Psychotherapy Outcome Research Research Articles

Power to detect homework effects in psychotherapy outcome research.

Studies of homework effects in psychotherapy outcome have produced inconsistent results. Although these findings may reflect the comparability of psychotherapy with and without homework assignments, many of these studies may not have been sensitive enough to detect the effects sizes (ESs) likely to be found when examining homework effects. The present study evaluated the power of homework research and showed that, on average, current power levels are relatively weak in controlled studies ranging from 0.58 for large ESs to 0.09 for small ESs. Thus, inconsistent findings between studies may very well be due to low statistical power.

Power to detect homework effects in psychotherapy outcome research.

Power to detect homework effects in psychotherapy outcome research.

Enhancing the clinical relevance of psychotherapy outcome research

Despite the many studies of psychotherapy outcome, generalisation of the results of these studies to clinical practice is difficult. Psychotherapy outcome research needs to become more clinically relevant. Patients who are recruited to psychotherapy studies need to be more clinically representative of patients seen in a naturalistic setting, as opposed to belonging to a specific diagnostic group.

Discussion

Some essential adaptations to the method for determining clinically significant change originally introduced by Jacobson, Follette and Revenstorf [Jacobson, N. S., Follette, W. C. & Revenstorf, D. (1984a). Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15, 336-352.] are presented. One adaptation deals with the failure in the original method to distinguish between analysis at the individual versus analysis at the group level. A second adaptation entails the provision of a closer approximation of the underlying true scores. This refinement represents an enhancement in precision. Specific aspects of this refinement may be understood in terms of a correction for error-based regression to the mean. Taking into account these adaptations, new procedures are described for determining (clinically significant) change. Some guidelines for the publication of outcome findings are also presented.

Solution-Focused Brief Therapy — One Model Fits All?

This article expresses concern about the indiscriminate acceptance of the solution-focused brief therapy (SFBT) model by some social workers and social agencies in spite of the dearth of empirical support for its claims to provide clients with more rapid and more enduring change than other treatment models. The article reviews the core assumptions and techniques of SFBT and outlines the strengths and limitations of the model in the context of the findings of psychotherapy process and outcome research and from the perspective of mainstream social work. The authors argue that social workers should avoid rigid adherence to narrow models of therapy and that social work students need to be exposed to multiple theories and techniques to be adequately prepared for practice. Agencies are encouraged to offer services based on a variety of treatment models in order to more adequately serve their clients and also to better position themselves to contribute to research that would further inform the profession about the combinations of model, client, and worker characteristics that lead to the most efficient and effective outcomes.

Reconsidering "between-group psychotherapy outcome research and basic science:" applications to child and adolescent psychotherapy outcome research.

Borkovec and Miranda (1996) proposed that the purpose of controlled outcome studies is to increase our understanding of the change mechanisms associated with psychotherapy, and they suggested several ways that between-group outcome research establishes cause-and-effect relationships. Child psychotherapy outcome research presents special challenges for the issues raised by Borkovec and Miranda and four of these are discussed herein: (a) the multitude of influences on children and adolescents that affect their functioning and therapy outcomes, (b) accurately defining the referral problem, (c) identifying appropriate outcome measures and reliable informants of change in child and adolescent treatment, and (d) considering developmental processes that influence therapeutic effectiveness. It is suggested that transporting clinical trials methods to natural settings is of limited value in identifying cause-and-effect relationships, and an alternative methodology is proposed for advancing child therapy outcome research. This approach advocates developing a profile of the underlying causes that predict psychopathology and therapy outcome for individual children in real clinical settings and then aggregating the data for youth with similar profiles and outcomes. These data can then be used to generate hypotheses about what interventions work for specific children, and investigators can employ prospective studies of therapy outcome for youth with similar profiles.

Reconsidering “between-group psychotherapy outcome research and basic science:” Applications to child and adolescent psychotherapy outcome research

Borkovec and Miranda (1996) proposed that the purpose of controlled outcome studies is to increase our understanding of the change mechanisms associated with psychotherapy, and they suggested several ways that between-group outcome research establishes cause-and-effect relationships. Child psychotherapy outcome research presents special challenges for the issues raised by Borkovec and Miranda and four of these are discussed herein: (a) the multitude of influences on children and adolescents that affect their functioning and therapy outcomes, (b) accurately defining the referral problem, (c) identifying appropriate outcome measures and reliable informants of change in child and adolescent treatment, and (d) considering developmental processes that influence therapeutic effectiveness. It is suggested that transporting clinical trials methods to natural settings is of limited value in identifying cause-and-effect relationships, and an alternative methodology is proposed for advancing child therapy outcome research. This approach advocates developing a profile of the underlying causes that predict psychopathology and therapy outcome for individual children in real clinical settings and then aggregating the data for youth with similar profiles and outcomes. These data can then be used to generate hypotheses about what interventions work for specific children, and investigators can employ prospective studies of therapy outcome for youth with similar profiles. © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 181–190, 1999.

A major dilemma in psychotherapy outcome research: disentangling therapists from therapies

A major dilemma in psychotherapy outcome research: disentangling therapists from therapies

Between‐group psychotherapy outcome research and basic science

In this paper, a view of the nature, purpose, and methods of experimentally controlled between-group therapy outcome research is presented. It is argued that the greatest progress in the development of increasingly useful interventions based on between-group therapy designs will come from (a) viewing such controlled therapy outcome research as basic science in which knowledge is acquired through experimental designs constructed to yield specific cause-and-effect conclusions and (b) combining this form of research with the clinical and nonclinical types more commonly called “basic research.” © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 147–158, 1999.

Individual psychotherapy outcome and process research: challenges leading to greater turmoil or a positive transition?

Psychotherapy is facing challenges that relate to the emergence of managed health care, the possibility of a national health care system, and advances in biological psychiatry. These situations have created pressure to achieve a more accurate assessment of psychotherapeutic effectiveness. Psychotherapy has been proven to be generally effective; however, there is uncertainty as to why. The field is currently experiencing apparent turmoil in three areas: (a) theory development for psychotherapeutic effectiveness, (b) research design, and (c) treatment technique. This chapter reviews the dynamics within each of the areas and highlights the progress made in treating mental disorders. We conclude that recent advances in research design may provide a transition that will bring psychotherapy closer to becoming a unified paradigm with an acceptable theory of effectiveness.

“Between-group psychotherapy outcome research and basic science” revisited

Case studies involving the measurement of every plausibly causal variable and every important outcome variable and covering the widest possible range of cases in terms of these variables are the highest priority for psychotherapy research. Such case studies looked at together will give us the best initial understanding of what variables are probably causal and what treatments yield the best results for particular kinds of patients, therapists, and settings. The accumulation of such case studies will show us where we would benefit by doing comparative controlled experiments of distinct therapies or by employing optimum-seeking designs for a particular therapy. Collaboration by the practitioner community will be needed to do this. The truly difficult and necessary work of applied psychotherapy research still lies ahead of us, hardly touched. © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 159–169, 1999.

Summary: Paradigms for psychotherapy outcome research

Summary: Paradigms for psychotherapy outcome research

Summary: paradigms for psychotherapy outcome research.

Summary: paradigms for psychotherapy outcome research.

Between-group psychotherapy outcome research and basic science.

In this paper, a view of the nature, purpose, and methods of experimentally controlled between-group therapy outcome research is presented. It is argued that the greatest progress in the development of increasingly useful interventions based on between-group therapy designs will come from (a) viewing such controlled therapy outcome research as basic science in which knowledge is acquired through experimental designs constructed to yield specific cause-and-effect conclusions and (b) combining this form of research with the clinical and nonclinical types more commonly called “basic research.” © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 147–158, 1999.

A major dilemma in psychotherapy outcome research: Disentangling therapists from therapies.

In interpreting results of psychotherapy outcome studies, particularly those of comparative studies, it is often difficult to disentangle the effects due to the treatments per se from those that may be due to differential competence and other characteristics of the therapists carrying out the treatments. This article attempts to address this general dilemma in psychotherapy outcome research, drawing on the experience and findings of the NIMH Treatment of Depression Collaborative Research Program. Issues discussed include the nature of the overall therapist sample, variability in therapist efficacy, therapist characteristics, training and supervision of therapists, and adherence and competence in carrying out a treatment. Implications discussed include the need to provide, both in presentations of the results of individual outcome studies and in dissemination of information regarding “empirically validated treatments,” critical information about the therapists carrying out the treatment.

Psychotherapy and Pharmacotherapy Treatment Outcome Research in Pediatric Populations

Reviewed treatment interventions for pediatric populations involving the combination of pharmacotherapy or psychotherapy or either treatment employed alone. The literature revealed a dearth of psychotherapy and pharmacotherapy outcome studies, with the exception of investigations of children diagnosed with attention-deficit hyperactivity disorder (ADHD). Issues pertaining to design, including sample selection, treatment integrity and comparability, and placebo controls also are reviewed. A potpourri of other issues are noted including parental attitudes toward the use of medication versus psychotherapy, treatment adherence, and patient/provider relationship. For children diagnosed with ADHD, the use of stimulant medication appears to be superior to psychotherapy employed alone in managing the behavior of these children as well as their classroom functioning. Recommendations are made for multimodal trials that examine the combined and individual use of pharmacotherapies and psychotherapies for various developmental and psychiatric disorders that occur in childhood and adolescence. Future studies also need to address the durable effects of these treatment options.

Toward a more clinically valid approach to therapy research.

Despite the advances in psychotherapy outcome research, findings are limited because they do not fully generalize to the way therapy is conducted in the real world. Research's clinical validity has been compromised by the medicalization of outcome research, use of random assignment of clients without regard to appropriateness of treatment, fixed number of therapy sessions, nature of the therapy manuals, and use of theoretically pure therapies. The field needs to foster a more productive collaboration between clinician and researcher; study theoretically integrated interventions; use process research findings to improve therapy manuals; make greater use of replicated clinical case studies; focus on less heterogeneous, dimensionalized clinical problems; and find a better way of disseminating research findings to the practicing clinician.

Managed care and the practitioner: A call for unity.

Prior to the advent of health maintenance organizations (HMOs), indemnity insurance plans provided economic incentives that fueled a significant portion of the cost crisis in health care. Although managed care successfully curbed many of the ethical and service-inflation problems that resulted from fee-for-service systems, the powerful economic incentives that fueled these systems still remained but in opposite form: Profits to HMOs tend to increase as service quantity declines. As the industry has matured, a number of new ethical questions have arisen specific to managed care. The authors examine these questions and take the view that mental health HMOs require legislative safeguards to ensure adequate consumer protection and service delivery. Psychotherapy outcome research and current clinical practices in managed care are examined to support this view. A “unionization” of providers around a managed care-specific body of ethical guidelines is proposed.

A multiperspective, multivariable evaluation of reliable change.

N. S. Jacobson and P. Truax's (1991) method for evaluating the clinical significance of client change has gained some prominence in psychotherapy outcome research. However, little has been done to investigate the validity of this methodology. This study addresses this limitation by comparing (a) the perceived level of change (as subjectively reported from 3 distinct perspectives) across outcome groupings based on Jacobson and Truax's reliable change index (RCI) and (b) subjective reports of therapeutic alliance and satisfaction across outcome groupings. The results of these comparisons indicate that the RCI is effective in identifying those who make reliable improvement in therapy but is less effective in differentiating between no-changers and deteriorators. In addition, the relationship between treatment outcome and satisfaction with service is questioned.

Toward a more clinically valid approach to therapy research.

Despite the advances in psychotherapy outcome research, findings are limited because they do not fully generalize to the way therapy is conducted in the real world. Research's clinical validity has been compromised by the medicalization of outcome research, use of random assignment of clients without regard to appropriateness of treatment, fixed number of therapy sessions, nature of the therapy manuals, and use of theoretically pure therapies. The field needs to foster a more productive collaboration between clinician and researcher; study theoretically integrated interventions; use process research findings to improve therapy manuals; make greater use of replicated clinical case studies; focus on less heterogeneous, dimensionalized clinical problems; and find a better way of disseminating research findings to the practicing clinician.