Demand characteristics, treatment rationales, and cognitive therapy for depression.

Abstract

In research design, the term demand characteristics refers to the sum total of cues that convey an experimental hypothesis to subjects and influence their behavior. In psychotherapy, the term may refer to the sum total of cues that convey the therapist's wishes, expectations, and worldviews to clients and influence their behavior. Psychotherapeutic demand may play a role in dissociative identity disorder, in the repressed memory controversy, and during the delivery of treatment rationales, a practice common to manual-guided psychotherapies. An exploration of demand characteristics during the presentation of the treatment rationale in one such psychotherapy— cognitive therapy for depression—is offered, and data from an analogue study of demand responding to this rationale are presented. Jonathan W. Kanter is now at the Department of Psychology, University of Wisconsin—Milwaukee; Elizabeth F. Loftus is now at the Department of Psychology and Social Behavior and the Department of Criminology, Law, and Society, University of California, Irvine. Correspondence concerning this article should be addressed to Robert J. Kohlenberg, Box 351525, Department of Psychology, University of Washington, Seattle, Washington 98195. E-mail: fap@u.washington.edu Mary was suffering from depression and anger and sought therapy from a cognitive therapist. Following the standard protocol, the therapist presented the therapy treatment rationale during the first session. He explained to Mary that when certain events occurred in her life, she first had thoughts about those events that then, in turn, produced her negative feelings. When Mary returned for the second session, she told him that she'd gone to her mother's for dinner, and when a plate of broccoli was placed on the table (a vegetable she never had liked), she noticed that she first thought, She doesn't care about me and then noticed that she felt angry and depressed. Did Mary's experience have anything to do with the explanation given to her in her initial therapy session? Mary's case is hypothetical but allows us to illustrate a case we will make, namely, that the therapist's explanation may well have influenced what Mary experienced and what she reported during her next therapy session In this article we apply the concept of demand characteristics to the treatment rationales presented to clients receiving psychotherapy. First, several aspects of the definition of demand characteristics are highlighted. Then, the notion of demand characteristics is extended to psychotherapy, with attention to dissociative identity disorder and the repressed memory controversy. In these two areas, the role of demand characteristics already has been investigated, and the notion has been raised that rigid adherence to a particular conceptual model of psychopathology may lead to demand responding. We then suggest that treatment rationales can be viewed as a package in which demands often are neatly wrapped and explicitly articulated. We review research on treatment rationales for systematic desensitization that has demonstrated the influence of demand characteristics, and describe a preliminary study investigating demand characteristics in treatment rationales for cognitive therapy for depression. Cognitive therapy is presented as an example of strong treatment that nonetheless may be a vehicle through which the unintended influence of demand characteristics may occur.