What is process research?
research that examines patterns, using therapist and or client data, that are evident within and across therapy sessions
(examines what happens in therapy)
what is process outcome research?
examines the relation between variables related to the process of providing psychotherapy and the outcome of psychotherapy
- How what happens in therapy is related to client change and tells us about HOW therapy works.
What are common factors?
therapeutic elements that occur in all or most treatments and are believed to be critical for client outcomes.
critical for successful client outcomes
what is fidelity?
when clinicians follow the same protocol.
–> however, because every person is unique, each treatment will also be delivered in a unique way
brings into question how much of the success of treatment is due to the treatment and how much is due to fidelity
What are some client variables?
- gender, age, SES, belief in therapy, goals, previous treatment, psychological minded, marital status
we examine these because diagnosis isn’t the only factor that determines therapy outcomes.
Client factors:
What is higher SES associated with?
higher engagement / higher completion and improvement
Client factors:
what is having a similar ethnicity to the therapist associated with?
more engagement / completion and improvement
Client factors:
Which gender is more likely to seek out treatment?
Women… however, this makes no difference in completion and improvement across time.
Client Factors:
what is higher age associated with?
more engagement… but doesnt make a difference in completion
Client factors…
what is symptom severity associated with?
differing outcomes for engagement, but poorer outcomes with completion and improvement
What is positive engagement associated with?
more engagement and higher completion
What is psychological reactance?
the tendency to react against attempts to influence or limit one’s behaviours or options
how is psycholigcal reactance associated with treatment outcomes?
low reactance = greater therapeutic gains in more directive treatments
high reactance - greater therapeutic gains in less directive treatments
What is psychological mindedness?
the ability to understand people and problems in psychological terms.
–> related to more positive treatment outcomes
What are some therapist variables that influence treatment?
- Professional background (mental health training more positive outcomes than regular health training)
- experience (has a small positive effect)
- Wellbeing ( the therapists wellbeing is consistently positively associated with treatment outcomes)
- Self disclosure ( small positive effect)
NO real effect of age or gender.
Ethnicity has an effect if the therapist is multicultural
What are some benefits of Therapeutic Self disclosure?
- relaxing initial rigid boundaries
- foster a more egalitarian relationship
- humanizing dimensions of therapy
- help clients adopt active and collaborative roles in therapy
- model interpersonal behaviours
(overall just helps to build a warmer and more authentic therapy experience)
How can self disclosure be harmful?
- can shift focus away from the client
- can denormalize the therapeutic space
- if self disclosure paints therapist in negative light they can lose the perception of capability / professionalism
- role reversal (client can feel like they need to take care of the therapist)
- risks exploiting the client
therapist variables account for 3% of variability of outcome in efficacy trails and 7% in effectiveness trials
this is probably because in therapy (like exposure therapy in OCD), practice exposure and homework makes the biggest difference in the outcomes.
the difference in therapist effectiveness is the most noticeable wen treating patients with high levels of problem severity.
helpful therapists had patients who improved from 13 to 55%
harmful therapists had patients who deteriorated in functioning
Treatment Variables:
interpretation
- comes from a more psychoanalytic / psychodynamic perspective…
- includes the thoughts, emotions and behaviours in the unconscious process..
- We are interpreting what the client is telling us and making a hypothesis about what that might mean.
- no consistent evidence in support of this being helpful. BUT there is more positive outcomes for individuals with high interpersonal skills
(this is likely because if you make an interpretation that is incorrect they will tell you).
Treatment Variables:
Directives.
is it better to be direct and guiding… or a neutral reflective therapist?
- can be determined by the clients level of reactance..
- therapists will usually adjust and be flexible with their interaction style to emphasize either direct guidance or self exploration and self directedness.
CBT is more directive than other treatments
- you are assigning homework and suggesting the homework should be done in a specific way.
Treatment Variables:
Between Sessions Assignments
has a positive effect….
medium correlation between assigning homework and positive effects…
the more you practice and the more you work the better you will get so this makes sense
Treatment Variables:
Insight
insight is being aware of symptoms and feelings and how things impact them…
if someone has low insight they probably won’t be able to interpret the cause and effect of things..
Insight is helpful for individuals who are internalizing (depression and anxiety) – giving them an additional perspective to work with is helpful.
Treatment Variables:
Symptom alleviation
most effective for clients who externalize.. (e.g., ODD, CD)
symptom reduction can be a good substitute for dead persons goals..
more about tollerating and coping than never feeling a type of way again
