Checklist quantification of a psychological therapy: pilot studies of reliability and utility.

Abstract

There is a need for an economical and quantified technique for describing the dosage and content of psychological therapies in research studies. This need is highlighted in studies of combined pharmacotherapy and psychological therapy, since techniques for describing the classes and dosages of drugs, but not the psychotherapies, have been well worked out. A research study of maintenance treatment of depressed women undergoing combinations of drugs and casework therapy led to the development of a quantitative checklist for therapists to record, immediately following the interview, the quantity, content, and quality of the casework treatment. The form is precoded for keypunching and computer analysis. Information collected included such “dosage” issues as the numbers, place, and recipients of casework contacts; the length of contact; and numbers of missed contacts. Detailed information on the content arid quality of individual sessions included time spent on various topics, affects expressed, and quality of patient's participation. The checklist was quick and simple to complete. Reliability studies indicated that the instrument was reliable between I trained raters, except for one qualitative rating which appeared infrequently. Validity, as measured by agreement between therapist and other raters, was acceptable on most variables In pilot studies of utility, the instrument gave meaningful descriptions of the nature of therapy in 40 patients during 8 months of treatment. Two patients selected for further analysis showed contrasting profiles of topics discussed and affect expressed; these profiles were consistent with clinical impressions. This simple checklist method is restricted to relatively uncomplicated non inferential aspects of patients´ interview behavior. It nonetheless ap-Vi pears capable of generating, in an economical way, data suitable for statistical testing of hypotheses, relating content in psychotherapy to such variables as personality and social background and to outcome.