Improving the yield of psychotherapy research

Abstract

Objective: Although the effectiveness of psychotherapy is well documented, little progress has been made in elucidating mechanisms of change. Major impediments to progress are the homogeneity assumptions evident in many psychotherapy studies. Case-specific research strategies avoid treating patients, therapists, and treatments as homogeneous variables and such studies are more successful at elucidating the link between psychotherapy processes and treatment outcome. Method: A case-specific, process-outcome study comprised of 39 patients treated by experienced therapists is presented. We did not focus on a supposedly homogeneous diagnostic group of patients (e.g., depressed patients) or particular manualized brands of therapy. Instead, we identified each patient's particular problems and conflicts (plan formulation) and then determined the degree to which therapists effectively addressed the patient's problems—that is, the degree to which therapists' interventions were compatible with (i.e., responsive to) the patient's plan. Results: Correlations between ratings of therapist responsiveness (plan compatibility of interventions) and a variety of outcome assessments were significant and substantial (accounting on average for 25% of outcome variance). Conclusion: The findings presented here suggest that the extent to which therapists are responsive to their patients' plans is a strong predictor of treatment outcome and of patients feeling positively about their therapy experience.