Studies of outcome of psychotherapy

Abstract

The differences in kinds of outcome measures are great if a behavior therapy study such as Paul's is compared to an insight therapy study such as Malan's, but the differences are much less if Marks and Gelder's studies are compared to any of the insight therapy studies. Nearly all the studies used the type of information described by Yates, but the behavior therapy studies of volunteers with monosymptomatic phobias used a much wider variety of sources of information than the studies of psychiatric patients treated either by behavior therapy or insight therapy. In addition to such sources of information as the patients themselves, therapists, family and friends, and independent assessors, some of these studies use physiologic measurements and observable behavior in the stressful situation to assess treatment outcome. It is unclear just how useful physiologic measurement and observable behavior can be in measuring outcome in psychiatric patients. Validated psychological tests are used in many of these studies, but they do not seem to demonstrate change. Another difference is the far greater emphasis placed upon assessing change in the presenting complaint in the behavior therapy studies. This is expected and reflects theoretical differences between these two forms of treatment. As previously noted, many of the behavior therapy studies investigated the mechanism of change, while among the insight therapy studies, only that of Hoehn-Saric has focused on mechanisms of change. At present, neither the insight nor behavior therapy studies answer the question of whether psychotherapy (insight or behavior) is more effective than allowing the difficulties it treats to run their natural course, but these studies do suggest a modified question. At the end of a brief duration of time, 4 to 6 months, for what types of problem is insight or behavior therapy better than no treatment, and for what types of problem is one of these treatments better than the other? A next step in obtaining answers to this question is for the insight therapists to do comparative studies of outcome with groups of patients suffering from specific, homogeneous main complaints such as frigidity, interpersonal anxiety, or agoraphobia. Behavior therapists have been doing such studies for the past few years.