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N. S. Jacobson and P. Truax's (1991) method for evaluating the clinical significance of client change has gained some prominence in psychotherapy outcome research. However, little has been done to investigate the validity of this methodology. This study addresses this limitation by comparing (a) the perceived level of change (as subjectively reported from 3 distinct perspectives) across outcome groupings based on Jacobson and Truax's reliable change index (RCI) and (b) subjective reports of therapeutic alliance and satisfaction across outcome groupings. The results of these comparisons indicate that the RCI is effective in identifying those who make reliable improvement in therapy but is less effective in differentiating between no-changers and deteriorators. In addition, the relationship between treatment outcome and satisfaction with service is questioned.

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Mental health care exerts an influence on the basis of its claim to scientific status, but that claim is false. What it actually does is induct people into understanding life in certain ways that are artifacts ofthe cultures of healing.-Robert Fancher At first glance, this chapter may seem out of place. Why would a book with a focus on the common factors-the "Heart and Soul" of psychotheiapyinclude a chapter on factots as specific as models and techniques? Any confusion is entirely understandable. Foi many yeats, common (e.g., the theiapeutic relationship) and specific (e.g., theiapeutic models and techniques) have been the primary and traditional categories used for understanding psychotheiapy research. In recent decades, the distinction has also been the majoi organizing scheme used by practitioners and researchers, many of whom feel compelled to represent their work either as primarily based on technique (e.g., empirically supported tieatments; Chambless & Hollon, 1998; Task Force on Promotion and Dissemination of Psychological Procedures, 1995) or based on common relationship factors (e.g., empirically supported relationships; Norcross, 2002). However, the common versus specific divide emphasizes a fundamental misunderstanding, namely, that the treatment model and the common factors are separate and distinct. In point of fact, the theiapeutic factors identified and discussed in this volume are intticately inteiwoven with the theoretical orientation of the theiapist and the tieatment provided (Wampold, 2007).