Psychology 3301F/G Chapter Notes - Chapter 14: Randomized Controlled Trial, Therapeutic Relationship, Socioeconomic Status
27 Apr 2018
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Psych 3301 Chapter 14
Process-outcome research: research that examines the relation between variables related
to the process of providing psychotherapy and the outcome of therapy
Process research: research that examines patterns using therapist and/or client data that
are evident within and across therapy sessions
Common factors: therapeutic elements that occur in all or most treatments and are believed
to be critical for successful client outcomes
• Treatment outcome research addresses the question of which intervention is more
efficacious whereas process research and process-outcome research asks about how
an intervention works
In the 9’s and 9’s psychologists interested in the process of psychotherapy began
using 2 important sources of data: recordings of psychotherapy sessions and standardized
measures of client’s and therapists’ experience of the treatment process
• Therapists tend to behave in ways consistent to their theoretical orientations
Levels of analysis for psychotherapeutic process and process-outcome studies
Time frame
Time Scale
Process focus
Outcome focus
liminal
Split-seconds
Facial expressions, shifts
in gaze
None
Momentary
Minutes
Specific statements,
changes in direction of
conversation
Emergence of specific
experiences such as
insight or catharsis
Situational
Hours
Changes in dynamics
across sessions
Immediate
improvements in mood
Daily
Days
Homework assignments,
between session
experiences
Change in functioning,
improved handling of
problems
Monthly
Weeks
Development of alliance,
phases of treatment
Ongoing improvements
in functioning
Seasonal
Months
Addressing recurrent
themes in treatment
Changes in adaptation
and identity
Perennial
Years
Long-term treatment
events
Personality change
• Vast majority of randomized control trial psychotherapy studies examine treatment
outcomes for different groups of clients on bases of presenting problems
• Client characteristics other than diagnosis may be very important predictors of
treatment success or failure
• Problem in synthesizing research is that different researchers have tended to
examine a variable in different ways across studies
• Difficult to detect patterns across studies that use different types of measures and
different timing of assessment
• Pre-existing client variables may have the greatest impact on client decisions about
seeking therapy but once treatment starts the relationship between client and
therapist generates a more powerful influence on course and outcome of treatment
Client variables that influence treatment
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• Socioeconomic status: Higher economic status is associated with a greater likelihood
of engaging in and staying in treatment
• Ethnicity: Similarity in client and therapist ethnicity is associated with a somewhat
greater likelihood of clients staying in treatment and of making therapeutic change
• Gender: women more likely to seek therapy but no gender difference in premature
termination of services, matching gender of client and therapist has little influence
on treatment outcome
• Age: client age is positively related to staying in treatment but unrelated to
treatment outcome
• Symptoms severity: greater symptom severity is related to poorer treatment
outcomes
• Functional impairment: greater overall impairment in functioning is related to
poorer treatment outcome
• Personality disorders: presence of personality disorder diagnosis associated with
premature termination, problems in therapy and less therapeutic change
• Ego strength: (capacity to use personality resources to manage negative emotional
states) related to positive treatment outcome
• Psychological mindedness: (ability to understand people and problems in
psychological terms) usually related to positive treatment outcome
• Psychological reactance: clients low in reactance experience greater therapeutic
gains in more directive treatments while clients high in reactance experience greater
therapeutic gains in less directive treatment
• Treatment expectations: positive expectations for treatment associated with
remaining in treatment and greater therapeutic gains
Ultimate outcome of treatment is affected by: way client feels about the therapist,
psychologist’s responses to client questions, degree of benefit client experiences early in
treatment and extent to which treatment influences client’s daily life
Therapists affect treatment because of: a) the manner in which interactions between
patient and therapist occur and evolve over the course of treatment and b) the power such
interactions exert on the process of therapeutic change
Therapist Variables that influence treatment
• Ethnicity: no consistent pattern of effect apparent
• Gender: therapist gender has no consistent effect
• Age: therapist age unrelated to treatment outcome; similarity in age doesn’t
significantly contribute to treatment outcome
• Professional Discipline: therapists trained in a mental health discipline tend to have
better treatment outcomes than those trained in a health discipline; inconclusive
about different mental health disciplines
• Professional experience: therapist experience is small but positively related to
treatment outcome
• Personality traits: personality traits little association with outcome
• Emotional well-being: consistently positively associated with outcome
• Values, attitudes and beliefs: no consistent patterns found
• Use of self-disclosure: small but positive effect on outcome
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Process-outcome research: research that examines the relation between variables related to the process of providing psychotherapy and the outcome of therapy. Process research: research that examines patterns using therapist and/or client data that are evident within and across therapy sessions. Levels of analysis for psychotherapeutic process and process-outcome studies . Emergence of specific experiences such as insight or catharsis. Ultimate outcome of treatment is affected by: way client feels about the therapist, psychologist"s responses to client questions, degree of benefit client experiences early in treatment and extent to which treatment influences client"s daily life. Therapists affect treatment because of: a) the manner in which interactions between patient and therapist occur and evolve over the course of treatment and b) the power such interactions exert on the process of therapeutic change. The sum of the therapist"s personal qualities is an important ingredient in any recipe for patient"s of less effective therapists good therapy.
