A study of psychotherapy interaction and continuation in psychotherapy

Abstract

PROBLEMEarly termination in psychotherapy has been studied in relation to actuarial variables and psychiatric diagnosis with somewhat conflicting result^(^^ *, More recently it has been related to the expectancies which patients and therapists have pertaining to psychotherapy@* 7 , and to therapist variables@, *). This study investigated selected behaviors and perceptions of patient and therapist in a first therapy interview and related these to duration of stay. A number of rating scales were devised for this purpose and provided the data for the study. METHODOur Ss were six therapists and 24 patients, with each therapist seeing four patients. The therapists were two psychologists with four years of postdoctoral experience in clinical psychology and four resident psychiatrists in the second year of their residency training.The patients were randomly assigned to the therapists after being accepted for psychotherapy a t our Outpatient Clinic. The patients selected had no prior psychotherapy experience and did not show evidence of psychosis or brain damage.2 The age range of the patients was limited to 18 to 50 years.The patients, 10 men and 14 women, had an average age of 27 years and a median educational level of twelfth grade. Their psychiatric diagnoses were as follows: Neuroses, 10; character and personality disorders, 11 ; psychosis, 1; and others, 2.Three judges listened to recordings of all first therapy interviews and independently completed a series of rating scales. Two of the judges were clinical psychologists and the third was a psychiatrist, all diplomates in their respective fields. In addition, the therapist completed three rating scales after the first interview and again after the fifth interview, if the patient were still in therapy. The patient also completed a rating scale after the first and fifth interviews. DEWRIPTION OF RATINQ SCALES3Outpatient Rating Scale. This is a 16-item scale designed to rate varioue aspects of the r t i e n t , the therapist's personal feelings toward the patient, and specific predictions concerning ength of stay in psychotherapy. A description of the scale has been given elsewhere'l). Both the therapist and the judges rated the f h t interview on this scale while the therapist also rated the fifth interview.

The therapist as a neglected variable in psychotherapy research.

“…After the data were secured on patient continuation in therapy, we compared the results for each of the six therapists. The findings were of real interest: “The two most favorably rated therapists each kept three out of four of their patients, whereas the two least favorably rated therapists each kept only one out of four assigned patients” (Garfield et al, 1963, p. 477). The two remaining therapists each had two remainers and two terminators.…”

“…However, when we do sometimes devote attention to therapist variability, we can note important differences among those appraised, and negative outcomes in therapy have also been secured (Lambert & Bergin, 1994). Some years ago, I conducted a study of continuation in psychotherapy that focused on the first therapy interview as a potential predictor (Garfield, Affleck, & Muffly, 1963). My colleagues and I taped the initial therapy interviews that each of six therapists had with four new patients.…”

Therapist ratings as predictors of therapy attendance

“…These problems are particularly evident in the context of research on therapist variables. Past studies in this area typically have involved small samples (Garfield, Affleck, & Muffly, 1963), a limited spectrum of therapist variables (Salzman, Shader, Scott, & Binstock, 1970) and failure to consider the topic of cross-validation (Garfield & Affleck, 1961).…”

Rating therapists who treat substance abusers

“…Garfield et al (1963) conducted a study with six subjects, who were all therapists, with four new clients. Three independent outside raters ranked the therapists with regard to how effective they were in creating an interactive relationship during the first therapy session.…”