John C. Norcross

Evidence-based practices in mental health : debate and dialogue on the fundamental questions

Editors Contributors Prologue 1. What Qualifies as Evidence of Effective Practice? 2. What Qualifies as Research on which to Judge Effective Practice? 3. Does Manualization Improve Therapy Outcomes? 4. Are Research Patients and Clinical Trials Representative of Clinical Practice? 5. What Should be Validated? 6. What Else Materially Influences What is Represented and Published as Evidence? 7. Do Therapies Designated as ESTs for Specific Disorders Produce Outcomes Superior to Non-EST Therapies? 8. How Well Do Both Evidence-Based Practices and TAU Satisfactorily Address the Various Dimensions of Diversity? 9. Are Efficacious Laboratory-Validated Treatments Readily Transportable to Clinical Practice? Dialogue: Convergence and Contention (after each chapter) References (after each chapter) Epilogue.

Evidence-Based Therapy Relationships: Research Conclusions and Clinical Practices

In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced.

Predicting change in smoking status for self-changers

Fourteen different measures were investigated as predictors of change in smoking status for self-change efforts at smoking cessation. Adult subjects (N = 866) were classified into five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Subjects were assessed on 10 change processes, self-efficacy, temptations to smoke, and their decisions weighing the advantages and disadvantages of smoking; and these 14 variables were used as predictors of change in smoking status 6 months later. Six significant functions were found which predicted movement for each of the stages. These predictors are of both theoretical interest and practical significance because they may be modified in self-change efforts to overcome addictive behaviors. Overall, the change processes of self-reevaluation and the helping relationship and the self-efficacy and decisional balance variables were the most efficacious predictor variables. A general pattern emerged in which processes oriented more toward environmental events, such as dramatic relief and social liberation, tended to predict failure or no progress whereas more experientially oriented processes predicted progress.

Attendance and outcome in a work site weight control program: Processes and stages of change as process and predictor variables☆

This naturalistic study assessed client changes during treatment and identified salient predictors of therapy attendance and outcome. Subjects were assessed on processes and stages of change, self-efficacy, social support, weight history (including expectations, goals, and reasons for losing weight), and demographics at the beginning, middle, and end of a 10-week, behaviorally oriented work site program for weight control. Significant shifts from contemplation to action occurred for clients remaining in treatment. There were also significant modifications in the use of change processes as a result of treatment: counterconditioning, contingency management, stimulus control, interpersonal control, and social liberation increased while medication use, wishful thinking, and minimizing threats decreased. Change processes employed during the early portion of the group treatment were the best predictors of treatment attendance and outcome, superior to self-efficacy, social support, weight history, and demographic variables. The results supported a transtheoretical model that emphasizes dynamic processes and stages as core dimensions for understanding how people change.

Factor structure of the Profile of Mood States (POMS): Two partial replications

Examined the factor structure of the Profile of Mood States (POMS) in samples of psychiatric outpatients (N = 165) and adult smokers (N = 298). Principal component analyses (oblique rotation) yielded seven interpretable components in both cases, which accounted for 66% and 64% of the total variance, respectively. Coefficients of congruence indicated that the two component structures were quite similar. Three of the six POMS scales (Anger-Hostility, Vigor-Activity, Fatigue-Inertia) were replicated successfully in both samples. The remaining three scales were factorally complex and tended to merge, partially attributable to social desirability, to high scale intercorrelations, and to the inherent confluence of psychopathology. The POMS appears to be an internally consistent, multidimensional instrument with a relatively stable factor structure. Caution is recommended in the separate scoring and interpretation of several POMS scales.

What Works for Whom: Tailoring Psychotherapy to the Person

This article introduces the issue of the Journal of Clinical Psychology: In Session devoted to evidence-based means of adapting psychotherapy to the patients (transdiagnostic) characteristics. Practitioners have long realized that treatment should be tailored to the individuality of the patient and the singularity of his or her context, but only recently has sufficient empirical research emerged to reliably guide practice. This article reviews the work of an interdivisional task force and its dual aims of identifying elements of effective therapy relationships (what works in general) and identifying effective methods of adapting treatment to the individual patient (what works in particular). The task force judged four patient characteristics (reactance/resistance, preferences, culture, religion/spirituality) to be demonstrably effective in adapting psychotherapy and another two (stages of change, coping style) as probably effective. Two more patient facets (expectations, attachment style) were related to psychotherapy outcome but possessed insufficient research as a means of adaptation. This special issue provides research-supported methods of individualizing psychotherapy to the person, in addition to his or her diagnosis.

Purposes, processes and products of the task force on empirically supported therapy relationships.

This article introduces the special issue of Psychotherapy devoted to evidencebased therapy relationships. It explicates the purposes, summarizes the processes, and introduces the products of the Division of Psychotherapys Task Force on Empirically Supported Therapy Relationships. The dual aims of the Division 29 Task Force were to identify elements of effective therapy relationships and to determine efficacious methods of customizing or tailoring therapy to the individual patient. This article concludes by featuring the limitations of the task forces work and by responding to frequently asked questions about its objectives and conclusions.

The EAT and EDI: Screening, interrelationships, and psychometrics

This study examined the Screening utility, scale interrelationships, and psycometric properties of the Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI). 12% and 8% of female college freshman (N =268) were identified as weight preccupied according to the EAT and EDI, respectively. Cross-classification analyses indicated 90% agreement between the total EAT score and the EDI Drive for Thinness subscale. Both instruments demonstrated acceptable levels of internal consistency and scale intercorrelations. The principal component analysis provided moderate support for the factorial integrity, and thus scoring, of the EDI. The screening potential and multidimensional nature of the EDI are discussed.

The Psychotherapist's Own Psychotherapy: Educating and Developing Psychologists.

In this article, the author synthesizes 25 years of his research on the personal therapy of mental health professionals. The author summarizes the high prevalence of personal treatment, its use by seasoned practitioners, its personal and professional goals, its typically positive outcomes, and its lasting lessons concerning the practice of psychotherapy. Particular attention is devoted to the therapists selection of a personal therapist and the conduct of treatment with patients who are themselves psychotherapists in comparison with patients who are laypersons. The cumulative results indicate that personal therapy is an emotionally vital, interpersonally dense, and professionally formative experience that should be central to the development of health care psychologists.

Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership.

T h is stu d y u p d ated sim ilar investig ations cond u cted in 1 9 8 1 and 1 9 9 1 on th e A m erican P sych olog ical A ssociation D ivision of P sych oth erap y m em b ersh ip to p rovid e a contem p orary p ortrait of p sych olog ists cond u cting p sych oth erap y and to ch ronicle h istorical trend s. F ive h u nd red th irty-eig h t p sych olog ists ( 5 7 % resp onse rate) com p leted a q u estionnaire in su m m er 2 0 0 1 reg ard ing th eir d em og rap h ic ch aracteristics, p rofessional activities, th eoretical orientations, and career ex p eriences. T h e resu lts p oint to an ag ing and increasing ly d iverse m em b ersh ip th at continu es to b e em p loyed p rim arily in p rivate p ractices (6 6 % ) and u niversity setting s ( 1 4 % ) and th at continu es to em b race eclectic/integ rative (3 6 % ) , p sych od ynam ic (2 1 % ) , and cog nitive (1 6 % ) orientations. P rofessional activities h ave rem ained q u ite sim ilar across th e p ast 2 0 years, w ith th e ex cep tion of a notab le d ecline in p ersonality and p rojective testing . Th e 4 ,0 0 0 p lu s m e m b e r s o f th e Div is io n o f Ps y c h o th e r a p y r e p r e s e n t o n e o f th e la r g e s t d iv is io n s o f th e Am e r ic a n Ps y c h o lo g ic a l As s o c ia tio n (APA) a n d c o n s titu te o n e o f th e p r o m in e n t c lu s te r s o f p s y c h o lo g is ts c o n d u c tin g p s y c h o th e r a p y . Alth o u g h Div is io n 2 9 m e m b e r s a r e n o t r e p r e s e n ta tiv e o f a ll lic e n s e d p s y c h o lo g is ts p r a c tic in g th e r a p y in th e U n ite d Sta te s , th e y a r e a d iv e r s e a n d s e a s o n e d c a d r e o f d o c to r a lle v e l c lin ic ia n s d e v o te d to th e s tu d y a n d p r a c tic e o f p s y c h o th e r a p y . Ev e r y 1 0 y e a r s , No rc r o s s , Pro c h a s k a , a n d a s s o c ia te s h a v e s tu d ie d th e Div is io n 2 9 m e m b e r s h ip . In 1 9 8 1 , Pro c h a s k a a n d No rc r o s s ( 1 9 8 3 ) c o n d u c te d th e f ir s t n a tio n a l s tu d y o f th e m e m b e r s h ip in o r d e r to p r o v id e a c o m p r e h e n s iv e p r o f ile o f Div is io n 2 9 p s y c h o lo g is ts . In 1 9 9 1 , No rc r o s s , Pro c h a s k a , a n d F a r b e r ( 1 9 9 3 ) a g a in in v e s tig a te d th e c o m p o s itio n , p r a c tic e s , a n d a ttitu d e s o f m e m b e r s . In k e e p in g w ith th is 1 0 y e a r in te r v a l, in 2 0 0 1 w e r e a s s e s s e d th e c h a r a c te r is tic s , p r a c tic e s , th e o r ie s , a n d s a tis f a c tio n s o f Div is io n 2 9 p s y c h o lo g is ts u s in g th e s a m e m e th o d o lo g y a s in o u r p r e v io u s s tu d ie s . Th e r e s u lts p r o v id e a c o n te m p o r a r y p o r tr a it o f p s y c h o lo g is ts c o n d u c tin g p s y c h o th e r a p y a s w e ll a s h is to r ic a l c o m p a r is o n s o f th e m e m b e r s h ip .