Psychotherapy outcome: An issue worth re-revisiting 50 years later.

Abstract

Responding to an invitation to celebrate the 50th anniversary of the journal Psychotherapy, the goal of this article is to describe three general ways by which the impact of psychotherapy might be improved: (a) clinically, by encouraging the assimilation of empirically based principles of change and psychopathology research into day-to-day practice; (b) empirically, by fostering process and outcome research focused on a wide range of common factors and basic findings; as well as (c) clinically and empirically, by facilitating active collaboration of practitioners and researchers in various types of practice-oriented research. Reflected in these three potential avenues of growth are the assumptions that (a) we can improve our understanding and impact of psychotherapy by building on convergences and complementarities across different theoretical orientations, domains of research, and professional expertise, and that (b) most of the clinical and research suggestions derived by such convergence and plurality may not require drastic changes in the practice of many psychotherapists.

Building clinicians-researchers partnerships: Lessons from diverse natural settings and practice-oriented initiatives

“…Second, because some of its findings (with regard to the alliance, for example) are convergent with those obtained in academic settings, POR can increase the strength of this knowledge. As argued elsewhere, when similar effects are cross-validated across different methodologies, each with its own strengths and limitations, we can feel more confident about the veracity and generalizability of these effects (Castonguay, 2013).…”

“…Also going beyond the concept of relevance, clinicians are more likely to participate in studies and continue to use research procedures in poststudy completion when such procedures do not require drastic changes to their practice (Castonguay, 2013;Koerner & Castonguay, 2014). Most clinicians will be indifferent to or even resentful if they are asked to put aside the way they have been practicing for years and forced to adopt completely new treatment packages (and/or theoretical orientations) in order to test a protocol within their own clinical routine.…”

“…This predominant, top-down approach to the generation and implementation of empirical knowledge has no doubt led to major contributions to our understanding and the efficacy of psychotherapy (Castonguay, 2013). However, since it is primarily guided by the theoretical interest of academicians and frequently conducted in highly controlled settings, this traditional approach to research has not been an optimal strategy to address day-to-day concerns of clinicians or to provide easily generalizable (applicable, actionable, and retainable) practice guidelines in clinical routine.…”

Clients’ experiences of the impacts of an experiential art therapy group

“…Insight and the acquisition of a new perspective of self -helped by and following from creative exploration in the artmaking process -was felt to be the most significant and lasting impact according to the selfrating questionnaire. In different orientations of verbal psychotherapies, insight is one of the general principles of change related to improvement (Castonguay, 2013;Connolly Gibbons et al 2009;Stiles et al, 1990). Increased sense of self, self-reflection and clarity of identity, which all improve self-knowledge, are also highlighted as major impacts experienced by art therapy clients in this as well as other art therapy studies (Stubbe Teglbjaerg, 2009;Uttley et al, 2015).…”

“…Similarly, in process research on verbal psychotherapies, the experience of the therapy process and its outcomes are often viewed as inseparable (Mcleod, 2011;Stiles et al, 1990;Wampold, 2013). However, even if the therapeutic process and its impacts are intertwined, it is important to make explicit whether the perspective on the impacting processes is based on the therapists' or clients' experiences, because clients' views have been shown in many cases to be better predictors of outcome than therapists' views (Castonguay, 2013;Horvath & Symonds, 1991;Martin, Garske & Davis, 2000;Weinberger & Rasco, 2007).…”