Models of Psychotherapy Outcome: Are They Applicable in Training Clinics?

Abstract

To explore whether psychotherapy models are applicable in the training clinic setting, the dose-effect model of psychotherapy outcome was tested in the outpatient clinic of an American Psychological Association-approved doctoral training program in clinical psychology. Outcome data, using the Outcome Questionnaire 45.2, were gathered immediately prior to each psychotherapy session during the course of treatment (mean total number of sessions: 14.81). Sixty-one clients, treated by 21 trainee clinicians, participated. Although a similar pattern emerged, response to treatment was not as rapid as the dose-effect model would predict. Ideas for future research are proposed.

Investigation of the Phase Model of Psychotherapy Across Therapeutic Orientations: Are Different Approaches Actually All That Different?

“…The dose response relationship was not consistent across settings (e.g. the delayed response seen in training clinics (Callahan & Hynan, 2005). Additionally, while the model has some aspects that could be described as change-based, such as the concept of the changing projected outcomes based on current dosage levels of psychotherapy, it is essentially a model of psychotherapy outcome, with a logarithmic assumption regarding the quantity of psychotherapy received and the improvement evidenced, with a somewhat dichotomous view of the therapeutic work being successful (improvement in the client) or unsuccessful (no improvement in the client).…”

Impact of Clinician Expectations on Termination Status and Therapeutic Outcome

“…It was hypothesized trainee clinicians' expectations for rate of recovery would be significantly greater than typical recovery rates provided in the literature (Callahan & Hynan, 2005;Hansen et al, 2002;Kadera et al, 1996). Additionally, it was hypothesized that clinicians' expectations for rate of recovery and premature termination would significantly impact their clients' treatment outcomes and termination status.…”

“…It is used to assess for the presence of 13 of the most common DSM-IV Axis I disorders including: major depressive disorder, bulimia, posttraumatic stress disorder, panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, alcohol abuse/dependence, drug abuse/dependence, somatization disorder, hypochondriasis, and psychosis (Zimmerman & Mattia, 2001b). Previous research has found that these 13 disorders represent approximately 75% of the diagnoses encountered in university psychology clinics (Callahan & Hynan, 2005).…”

“…Utilizing session-by-session scores on the Outcome Questionnaire (OQ-45; Lambert et al, 1994) as an indicator of client progress, Kadera et al (1996) tracked the progress of 64 clients in a university-based training clinic and reported a slowed dose-effect response curve with only 22% of clients seeing improvements after 8 sessions. A more recent study conducted by Callahan and Hynan (2005) examined session-by-session scores on the Outcome Questionnaire 45.2 (OQ45.2; Lambert et al, 1996) as an indicator of clinically significant change for 61 clients. The researchers found particularly modest effects with a mere 8% of clients showing significant improvements after 8 sessions of psychotherapy and only 38% of clients categorized as improved after 52 sessions.…”

Attachment theory within clinical supervision: application of the conceptual to the empirical

“…Connections between supervision and client progress have been uncovered (Callahan, Almstrom, Swift, Borja, & Heath, 2009;Wrape, Callahan, Ruggero, Watkins, in press: Watkins, 2011), therefore further research in this area is warranted. It is possible that better understanding supervisory-specific attachment or leader-member exchange could influence the way trainees address ruptures or premature termination, two major challenges for clinicians, especially in training facilities (Callahan, Aubuchon-Endsley, Borja, & Swift, 2009;Callahan & Hynan, 2005). These are just a few of the numerous avenues to explore in attachment within supervision, as currently much is left uncovered.…”