Ideal control mastery technique correlates with change in a single case.

Abstract

The authors present a study of a 16-session psychotherapy conducted from the perspective of control mastery theory (CMT), a cognitive–psychodynamic– humanistic theory of psychopathology and psychotherapy process. Following every session, measures of the client’s in-session affect, the therapist’s in-session techniques, therapeutic alliance, and session outcome were obtained. The authors developed a quantitative prototype of ideal CMT technique for this case and determined how closely each session’s technique matched the prototype. The closer the therapist’s in-session technique was to ideal CMT technique, the better the client’s in-session affect and the better the session outcome. Providing ideal CMT technique was associated with better session outcome, even after controlling for the passage of time, in-session affect, and therapeutic alliance. Psychotherapists are often critical of psychotherapy research (Bohart, O’Hara, & Leitner, 1998; Henry, 1998; Persons & Silberschatz, 1998). This criticism is, in part, because studied psychotherapies sometimes poorly approximate practiced psychotherapies. Consider, for example, the researchers’ use of treatment manuals to tailor the delivery of therapeutic techniques to specific diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994). Practitioners in the real world prefer to use clinical theory to develop individualized case formulations and flexible treatment plans to prescribe techniques (Drozd & Goldfried, 1996). Even therapists who advocate the use of treatment manuals in their practice tend to modify the manual to suit the particular complexities of each case (Persons, Bostrom, & Bertagnolli, 1999). Thus, studies that report on the effects of manualized treatments fail to study what therapists actually do. In addition, clinical practitioners complain that psychotherapy research pays undue attention to questions of minimal concern to the psychotherapist while neglecting questions that matter most to clinicians. For instance, the bulk of psycho-