (p = 0.0289), independent of SSc variant. There was a statistically significant correlation between pain resolution until the 15th session of REC and future ulcer healing (p < 0.0001). At followup, there were relapses in 2 ulcers 30 days after treatment. In the 20 patients with SSc who did not undergo REC, at followup, after 90 days of conventional treatment, there was healing of 7 ulcers (35%). CONCLUSION: REC could represent a therapeutic option in the treatment of ischemic cutaneous ulcers in SSc.     

The Relationships Between Hope and Outcomes at the Pretreatment, Beginning, and Later Phases of Psychotherapy.

Individual differences in self-reported hope assessed before and during treatment were related to outcome markers of therapeutic improvement. Clients were assigned to either a motivational orientation group or a waiting list group. All clients thereafter received 12 weeks of individual therapy. As hypothesized, higher baseline hope was associated with greater client wellbeing, functioning and coping, and regulation of emotional distress and fewer symptoms. High- relative to low-hope clients also reported that the orientation group was significantly more helpful. As hypothesized, agency scores (tapping motivation) from baseline were associated with positive changes in outcome variables early in therapy, and pathways scores (tapping planfulness) from baseline were associated with positive changes in later therapy sessions. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)