Sequential analyses of language variables in psychotherapy process research.

Presents rationales for the increased use of sequential analyses of language variables in psychotherapy, including this strategy's special applicability in process investigations, its potential for specifying influence patterns, and its ability to produce findings pertinent to the practicing clinician. Limitations with the preponderant strategy of only reporting frequency magnitudes of therapist and patient language variables are outlined, as well as several problems with which the sequential approach must grapple, such as the development of interactional terminology and the specification of endpoints for the therapy processes under investigation. Replicable single-case studies, utilizing sequential analyses, are recommended to assess what degree and type of changes in patient–therapist language use are of therapeutic significance. (81 ref) (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)     

Predicting future clinical adjustment from treatment outcome and process variables.

General issues relating to the use of outcome and process data from the treatment of antisocial children to predict future childhood adjustment are examined. For outcome measures, it was assumed that variables based on direct observation of child behavior would provide a better predictor of long-term adjustment than would ratings by participant adults. Long-term adjustment measures consisted of police arrest and out-of-home placement data collected 2 years after treatment termination. Observation data collected at termination predicted future police arrest, but parent and teacher ratings did not. It was also hypothesized that measures of the processes thought to produce the changes in child antisocial behavior would serve as predictors of future adjustment. The data supported this hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptom severity, psychotherapy process, and outcome.

We studied therapeutic process and outcome in relation to symptom severity and types of measures used. Seventy-seven clients seeking treatment at an outpatient clinic completed the SCL-90-R at intake and both the SCl-90-R and the Strupp Post-Therapy Client Questionnaire upon termination. We hypothesized that when self-report measures were used, process variables (warmth, respect, interest, and acceptance) would be more strongly related to perceived final adjustment status than to pre–post therapy change. In addition, we hypothesized that process variables would correlate with outcome for clients with moderate and severe symptomatology but not for clients with mild symptoms. Results indicated support for the relationship between self-report measures and final adjustment. There was partial support for the symptom severity hypothesis. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evaluation of process and outcome in individual child psychotherapy.

The purpose of this study was to demonstrate the use of an objective method for the evaluation of therapy process and outcome in cases of individual child psychotherapy. Fourteen children ranging in age from 4 to 6 years were videotaped during the first and eighth sessions in interaction with their therapists. Approximately half the children received psychodynamic play therapy whereas the other half received client-centered play therapy. Using the Play Therapy Observational Instrument (PTOI) of Howe & Silvern (1981), videotapes were scored on 19 items. Data was reduced to 3 clusters: emotional discomfort, quality of interaction with the therapist, and beneficial fantasy play. No significant differences were obtained between therapeutic approaches. However, the PTOI was found to be sensitive to mean behavioral and verbal changes in the children from session one to session eight. Hence it appears that the PTOI scales offer clinicians a method of reviewing, tracking and assessing the process and outcome of their therapy work with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review.

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal variables in telephone crisis intervention: Their relationship to selected process and outcome variables.

Analyzed temporal variables (counselor talk, caller talk, and silence) in a sample of taped calls to a suicide prevention and crisis service. In comparing 3 outcome groups (showing, not showing, or canceling subsequent appointment for face-to-face counseling), the most important finding was that no-show calls had more silence than the other 2 groups. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the basic ingredients of psychotherapy.

Presents a parsimonious statement of essential conditions for psychotherapeutic change: (a) a helping relationship patterned after the parent-child relationship, (b) the creation of a power base from which the therapist influences the client through common psychological techniques, and (c) a client who has the capacity to profit from the experience. It is asserted that the full range of common influencing techniques is inevitably brought to bear on any psychotherapeutic relationship, and this constitutes one of its defining characteristics. These conditions are equally applicable to psychoanalytic psychotherapy and behavior therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient and therapy process variables relating to dropout and change in psychotherapy.

Investigated the relationship between pretherapy patients and process variables and change in 91 19–54 yr old adults who received psychotherapy from 26 trainees at a university teaching hospital. Pretherapy measures included Rotter's Internal–External Locus of Control Scale, the Eysenck Personality Inventory, and the SCL-90 (Revised). Upon termination of therapy, Ss completed the SCL-90, the Barrett-Lennard Relationship Inventory—Form OS64, and a personal evaluation form; therapists completed a psychotherapy process inventory and a discharge summary. Results indicate that process variables rather than preexisting S traits were the best predictors of outcome. Therapist ratings of Ss' involvement in therapy were the best single predictor of symptomatic change. Variables differentiating dropouts from remainers were also investigated. Few outcome differences were observed between Ss who remained in and Ss who dropped out of therapy. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist and client: Two views of the process and outcome of psychotherapy.

At termination of their therapeutic relationships, 8 male and 7 female therapists (aged 26–59 yrs) along with their 38 male and 37 female clients (aged 19–40 yrs) each independently and anonymously completed a questionnaire concerning the process and efficacy of therapy. Unlike previous findings, the clients rated therapeutic outcome more favorably than did their therapists. In addition, each group attributed the change to different aspects of the therapeutic relationship. Both the aspects cited and the ratings differed as a function of the sex of both therapist and client. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of outcome in psychotherapy.

Examined the relationships among 8 different criteria of outcome in psychotherapy: mmpi and 74 items from the butler and haigh q-sort given before and after psychotherapy; global ratings of improvement completed by clients, therapists, and supervisors; and before-and-after ratings of degree of client disturbance by therapists, supervisors, and 2 independent judges. 34 clients were seen by 19 therapists. In general, there tended to be little relationship between the various criteria of change. Global ratings of improvement provided the most positive indexes of change, whereas the other measures indicated no significant changes. A factor analysis of parallel data indicated that there were several separate factors evident in the criterion matrix. Findings are discussed in terms of their implications for research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process ratings forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance: Its place as a process and outcome variable in dynamic psychotherapy research.

Argues that conceptual unclarity has surrounded psychotherapy research efforts to define and measure the therapeutic alliance. A precisely defined conception of the therapeutic alliance is offered that focuses on the patient's active collaboration in the tasks appropriate to the treatment process. The therapeutic alliance is thus distinguished from patient characteristics and attitudes as well as from therapist contributions to the formation of the alliance. The importance of the therapeutic alliance as a change measure in process research is underscored, and its place as a primary indicator of outcome is described. Empirical studies are reviewed, with particular reference to the Menninger Treatment Interventions Project, and the use of single-case methodology is considered. The special relevance of the therapeutic alliance to the investigation of the therapeutic change process with borderline patients is outlined. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV counseling research needs suggested by psychotherapy process and outcome studies.

HIV risk reduction counseling is commonly used to prevent the spread of HIV. Such counseling is an interpersonal process that shares many characteristics with psychotherapy. Research on HIV counseling can benefit from methods and findings from psychotherapy research, and scientist-practitioners are well qualified to design or collaborate in studies that incorporate their expertise in psychotherapeutic process and in research. Studies of the relationship between the counselor and client, the structure of the counseling sessions, client experiences, and specific intervention techniques are suggested on the basis of consistent findings and important themes in psychotherapy literature. Research findings from studies adapting techniques and results from psychotherapy studies could significantly improve the effectiveness of current risk reduction counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating outcome in psychotherapy: A hardy perennial.

Discusses issues raised by D. Fiske (see pa, vol. 47:issue 5) and by L. Luborsky (see pa, vol. 47:issue 5) with reference to outcome research in psychotherapy generally, and to a previous paper by the authors (see pa, vol. 47:issue 5 ) in particular. While attention in the past has tended to focus on general criteria of improvement, it is believed that in the future more consideration must be given to the specific changes sought by means of therapy with multiple measures devised for appraising such change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways to change in the psychotherapy of depression: Relating process to session change and outcome.

Identified a pathway from in-session process, and problem resolution, to post-session change and final outcome. Two brief treatments for depression, one using client-centered (CC) and the other process-experiential (PE) interventions, were compared on client process and outcome. The PE group showed significantly higher levels of experiencing, vocal quality and expressive stance, and greater problem resolution than the CC group in 2 of 3 PE interventions studied. Ss' degree of problem resolution correlated significantly with depth of experiencing, and sustained resolution over treatment resulted in better outcome. Ss' task-specific post-session change scores correlated significantly with change in depression post-therapy and 6 mo later, indicating that repeated post-session change is related to reduction in symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminating variables among psychotherapy dropouts from a psychological training clinic.

In contrast to most previous research on psychotherapy dropout, this study hypothesized that significant differences would be found among clients who terminate prematurely during the 3 major phases of therapy: intake, evaluation, and therapy proper. For 624 clients receiving individual, dynamically oriented therapy at a psychological training clinic, discriminant function analyses revealed that each of the 3 phases of therapy can be significantly distinguished with regard to the client characteristics related to dropout. Discriminating variables included demographics, psychiatric ratings, and diagnostic ratings. Compared with completers, intake dropouts were categorized with 77.06% accuracy (p?p?p?     

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)