We review the historical debate about the assessment of psychotherapy outcome, along with the current status of outcome research. Although strides in statistical techniques have allowed us to conclude that psychotherapy is effective, we argue that typical statistical measurement does not allow researchers to demonstrate the complexity of change for individuals. We thus recommend that researchers include individualized and qualitative approaches in their assessments of psychotherapy outcome.
We used the Actor Partner Interdependence Model (APIM; Kashy & Kenny, 2000) to examine the dyadic associations of 74 clients and 23 therapists in their evaluations of working alliance, real relationship, session quality, and client improvement over time in ongoing psychodynamic or interpersonal psychotherapy. There were significant actor effects for both therapists and clients, with the participant's own ratings of working alliance and real relationship independently predicting their own evaluations of session quality. There were significant client partner effects, with clients' working alliance and real relationship independently predicting their therapists' evaluations of session quality. The client partner real relationship effect was stronger in later sessions than in earlier sessions. Therapists' real relationship ratings (partner effect) were a stronger predictor of clients' session quality ratings in later sessions than in earlier sessions. Therapists' working alliance ratings (partner effect) were a stronger predictor of clients' session quality ratings when clients made greater improvement than when clients made lesser improvement. For clients' session outcome ratings, there were complex three-way interactions, such that both Client real relationship and working alliance interacted with client improvement and time in treatment to predict clients' session quality. These findings strongly suggest both individual and partner effects when clients and therapists evaluate psychotherapy process and outcome. Implications for research and practice are discussed.
We investigated changes over 12 to 42 months in 23 predoctoral trainees during their externship training in a psychodynamic/interpersonal psychotherapy clinic. Over time, trainees increased in client-rated working alliance and real relationship, therapist-rated working alliance, client-rated interpersonal functioning, ability to use helping skills (e.g., challenges, immediacy), higher-order functioning (e.g., conceptualization ability, countertransference management), feelings about themselves as therapists (e.g., more authentic, more self-aware), and understanding about being a therapist (e.g., theoretical orientation, curiosity about client dynamics). In contrast, trainees did not change in engaging clients (return after intake or for at least 8 sessions), judge-rated psychodynamic techniques in third and ninth sessions across clients (although trainees used more cognitive-behavioral techniques over time in third but not ninth sessions), or changes in client-rated symptomatology. Trainees primarily attributed changes to graduate training, individual and group supervision, research participation, and working with clients. Implications for training and research are discussed.
A theory of the research training environment (RTE) proposed by Gelso (Counseling Psychologist, 8:7-35, 1979; Professional Psychology: Research and Practice, 24:468-476, 1993; The Counseling Psychologist, 25:307-320, 1997) is updated, and the research evidence that bears upon this theory is reviewed. Evidence accumulated over more than three decades supports the influence of the RTE on the research attitudes, research self-efficacy, and research productivity of graduate students in psychotherapy-related fields in psychology. Both the global RTE and 10 ingredients posited by RTE theory are reviewed. The ingredients that seem to have the greatest association with theorized training outcomes in students are (1) faculty modeling of scientific behavior, (2) positive reinforcement of students' scientific behavior, (3) teaching students, through the advising relationship and research teams, that science can be a partly social-interpersonal experience, and (4) teaching students that all research is flawed and limited. The training program faculty is responsible for arranging the training environment so that it will maximally impact psychotherapy graduate students' research attitudes, research self-efficacy, and productivity.
This study investigated client motivations for concealing versus disclosing secrets in therapy as well as how this negotiation process relates to therapeutic process and outcome. About half of the participants had both revealed a secret and were concealing a secret in therapy. Disclosed secrets were most likely to be related to relationships and were disclosed because the clients felt they could trust their therapists and because they thought they could benefit from sharing the secret. Concealed secrets were most likely to be sexual in nature and to be concealed due to shame or embarrassment. Clients initially experienced comparable levels of negative and positive emotions when they first disclosed their secret. However, over time, their feelings about the disclosure became more positive and less negative. Concealment was negatively related to the real relationship.
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