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This study demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effect of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed.

The efficacy of cognitive therapy was examined for 70 depressed private prac-tice patients. Although these patients had a broader range of psychopathol-ogy than patients in controlled outcome studies of cognitive therapy, they had comparably large reductions in Beck Depression Inventory (BDI) scores. Patients who completed treatment had an average reduction in BDI scores of 65.5%. Initial BDI scores, endogenous symptoms, compliance with home-work, and the interaction between homework and initial BDI scores were statistically significant predictors of end-of-treatment BDI scores. The squared correlation between the observed end-of-treatment BDI scores and the esti-mated expected value was .81. Controlling for other factors, patients who did homework improved three times as much as those who did not. The effect of homework was substantially larger for patients with high initial BDI scores; thus, studies that include only patients with high initial BDI scores may overstate the importance of homework on a general population. In spite of significant improvement, 50% of patients terminated treatment prema-turely. premature termination was most likely in patients with personality disorders, high initial BDI scores, and no endogeneous symptoms.A large body of evidence shows that a standardized course of cognitive ther-apy is effective in the treatment of homogeneous samples of unipolar depressed outpatients treated in a research setting

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