George Silberschatz

Are Results of Randomized Controlled Trials Useful to Psychotherapists

Two clinicians provided opposite answers to the title question: Persons argued that information from randomized controlled trials (RCTs) is vital to clinicians, and Silberschatz argued that information from RCTs is irrelevant to clinicians. Persons argued that clinicians cannot provide top quality care to their patients without attending to findings of RCTs and that clinicians have an ethical responsibility to inform patients about, recommend, and provide treatments supported by RCTs before informing patients about, recommending, and providing treatments shown to be inferior in RCTs or not evaluated in RCTs. Silberschatz argued that RCTs do not and cannot answer questions that concern practicing clinicians. He advocates alternative research approaches (effectiveness studies, quasi-experimental methods, case-specific research) for studying psychotherapy.

How Do Interpretations Influence the Process of Psychotherapy

Due to imprecise methods of evaluating therapist behaviors, little progress has been made in demonstrating how the therapist contributes to the success of psychotherapy. More important, the suitability of the therapists behavior to the particular needs of a given patient has not been adequately assessed. In this article, we describe a new approach for assessing the suitability of therapist interventions. We hypothesized that the suitability of interpretations would be more predictive of patient progress than the category of interpretation: transference versus nontransference. The transcripts of three brief psychodynamic psychotherapies were studied. Interpretations in the three therapies were identified and categorized as transference or nontransferen ce and were then rated for suitability. Patient productivity was rated using the Experiencing Scale. As predicted, in each case suitability of interpretations correlated significantly and positively with patient productivity, whereas type of interpretation did not correlate with patient progress.

The Plan Formulation Method

The Plan Formulation Method, a procedure for developing comprehensive clinical case formulations, is illustrated using the case of Ms. Smithfield. The theory out of which the Method developed and the steps involved in developing a Plan Formulation are described. The Plan Formulation Method has been employed with excellent reliability to a wide variety of cases by different researchers. The validity of the Method has been tested in both process and outcome studies. Applications of the Method to the empirical validation and comparison of different theories of psychotherapy are discussed.

Measuring the Therapist's Impact on the Patient's Therapeutic Progress.

This article describes methods and concepts developed by the Mount Zion Psychotherapy Research Group for empirically evaluating the pertinence of suitability of a therapists interventions (behaviors) to a patients particular problems, needs, and treatment goals. Intensive studies of 2 brief psychotherapy cases are presented. In these studies, patient-initiated critical incidents (tests) were identified, the case-specific accuracy of the therapists responses to these incidents was rated, and the impact of these interventions on subsequent patient behavior was measured. The findings indicated that these patients tended to show improvement in the therapeutic process when the therapists interventions were in accord with their particular problems and treatment goals. The application of this method to clinically relevant studies of psychotherapy is discussed.

Conceptualizing Adult Development

On the premise that human development is a lifelong process, and with awareness of certain limitations of the stage model, the authors conceptualize a new model based on developmental process. This model is offered as a basic model for the development of mental functions and structures in both childhood and adulthood.

An examination of three methods of psychodynamic formulation based on the same videotaped interview

While psychodynamic theory and therapy are approaching their centennial, the science of psychodynamics is still in an earlier developmental stage. Any scientific field generates the most controversy and excitement when it is still developing. For psychodynamic psychology this means that its basic units of observation as well as its rules for justifying clinical inference in formulating and testing dynamic hypotheses require more development. In short, we are still evaluating different methods for both discovering and validating psychodynamic propositions. This is especially true for central features of dynamic psychology, including intrapsychic conflict, relationships, and transference patterns. This report compares three different methods for making a dynamic case formulation: 1) the Core Conflictual Relationship Theme (CCRT) of Luborsky (Crits-Christoph and Luborsky 1985a,b; Luborsky 1976, 1977, 1984, and companion paper in this issue; Levine and Luborsky 1981), 2) the Plan Diagnosis (PD) method of Silberschatz, Curtis and colleagues of the Mount Zion group (Caston 1986; Curtis and Silberschatz 1986; Rosenberg et al. 1986; Curtis et al. 1988) and, 3) the Idiographic Conflict Formulation (ICF) of Perry and Cooper (1985, 1986, and companion paper in this issue). Each has a slightly different focus. The CCRT focuses on relationship patterns as the central feature of individual dynamics and transference in or out of the treatment situation. The Plan Diagnosis focuses on dynamic features related to transference, resistance and insight in therapy. The Idiographic Conflict Formulation focuses on stress and internal conflict, and the individuals adaptation to them in or out of treatment.

Testing Hypotheses of Psychotherapeutic Change Processes

How the therapist influences the process and outcome of psychotherapy is a widely debated topic in the psychotherapy research literature. Despite a large body of research (see Parloff, Waskow, and Wolfe 1978; Schaffer 1982 for reviews) surprisingly little progress has been made in understanding how the therapist contributes to the success or failure of psychotherapy. In this paper we will present the argument that the lack of progress is due to (1) inadequate conceptualization of how therapist interventions affect particular patients, and (2) imprecise, overly global methods of evaluating therapist behaviors. In particular, the relevance or suitability of the therapist’s behavior to the particular problems and needs of a given patient has not been adequately assessed.

A method of choosing CCRT scorers

This study compared interjudge agreement in 2 sample cases in which both experienced as well as inexperienced scorers were used. Scorers were given only a single page of core conflictual relationship theme (CCRT) instructions to help them learn the method. The results in both cases suggest that there was significantly greater interjudge agreement among experienced CCRT scorers compared with inexperienced scorers.

Abuse and disabuse of the drug metaphor in psychotherapy research : hold on to the baby as you throw out the bath

Stiles and Shapiro (1994) argue that trivial correlations between process variables and treatment outcome point to inherent methodological limitations of correlational designs in process-outcome research. In coming to such a far-reaching (erroneous) conclusion, Stiles and Shapiro are throwing out the baby with the bath. Correlational designs are perfectly appropriate for testing process-outcome correlations if process measures are adequately conceptualized. Examples of case-specific measures of therapist responsiveness are reviewed to illustrate the power of correlational designs.

What have we learned about how the alliance develops over the course of therapy

This is a commentary on Dinger, Strack, Sachsse, and Schauenburgs (2009) study of how therapist attachment styles and patient factors contribute to the development of the therapeutic alliance. I first address whether the research is useful for clinicians, arguing that it is not, and then discuss how the work could be presented to maximize both its scientific and its clinical impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved).