Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory. There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy in two-plus-one sessions: Outcomes of a randomized controlled trial of cognitive–behavioral and psychodynamic–interpersonal therapy for subsyndromal depression.

A total of 116 clients with a range of subsyndromal depression received 3 therapy sessions: 2 sessions 1 week apart followed by a 3rd session 3 months later (the 2?+?1 model). Clients were stratified for severity on the Beck Depression Inventory (BDI) as stressed, subclinical, or low-level clinically depressed. In a 2?×?2 design, they received either cognitive–behavioral (CB) or psychodynamic–interpersonal (PI) therapy, either immediately or after a 4-week delay. An initial advantage for the immediate condition disappeared once the delayed-condition clients received treatment. Improvement rates at the end of treatment were 67% (stressed), 72% (subclinical), and 65% (low-level clinically depressed). There were no significant differences between CB and PI treatment methods, with the exception at 1-year follow-up, when the BDI showed a significant advantage for CB. Implications for designing very brief planned interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling session impact as viewed by novice counselors and their clients.

The Session Evaluation Questionnaire (SEQ) was used to measure the perspectives of 17 graduate-student counselors and their 72 17–39 yr old clients on 942 individual counseling sessions along 2 evaluative dimensions—depth and smoothness—and 2 dimensions of postsession mood—positivity and arousal. A components-of-variance analysis showed that, from both perspectives, SEQ ratings varied greatly from session to session; ratings were only modestly predictable from differences among counselors or among counselor–client dyads. However, averages across 6–20 sessions permitted adequately reliable differentiation among dyads, for example, for comparisons with outcome measures. Correlations between corresponding counselor and client dimensions ranged from moderate to negligible, whether calulated across sessions, across clients, or across counselors, Novice counselors' judgments of session depth and value may have had little relation to their clients' evaluations. On the other hand, counselors' comfort in sessions and postsession positive mood were moderately predictive of client reactions. (32 ref) (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)     

Node-link mapping and the evaluation of drug abuse counseling sessions.

Node-link mapping is a visual representation system that can be used in group and individual counseling sessions to illustrate clients' problems, issues, and plans. One hundred sixty-nine methadone treatment clients and their 10 counselors evaluated each of their individual and group sessions during a 2.5-month period by using the Session Evaluation Questionnaire (W. B. Stiles, 1980) and map rating items. A series of multivariate analyses of variance and correlational analyses indicated that the use of mapping (including the quantity and quality of mapping) was positively related to higher ratings of session depth by both clients and counselors. In addition, mapped group sessions were rated higher on several evaluative dimensions than were mapped individual sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session depth and smoothness in relation to the concept of engagement in counseling.

Investigated the relation of client-counselor evaluation of initial interview to client return for another session. At the end of the initial session, 5 professionals, 5 practicum trainees, and their 290 college-student clients completed the depth and smoothness indexes of the Session Evaluation Questionnaire (W. B. Stiles; see record 1980-12384-001). Clients also completed the Client Satisfaction Questionnaire, and counselors completed items from the Pre-Counseling Assessment Blank (C. J. Gelso and D. H. Johnson, 1983). The duration of the intake interview was recorded. Client return was positively related to: longer interviews; deeper interviews, as rated by both client and counselor; and greater client satisfaction, disturbance, and motivation. The results are discussed in relation to the concept that the initial session represents an engagement session when clients return for more sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The interpersonal structure of "good" versus "bad" group counseling sessions: A multiple-case study.

Selected "good" and "bad" sessions from 3 short-term personal growth groups with 20 clients on the basis of group members' ratings of session depth and engagement. Multidimensional scaling provided a map of the latent structure of the speaking turns within these sessions. A two-dimensional solution provided the best fit for the data for each of the 6 sessions examined (i.e., a good and a bad session for each of the 3 groups). These 2 dimensions were interpreted as control (dominant vs submissive) and affiliation (friendly vs hostile). As hypothesized, the leader's position in the good sessions was less extreme on the identified dimensions, which suggested greater leader flexibility. Contrary to the hypothesis, the content of the dimensions was similar in the good and bad sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of patient and therapist-reported experiences of the initial session to outcome: An initial investigation.

Explored the impact of the initial psychotherapeutic session on outcome in 32 therapist–patient dyads. Ss were 18+ yrs old. Therapy consisted of a maximum of 8 sessions. The therapeutic interaction was assessed with selected portions of the Therapy Session Report, completed immediately after the first session by the participants. It was found that the patient's perception of the therapist's functioning during the first meeting related significantly to patient and therapist reports of symptom change subsequent to 4 sessions and length of treatment. In addition, there was a significant, linear decline in symptoms (reported by patient and therapist) after 8 therapy sessions. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session evaluation and recall of important events as a function of counselor experience.

Session evaluation and type of participant-recalled important event were investigated in 25 novice counselor dyads and 9 experienced counselor dyads during 9 sessions of short-term counseling. Counselor experience was the independent variable and session evaluation was the dependent variable. Results based on the Session Evaluation Questionnaire (W. B. Stiles, 1980) showed a significant interaction effect between counselor experience and role of participant (client or counselor) for session depth. Clients also reported an increase in positive affect over the course of counseling. Experienced counselors recalled more important events involving insight, whereas novice counselors recalled more important events involving exploration of feelings or self-critique. The type of important event recalled by clients also changed over the sessions of counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of training in dream recall and dream interpretation skills on dream recall, attitudes, and dream interpretation outcome.

Forty-two volunteer clients with below-average dream recall and attitudes toward dreams participated in training sessions focusing on either improving dream recall and attitudes toward dreams, building dream interpretation skills, or educating about counseling. After training, individual dream interpretation sessions were conducted. No significant differences were found among the 3 conditions in regard to dream recall, attitudes toward dreams, or client- or therapist-reported session outcome, but effect sizes suggested that participants in the skills condition gained more from sessions than did participants in the dream recall–attitudes condition. Session outcome for all volunteer clients was equivalent to those in previous studies of volunteer clients with no training, suggesting that training was not necessary and that these participants were able to benefit from single-session dream interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical attractiveness and counseling skills.

80 college students assumed the role of a client with social skill problems during 3 counseling sessions. Videotaped interchanges between a male client and a female counselor during an initial intake session were presented, and audiotapes with background slides of the counselor were presented during 2 subsequent therapy sessions. Physical attractiveness had an impact on perceived effectiveness independent of the counselor's skillfulness. In contrast, analyses of future expectancy data revealed that only in the good skills condition did attractiveness augment impressions about the desirability of the counselor in treating other social and behavioral problems. Correlational analyses suggested that clients in the good skills condition, who were most influenced by attractiveness in Session 1, judged the counselor most favorably following Session 3 in terms of her potential effectiveness in treating new problems. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social influence revisited: Effects of counselor influence on outcome variables.

Examined the relationship of social influence variables, symptom change, and premature termination of counseling in 51 adult outpatients in counseling. Clients completed the Brief Symptom Inventory before their 1st session and again after 4 sessions. At the end of their 1st session, Ss also completed the Counselor Rating Form (CRF) based on their initial perceptions of their counselors. Counselor social influence variables (e.g., attractiveness) related positively to client improvement. CRF scores were significantly related to symptom change over 4 sessions and significantly predicted symptom change. All 3 dimensions of the social influence model were significantly and equally related to outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Formation of a therapeutic relationship: Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome.

Studied the formation of a psychotherapy relationship using self-reports of clients and therapists. Items designed as measures of a set of dimensions considered salient to the process of therapy were incorporated into client and therapist report forms. These were completed separately by clients and therapists immediately following each of the initial 10 sessions. It was hypothesized that report-form dimension scores early in treatment would predict persistence in treatment, duration of treatment, and retrospective evaluations of outcome. Subjects were 91 students (36 males, 55 females) attending a large urban unversity and 19 therapists (10 females, 9 males) on the staff of the university student counseling service. A number of client and therapist dimensions predicted persistence in treatment as early as the 3rd session. Dimension scores failed to predict duration of treatment for remainers, however. A greater number of dimension scores correlated with therapist outcome ratings than with client outcome ratings. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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)     

A comparative analysis of the therapeutic focus in cognitive–behavioral and psychodynamic–interpersonal sessions.

This study compared therapeutic foci in a sampling of 30 cognitive-behavioral and 27 psychodynamic-interpersonal manual-driven treatments for depression. High- and low-impact sessions were coded for each client, with the Coding System of Therapeutic Focus. Results indicated that psychodynamic-interpersonal sessions focused more on such variables as emotion, patterns, incongruities, the impact that others made on clients, clients' expected reaction of others, the tendency to avoid therapeutic progress, therapists themselves, clients' parents, and links between people and time periods in clients' lives. Cognitive-behavioral sessions placed greater emphasis on external circumstances and clients' ability to make decisions, gave more support and information and encouraged between-session experiences, and focused more on the future. Relatively few differences emerged as a function of session impact. Results are discussed in terms of the different and similar theoretical conceptions of the change process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of the psychotherapy relationship in long- versus short-term therapy.

Examined participant perceptions of therapy by comparing long- with short-term therapy dyads. 30 therapy dyads from 3 large midwestern community mental health centers were included. Therapists and clients (20–49 yrs old) completed the Therapy Session Report 4 times and the Survey of Interpersonal Values twice immediately following scheduled therapy sessions. Results indicate that therapists and clients in long-term therapy dyads were more phenomenologically congruent in their feelings toward psychotherapy and each other and in their perceptions of therapeutic goals and processes than were therapists and clients in short-term therapy dyads. Often these perceptions were shared at the very outset of therapy. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of psychotherapist trainees' alpha-amylase and cortisol levels during treatment of recently suicidal clients with borderline traits.

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist–patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)