The studies presented here describe the development of an instrument to measure a range of beliefs potentially important as reasons for not committing suicide. Sixty-five individuals generated 72 distinct reasons; these were reduced to 48 by factor analyses performed on two additional samples, and the items were arranged into the Reasons for Living Inventory (RFL), which requires a rating of how important each reason would be for living if suicide was contemplated. In addition, factor analyses indicated six primary reasons for living: Survival and Coping Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide, Fear of Social Disapproval, and Moral Objections. The RFL was then given to two additional samples, 197 Seattle shoppers and 175 psychiatric inpatients. Both samples were divided into several suicidal (ideators and parasuicides) and nonsuicidal groups. Separate multivariate analyses of variance indicated that the RFL differentiated suicidal from nonsuicidal individuals in both samples. In the shopping-center sample, the Fear of Suicide scale further differentiated between previous ideators and previous parasuicides. In the clinical sample, the Child-Related Concerns scales differentiated between current suicide ideators and current parasuicides. In both samples, the Survival and Coping, the Responsibility to Family, and the Child-Related Concerns scales were most useful in differentiating the groups. Results were maintained when the effect of recent stress was held constant.The frequency of suicidal behavior sug-point in their lifetime; between 53% and 67% gests that it is a phenomenon that cannot be report seriously considering it. ignored. Over 25,000 individuals a year killThe majority of research in the field of themselves in the United States (U.S. Vital suicidology, to date, has been directed at Statistics, 1973Statistics, , 1975, and it is estimated identifying characteristics of suicidal persons that two to eight times this number, or from to enhance prediction of suicidal behavior 50,000 to 200,000 persons a year parasuicide (Beck, Resnick, & Lettieri, 1974; Kreitman, (i.e., intentionally self-injure, behavior usu-1977;Neuringer, 1974). With few exceptions ally labeled in the U.S. as attempted suicide; (e.g., Goodstein, 1982) almost all of this work Berman, 1975). Linehan and colleagues (Li-has focused on identifying maladaptive atnehan & Laffaw, in press; Linehan & Nielsen, tributes of suicidal persons. Little attention 1981; Linehan, Note 1) found that from 10% has been given the question of whether suito 16% of an adult, general population in cidal persons lack important adaptive char-Seattle report attempting suicide at some acteristics present among nonsuicidal individuals, and, if so, what these characteristics This research was supported by National Institute might be. Grant MH34486.Focusing on adaptive, life-maintaining The authors would like to thank Kirk Strosahl for his characteristics of nonsuicidal people is sim-••isrrssrssr^riSM. ** s ^ approach pL inehan, Departm...

Many branches of medicine rely heavily on lab tests to monitor client treatment response and use this information to modify their treatment. By contrast, those who offer psychological interventions seldom rely on formal assessments (lab tests) to monitor their clients' response to treatment. Data are presented that demonstrate that clinicians rarely accurately predict who will not benefit from psychotherapy. This finding is contrasted with the use of a questionnaire (lab test data) and decision rules on the basis of a client's expected progress. Results have indicated that formal methods of monitoring were able to identify 100% of the patients whose condition had deteriorated at termination, and 85% by the time they had attended three treatment sessions. Practitioners are encouraged to consider formal methods of identifying the deteriorating client.

Client-focused research systems have been developed to monitor and provide feedback information about clients' progress in psychotherapy as a method of enhancing outcome for those who are predicted to be treatment failures. In the current study, the authors examined whether feedback regarding client progress and the use of clinical support tools (CSTs) affected client outcome and number of sessions attended. Results showed that clients in the feedback plus CST group stayed in therapy longer and had superior outcomes. Nearly twice as many clients in the feedback plus CST group achieved clinically significant or reliable change, and fewer were classified as deteriorated by the time treatment ended.

Empirically supported psychotherapies, treatment guidelines, best practices, and treatment manuals are methods proposed to enhance treatment outcomes in routine practice. Patient‐focused research systems provide a compatible and contrasting methodology. Such systems monitor and feed back information about a patient's progress during psychotherapy for the purpose of enhancing outcomes. A meta‐analytic review of three large‐scale studies is summarized and suggests that formally monitoring patient progress has a significant impact on clients who show a poor initial response to treatment. Implementation of this feedback system reduced deterioration by 4% to 8% and increased positive outcomes. Our interpretation of these results suggests that it may be time for clinicians routinely and formally to monitor patient treatment response.

Most research on the dose-effect model of change has combined data across patients who vary in their total dose of treatment and has implicitly assumed that the rate of change during therapy is constant across doses. In contrast, the good-enough level model predicts that rate of change will be related to total dose of therapy. In this study, the authors evaluated these competing predictions by examining the relationship between rate of change and total dose in 4,676 psychotherapy patients who received individual psychotherapy. Patients attended 6.46 sessions on average (SD = 4.14, range = 3-29, Mdn = 5). The results indicated that although patients improved during treatment, patients' rate of change varied as a function of total dose of treatment. Small doses of treatment were related to relatively fast rates of change, whereas large doses of treatment were related to slower rates of change. Total dose had a nonlinear relationship with the likelihood of clinically significant change. Given the variability in rates of change, it appears that time limits for treatment uniform to all patients would not adequately serve patients' needs.

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Patient-focused research attempts to provide information that answers the question: Is this treatment benefiting this patient? Although several systems have been developed to monitor and provide feedback about a patient's response to psychotherapy, few if any have been tested empirically. The current study divided 609 patients into four groups (two experimental and two control) to determine if feedback regarding patient progress, when provided to a therapist, affected patient outcome and number of sessions attended. Results showed that feedback increased the duration of treatment and improved outcome relative to patients in the control condition who were predicted to be treatment failures. Twice as many patients in the feedback group achieved clinically significant or reliable change and one-third as many were classified as deteriorated by the time treatment ended. For those patients who were predicted to have a positive response to treatment, feedback to therapists resulted in a reduction in the number of treatment sessions without reducing positive outcomes.

Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record