A Preliminary Probe of Personality Predicting Psychotherapy Outcomes: Perspectives from Therapists and Their Clients

Abstract

Background: It is widely established that personality disorder has as broad negative impact on psychotherapy outcomes. Given the increased emphasis on dimensional traits for personality pathology in the DSM-5 and the proposal for the ICD-11, it is important to understand how traits are linked to treatment outcomes. Building on past research with general traits, we hypothesized that more nuanced and specific relations would be apparent. Furthermore, much of the past research has relied upon self-reports of personality and little is known about how ratings from therapists might be related to outcomes. Sampling and Methods: The present paper examined how dimensional traits from the Five-Factor Model predicted outcomes in a case series of 54 therapist-client dyads within a doctoral training clinic. Importantly, this extends past research as dimensional traits were rated by both therapists and clients at intake as well as sequentially over the course of therapy. Results: Correlations and regression analyses indicated that traits predicted a variety of outcomes including initial engagement in treatment as well as overall symptom reduction across therapy. Specifically, preliminary evidence suggests that therapist-rated conscientiousness at intake was positively related to clients’ early engagement in therapy. In addition, openness to experience after the 4th session – particularly as rated by the client – was predictive of long-term therapy outcomes. Conclusions: Broadly, these results provided preliminary information about the promise of dimensional models for improving the clinical utility of personality disorder diagnoses. More specifically, these results reinforced the relevance of personality assessment during therapy and indicated the potential predictive value of ratings by therapists and their clients.

Clinical utility of categorical and dimensional perspectives on personality pathology: A meta-analytic review.

“…In a seminal investigation of this issue, Samuel and Widiger (2011) found that FFM ratings of outpatients undergoing treatment for substance abuse were stable over 6-month intervals, and helped predict salient aspects of patients’ psychological functioning (see also Bucher, Suzuki, & Samuel, 2019, for additional evidence bearing on the latter issue). Along somewhat different lines, Samuel, Bucher, and Suzuki (2018) found that both therapist- and patient-derived FFM ratings predicted salient dimensions of therapeutic outcome in an outpatient doctoral training clinic.…”

Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice.

“…For example, certain treatments are particularly effective in promoting personality change (e.g., Hudson & Fraley, 2015;Roberts et al, 2017), which in turn can improve other mental health symptoms (e.g., Conrod et al, 2013;Zinbarg, Uliaszek, & Adler, 2008). Alternatively, explication of traits can guide clinicians in matching treatments to patient's personality vulnerabilities, as they have been found to moderate therapeutic process (e.g., traits related to agreeableness moderate efficacy of behavioral therapy for distress; Kushner, Quilty, Uliaszek, McBride, & Bagby, 2016;Samuel, Bucher, & Suzuki, 2018). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

The clinical utility of the ICD-11 classification of personality disorders and related traits: A preliminary scoping review

“…Studies that exclusively utilized approaches to personality disorder diagnosis other than the ICD-11 and/or its dimensional operationalizations were excluded from the current review (e.g. Leichsenring et al, 2019; Samuel et al, 2018). While conceptual, theoretical and critical literary contributions were used in the formation of the introduction, this non-empirical research was also excluded (e.g.…”