Archival records were used to compare the therapy process in 30 brief psychodynamic and 32 cognitive-behavioral therapies. Verbatim transcripts of 186 treatment sessions were rated with the Psychotherapy Process Q-set, designed to provide a standard language for the description of process. Results demonstrated that although some features were common to both treatments, there were important differences. Cognitive-behavioral therapy promoted control of negative affect through the use of intellect and rationality combined with vigorous encouragement, support, and reassurance from therapists. In psychodynamic psychotherapies, there was an emphasis on the evocation of affect, on bringing troublesome feelings into awareness, and on integrating current difficulties with previous life experience, using the therapist-patient relationship as a change agent. The clinical theoretical precepts underlying psychodynamic treatments received considerable support. In cognitive-behavioral therapies, there was evidence for the importance of developmental, as opposed to rationalist, intervention strategies for treatment outcome.

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Relying on brand names of therapy can be misleading. These findings suggest that the basic premise of controlled clinical trials (i.e., that the compared interventions represent separate and distinct treatments) may not have been met in the NIMH Treatment of Depression Collaborative Research Program. The implications of these findings for using controlled clinical trials to study psychotherapy are discussed.

This study examined psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Transcripts of brief interpersonal and cognitive-behavioral therapies were rated using the Psychotherapy Process Q Set (PQS), an instrument designed to provide a standard language for describing therapy process. Results demonstrated that there were important areas of overlap and key differences in the process of the treatments. There were important differences in therapist stance, activity, and technique that were consistent with theoretical prescription, but patient characteristics within sessions were quite similar. Patient in-session characteristics as measured by the PQS were related to outcome across the treatment samples. These findings are linked to theoretical models, which may help explain the role of nonspecific factors associated with nondifferential treatment outcome in brief therapy.

This study examined the effects of specific factors, that is, of well-defined therapist actions and techniques and patient behaviors and attitudes, on psychotherapy outcome. Forty patients diagnosed as suffering from stress-response syndromes following a traumatic event or a bereavement were treated in a brief, 12-session psychodynamic psychotherapy. Transcripts of therapy hours were rated with a Psychotherapy Process Q Sort designed to provide a standard language for the description and classification of the therapy process. Results demonstrated that specific factors were indeed predictive of treatment outcome, though usually in interaction with patient pretreatment disturbance level. The characteristics of process that predicted successful outcome with less and more disturbed patients paralleled the long-recognized distinction between "expressive" and "supportive" approaches. The data suggest that patient change is far more complex than the nonspecific hypothesis of therapeutic effectiveness implies. The view is presented that the failure to identify consistent correlations between specific aspects of process and treatment outcomes is the product of the attempt to find simple, direct associations, to the neglect of more complex research conceptualizations of process that adequately reflect the interaction of multiple influences in clinical treatments.

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Two studies investigated the influence of therapist gender as well as patient age and pretreatment distress level on process and outcome in a brief 12session psychodynamic psychotherapy. Pre-and posttherapy assessments disclosed that patients treated by female therapists experienced more symptomatic improvement and reported more satisfaction with treatment than those treated by male therapists. However, patient age accounted for twice, and patient pretreatment level of disturbance more than three times, the outcome variance contributed by gender. In Study 2 female therapists were judged to arouse less negative affect in women patients and to arouse fewer interpersonal difficulties.There has been a good deal of discussion concerning the role of gender in psychotherapy. The emergence of gender as a theme in both clinical and research literatures is in part a reflection of contemporary social issues, but the fact that the recipients of treatment in mental health settings are more likely to be women, while the providers are more often men (Brodsky & Hare-Mustin, 1980) has given rise to some uncertainty about the effectiveness of this common gender match in promoting change and psychological well-being in women clients. Much of the debate revolves around the concern that male therapists may serve Grateful acknowledgment is extended to Mardi J. Horowitz and his colleagues at the Center for the Study of Neuroses,