Due to imprecise methods of evaluating therapist behaviors, little progress has been made in demonstrating how the therapist contributes to the success of psychotherapy. More important, the suitability of the therapist's behavior to the particular needs of a given patient has not been adequately assessed. In this article, we describe a new approach for assessing the suitability of therapist interventions. We hypothesized that the suitability of interpretations would be more predictive of patient progress than the category of interpretation: transference versus nontransference. The transcripts of three brief psychodynamic psychotherapies were studied. Interpretations in the three therapies were identified and categorized as transference or nontransference and were then rated for suitability. Patient productivity was rated using the Experiencing Scale. As predicted, in each case suitability of interpretations correlated significantly and positively with patient productivity, whereas type of interpretation did not correlate with patient progress.
Two clinicians provided opposite answers to the title question: Persons argued that information from randomized controlled trials (RCIs) is vital to clinicians, and Silberschatz argued that information from RCIs is irrelevant to clinicians. Persons argued that clinicians cannot provide top quality care to their patients without attending to findings of RCIs and that clinicians have an ethical responsibility to inform patients about, recommend, and provide treatments supported by RCIs before informing patients about, recommending, and providing treatments shown to be inferior in RCIs or not evaluated in RCIs. Silberschatz argued that RCIs do not and cannot answer questions that concern practicing clinicians. He advocates alternative research approaches (effectiveness studies, quasi-experimental methods, case-specific research) for studying psychotherapy. The question of whether the results of randomized controlled trials (RCTs) are useful to practicing clinicians is a controversial one in the field of the psychological therapies. We present the two sides of the argument, with Persons arguing that information from RCTs is vital to clinicians and Silberschatz arguing that information from RCTs is irrelevant. After presenting each of our points of view, each author rebuts the other's position. We conclude with a brief review of our key points of agreement and disagreement. Two Points of View Results of RCTs Are Vital to Clinicians (Jacqueline B. Persons) Clinicians must attend to the results of RCTs for clinical, ethical, and legal reasons. I present examples of clinically useful information provided by RCTs. I also describe factors that make it difficult to export RCT-supported protocols from research to clinical settings, and I propose strategies for alleviating some of those difficulties.
The findings presented here suggest that the extent to which therapists are responsive to their patients' plans is a strong predictor of treatment outcome and of patients feeling positively about their therapy experience.
This article describes methods and concepts developed by the Mount Zion Psychotherapy Research Group for empirically evaluating the pertinence of suitability of a therapist's interventions (behaviors) to a patient's particular problems, needs, and treatment goals. Intensive studies of 2 brief psychotherapy cases are presented. In these studies, patient-initiated critical incidents (tests) were identified, the case-specific accuracy of the therapist's responses to these incidents was rated, and the impact of these interventions on subsequent patient behavior was measured. The findings indicated that these patients tended to show improvement in the therapeutic process when the therapist's interventions were in accord with their particular problems and treatment goals. The application of this method to clinically relevant studies of psychotherapy is discussed.
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