This study examined whether 49 patients from a randomized controlled trial developed insight during therapy and whether insight predicted long-term outcome in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for Cluster C personality disorders. Videotaped sessions early and late in treatment were analyzed using the Achievement of Therapeutic Objectives Scale. Patients' level of insight increased significantly during STDP but not CT. After controlling for early symptom change and early insight, insight near the end of therapy predicted improvement of symptom severity and interpersonal functioning during a 2-year follow-up period. These results support the theoretical assumption that insight may be a factor in the change process, central to STDP. Within CT, gain of insight did not predict long-term improvement.
This study examined interrater reliability and sensitivity to change of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough, Larsen, et al., 2003) in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT). The ATOS is a process scale originally developed to assess patients' achievements of treatment objectives in STDP, but further operational definitions have led to a theoretically neutral assessment device, making it applicable to other treatment modalities as well. Videotapes from a randomized controlled trial comparing the effectiveness of STDP and CT for patients with Cluster C personality disorders were rated by independent raters, typically at Sessions 6 and 36. The results indicated good to excellent interrater reliability, as well as adequate sensitivity to change in theoretically expected ways, in both STDP and CT. The results lend further support to the psychometric soundness of the ATOS and show promise for its use when comparing STDP and CT.
The aim of this study was to conduct a further investigation of the reliability of an innovative new measure for examining processes within psychotherapy sessions, the Achievement of Therapeutic Objectives Scale (ATOS). The ATOS assesses seven common factors in psychotherapy: insight, motivation, activating affects, inhibitory affects, new learning (appropriate expression of feeling), sense of self, and sense of others. Through the use of ATOS, a patient's degree of 'assimilation' or 'achievement' of the objectives of psychotherapy can be captured throughout the therapy process. A previous reliability study with graduate students demonstrated poor to fair reliability with 8 hours of training. This study sought to improve reliability by providing 15 hours of training in using the ATOS, in five classes of three hours, and with more focused rating. When all subscales were rated simultaneously, students (N=32) attained ICCs in the fair to good range of .42-.71. When students were allowed to focus on two subscales at a time (rather than the full scale) during 20 hours of additional practice, ICC values increased to the range of .76-.95. The study suggests that an investment in solid training of
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