Is the use of interpretations associated with treatment outcome? A systematic review and meta-analytic answer.

Abstract

Interpretation is the doyen of therapeutic techniques and has received some of the greatest theoretical and clinical attention. Nevertheless, to date, no meta-analysis has examined its effect on psychotherapy outcome. In the present systematic review and meta-analysis, we examined the association between interpretations and psychotherapy outcome. The meta-analysis was preregistered in PROSPERO. From 13,195 initially identified abstracts, we extracted 16 independent effect sizes from a total of 897 patients. Findings suggest a medium effect size (r = −.23, p = .002), indicating that the use of interpretations is associated with better outcome. This association remains consistent across types of interpretation measures, assessor perspectives, study quality, and number of sessions. Sensitivity analyses demonstrated the robustness of the results.

What to say, when to say it, how to say it: Helping patients deal with painful emotions.

“…However, with some patients, relationship issues are more important, while in others, interpretative techniques are most relevant. It is important to remember that Zilcha-Mano et al (2023) found that the association between the utilization of interpretations and outcome is comparable to the association between therapeutic alliance and outcome.…”

“…However, with some patients, relationship issues are more important, while in others, interpretative techniques are most relevant. It is important to remember that Zilcha-Mano et al (2023) found that the association between the utilization of interpretations and outcome Leon Hoffman https://orcid.org/0000-0001-7466-5513 I thank the editors for allowing me to discuss this very important paper by Sigal Zilcha-Mano, John R. Keefe, Hadar Fisher, Tohar Dolev-Amit, Nirit Veler-Poleg, and Jacques P. Barber.…”

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The meta-analysis reported by Zilcha-Mano et al (2023) is an important contribution. The authors ask a simple question, but one not easy to answer: Does a process variable (interpretation) improve outcome?

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Why do interpretations account for relatively little variance in treatment outcome?

“…Although there have been many reviews and theoretical articles on the role of interpretation in psychotherapy, this is the first meta-analysis examining the association between interpretations and treatment outcome (Zilcha-Mano et al, 2023). Rigorous standards for conducting meta-analyses were stringently followed, with findings derived from a relatively small sample of 16 studies with 897 patients in total.…”

“…However, the context, specificity, and degree of responsiveness in interpretation require further explication. To their credit, the authors of this meta-analysis suggest that future studies need to “explore in greater depth for whom interpretations should be more intensely used, by whom, and when” (Zilcha-Mano et al, 2023, p. 18). The authors also point out that future research should examine patient characteristics, the quality of interpretations, their accuracy, and responsiveness as potential moderators.…”