Third-party payment and the outcome of psychotherapy.

Theorists have long debated whether the efficacy of psychotherapy is enhanced when clients are required to pay for their treatment. The aim of the present experiment was to assess this issue in a naturally occurring clinical setting. Clients in the study were individuals who had sought psychotherapy from a low-cost treatment center. One group of clients paid the fees normally charged by the treatment center, whereas another randomly selected group did not pay because a grant was used to cover the cost of their therapy. Results failed to reveal any reliable difference in the outcomes of clients who had paid for treatment and those whose treatment had been subsidized. These findings suggest that the effectiveness of psychotherapy is not impaired when someone other than the client pays for the therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can rational emotive behavior therapy (REBT) be effectively used with people who have devout beliefs in God and religion?

Several writers on religion and psychotherapy claim that people who follow a "loving God" model and who see God as a partner who works with them to resolve their problems are less emotionally disturbed and can benefit more from "rational" systems of therapy than religionists who have a more negative view of God. Some authors have specifically written that rational emotive behavior therapy (REBT) includes many religious philosophies and that the principles and practices of REBT are similar to those endorsed by certain kinds of devout religionists. In this article, the author describes the constructive philosophies of REBT and shows how they are similar to those of many religionists in regard to unconditional self-acceptance, high frustration tolerance, unconditional acceptance of others, the desire rather than the need for achievement and approval, and other mental health goals. It shows how REBT is compatible with some important religious views and can be used effectively with many clients who have absolutistic philosophies about God and religion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (1) the overall effectiveness of psychotherapy for depressed clients, (2) its effectiveness relative to pharmacotherapy, and (3) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of fees on psychotherapy: What is the evidence?

Reviews theoretical support and research regarding how fees affect psychotherapy. The 2 theories about fee effects, psychoanalysis and cognitive dissonance, have not been appropriately tested. The belief that some fee is necessary for effective psychotherapy has been disputed, but within the limits of brief therapy with particular samples and without the involvement of the therapist in the payment process. Fees appear to present a barrier to patients in entering or continuing therapy, and fees may be more important motivators to therapists than to patients. Currently the effect of fees on psychotherapy outcome is uncertain. There is a need for further research in which sliding-scale fees, private practice settings, and therapies of some duration are used and the role of the therapist in particular is explored. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tarasoff and confidentiality in AIDS-related psychotherapy.

We investigated whether clinicians employ the Tarasoff factors (dangerousness and identifiability of victim) when deciding to break confidentiality in acquired immune deficiency syndrome (AIDS)-related psychotherapy situations. Practicing clinicians were provided with a series of hypothetical psychotherapy scenarios depicting different AIDS clients (prostitute, IV drug user, homosexual, and bisexual). Within each type of scenario, degree of dangerousness and identifiability of victim were systematically varied. Results indicated that clinicians do use both of these factors when deciding to break confidentiality, although dangerousness appeared to be more relevant than identifiability of victim. Clinicians who had psychotherapy contact with AIDS clients were less likely to break confidentiality than those who did not have such contact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors That Influence Fee Setting by Male and Female Psychologists.

What factors influence how psychologists in private practice set fees for self-pay clients? An anonymous survey in one county showed that male and female clinical psychologists did not differ in fees requested for services to self-pay clients, indicating that they equally value their time and work effort. They felt that their fees were strongly influenced by personal and local factors (i.e., education/qualifications, business experience, and local competition). Female psychologists indicated that local competition had a significantly greater influence on fee setting than did male psychologists. This perception among female psychologists might arise from competition with the larger number of nondoctoral therapists, who are predominately female, or from higher awareness through more active networking. The usefulness of this model for studies of self-employment is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client satisfaction, clinical significance, and meaningful change in psychotherapy.

Evaluated the use of the N. S. Jacobson et al (see record 1985-00073-001) criteria for clinical significance in psychotherapy data analysis. The hypothesis that a group of psychotherapy clients showing clinically significant symptom changes would report greater satisfaction and benefit from psychotherapy than would a group of clients who changed moderately or not at all was supported. Statistical and clinical significance are defined, and the concept of when meaningful change has occurred in psychotherapy is discussed in relation to clinical significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recommendations for a cost-offset model of psychotherapy allocation using generalized anxiety disorder as an example.

As inexpensive interventions gain empirical support, there is an increasing risk that such data may be used by health maintenance organizations to unfairly restrict the number and type of therapy sessions reimbursed for all clients, even those less likely to benefit from economical treatments. As a result, it is important to identify clients who may not respond to specific therapies and to empirically support ways to treat them. Successful treatment of nonresponders is also valuable because predictors of treatment failure tend to predict cost related to medical and disability expenses. Using generalized anxiety disorder as an example, this article suggests a flexible and comprehensive approach to cost-benefit analysis in psychotherapy that includes clients who may not improve in response to current data-based interventions. In addition, suggestions are made for the identification of alternative treatment approaches, and a potential treatment allocation model is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A response to Greenberg's review of Therapeutic experiencing: The process of change.

Responds to Greenberg's review of the current author's book, Therapeutic experiencing: The process of change (see record 2007-09053-001). How do we make sense of what clients say and do? This is a fundamental issue in psychotherapy, the nettling theme in Professor Greenberg's review, and the focus of this response. Quite apart from the present volume, I have struggled with this issue in framing a comprehensive theory of human beings, in outlining the theory and basic methods of an experiential psychotherapy, and in a separate series of articles. It is time for the field of psychotherapy to come to grips with the key questions underlying the issue of how we make sense of what clients say and do. Not only would this be good for the field of psychotherapy, it might also clarify why Professor Greenberg is entitled to be puzzled by the theory and methods of this experiential way of making sense of what clients say and do. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression.

Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder, that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients), whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference posttreatment and at 1-year follow-up. Among those who received CB therapy, posttreatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward integrating feminist psychotherapy and feminist philosophy.

Describes liberal, cultural, radical, and socialist feminist philosophies and proposes that psychologists' orientations toward feminist political and philosophical theory will have an impact on their practice of feminist psychotherapy with regard to their preferences for group or individual modalities, therapeutic interventions, diagnostic practices, and organizational affiliations. Psychologists' philosophical positions may also influence their attitudes about research, epistemology, and the role of men and women as clients and therapists. Specific connections between feminist philosophy and psychological theories and other aspects of practice are discussed. It is proposed that all psychologists who work with gender-related issues can benefit from contemplating how their therapeutic practices intersect with feminist philosophy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fee assessment and outpatient psychotherapy.

To test the widely held belief that fee assessment policy affects the psychotherapeutic process, data were gathered from the records of 434 clients who had received individual outpatient psychotherapy at a mental health center in 1972. The 3 predictor variables were fee (no payment, welfare, insurance, scaled payment, and full payment), diagnosis (psychosis, neurosis, personality disorder, transient situational disturbance, and other), and socioeconomic status (5 levels). A least-squares multivariate analysis of variance found only diagnosis to be significantly related to the outcome, number of appointments, and attendance of individual outpatient psychotherapy. Failure to find significant effects of fee assessment categories on therapeutic process suggests the invalidity of therapeutic purposes as a rationale to charge fees for psychotherapy. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic services for ethnic minorities: Two decades of research findings.

Considerable controversy exists over the effectiveness of psychotherapy for ethnic minority clients, especially when treated by White therapists. Some researchers and practitioners believe that ethnic clients are less likely to benefit from treatment. Others maintain the position that ethnic clients are as likely as Whites to show favorable outcomes from treatment and that ethnic or racial matching of clients and therapists is unnecessary. The available research findings fail to demonstrate that ethnic minorities achieve differential treatment outcomes, which tends to support the latter position. Explanations for the persistence of the controversy have included the lack of rigorous research on the issue and the social-political context of the controversy. This article argues that the issue has been misconceptualized. Ethnic or racial match in treatment is more of a moral/ethical concern, whereas cultural match is more of an empirical issue. Failure to differentiate between the two types of matches has prolonged an unresolvable question. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of congitive-dissonance theory to an aspect of psychotherapeutic practice.

"The present paper is designed to link dissonance theory with one practical reality-oriented aspect of the process of psychotherapy with emotionally troubled individuals—namely, the charging of fees." Freud stated that "money matters are treated by civilized people in the same way as sexual matters—with the same inconsistency, prudishness, and hypocrisy. It is… avowed… that in order to accomplish any significant therapeutic work the patient must be charged a fee that is somewhat painful and discomforting." Dissonance theory "would predict that if a person paid nothing for something that he believed was worth nothing he would not experience cognitive dissonance. Rather his cognitive world would be in a state of harmony in this regard. My main purpose has been to stimulate greater clinical interest in the possibilities of employing general psychological theories, developed in the more traditional academic areas of psychology, to shed light upon seemingly complex issues in the field of clinical psychology." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence tactics in psychotherapy.

Examined the process of psychotherapy within the context of social power theory. Therapist influence acts were classified in terms of the goals or reasons why therapists exercised influence and the strength of the influence attempt. The analysis was based on 22 tapes of psychotherapy sessions, provided by 5 female and 6 male therapists. Each therapist provided a tape of 1 male and 1 female client. Findings indicate that therapists were consistent in their use of tactics from one client to another. Male therapists, compared with female therapists, used significantly more influence tactics and interrupted their clients significantly more often. Therapists of both genders used significantly more passive forms of influence earlier in the session and more active forms later. Therapists of both genders told female clients what to do significantly more often than they did male clients, although they significantly more often explained thoughts, feelings, and behaviors to male clients than to female clients. Therapists used stronger influence attempts—those judged as demanding a response from the client—significantly more frequently with female clients than with male clients. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The clinical management of client dynamics and fees for psychotherapy: Implications for research and practice.

Research indicates that there is no clear relationship between fees and therapy effectiveness, although fees do impact the therapeutic process. By integrating E. Fromm's (1947) personality theory with a typology of client dynamics in response to fees, it is suggested that therapists are aided in the conceptualization of client dynamics and are able to develop proactive treatment interventions. For example, receptive clients may use fees to get attention, to foster helplessness, or to maintain ties with the therapist in the therapeutic relationship. Dynamics of exploitative, hoarding, and marketing clients are also outlined. A major benefit of the typology is that therapists can assess, evaluate, and interpret clients' dynamics in terms of goals, needs, feelings, and behavioral expressions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What clients find helpful in psychotherapy: Developing principles for facilitating moment-to-moment change.

Clients who had completed psychotherapy were interviewed about the significant experiences and moments they recalled within their sessions. These interviews were analyzed using grounded theory, creating a hierarchy of categories that represent what clients find important in therapy. From the hermeneutic analysis of the content of these categories, a list of principles was constructed to guide the moment-to-moment process of psychotherapy practice. The authors respond to the call for qualitative outcome studies and demonstrate how qualitative psychotherapy research can lead to empirically derived principles that then can become the foundation of future research and psychotherapy integration efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing Hatha yoga with dynamic group psychotherapy for enhancing methadone maintenance treatment: a randomized clinical trial

BACKGROUND: As more methadone treatment programs are funded in an attempt to curb substance abuse and HIV infection among i.v. drug users, more cost effective treatment approaches are being sought. OBJECTIVES: To investigate whether clients in outpatient methadone maintenance treatment who practice weekly Hatha yoga in a group setting experience more favorable treatment outcomes than those who receive conventional group psychodynamic therapy. METHODS: After a 5-day assessment period, 61 patients were randomly assigned to methadone maintenance enhanced by traditional group psychotherapy (ie, conventional methadone treatment) or an alternative Hatha yoga therapy (ie, alternative methadone treatment). Patients were followed for 6 months and evaluated on a variety of psychological, sociological, and biological measures. The revised Symptom Check List provided the primary psychological measures; the Addiction Severity Index provided various indices of addictive behaviors. RESULTS: The evidence revealed that there were no meaningful differences between traditional psychodynamic group therapy and Hatha yoga presented in a group setting. Both treatments contributed to a treatment regimen that significantly reduced drug use and criminal activities. Psychopathology at admission was significantly related to program participation regardless of treatment group. DISCUSSION: In addition to examining the characteristics of patients who present for treatment, this study identifies unexpected staff issues that complicate the integration of alternative and traditional treatment strategies. CONCLUSION: Alternative methadone treatment is not more effective than conventional methadone treatment, as originally hypothesized. However, some patients may benefit more from alternative methadone treatment than conventional methadone treatment. Additional research is necessary to determine characteristics that identify patients who might benefit from alternative methadone treatment.     

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)