Kelley A. Tompkins

Working with clients by incorporating their preferences.

Working with clients by integrating their therapy preferences into the treatment decision-making process has been identified as an important part of evidence-based practice in psychology. Accommodating client preferences has also been demonstrated to lead to fewer treatment dropouts and improved therapy outcomes. In this article, we present a number of clinical interventions or techniques for addressing client preferences in psychotherapy. Clinical examples demonstrating the techniques are also provided.

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence.

Women Faculty Distressed: Descriptions and Consequences of Academic Contrapower Harassment

Academic contrapower harassment (ACPH) occurs when someone with seemingly less power in an educational setting (e.g., a student) harasses someone more powerful (e.g., a professor). A representative sample of 289 professors from U.S. institutions of higher education described their worst incident with ACPH. Open-ended responses were coded using a keyword text analysis. Compared to the experiences of men faculty, women faculty reported that students were more likely to challenge their authority, argue or refuse to follow course policies, and exhibit disrespectful or disruptive behaviors. Although sexual harassment was uncommon, men faculty were more likely than women faculty to recount such incidents. Women faculty reported significantly more negative outcomes as a result of ACPH (e.g., anxiety, stress-related illness, difficulty concentrating, wanting to quit) than men faculty, and negative outcomes were most likely to result from ACPH involving intimidation, threats, or bullying from students. Implications for the prevention and reporting of ACPH are discussed.

The Relationship Between Clients' Depression Etiological Beliefs and Psychotherapy Orientation Preferences, Expectations, and Credibility Beliefs.

The purpose of this study was to examine the relationship between clients’ etiological beliefs for depression and treatment preferences, credibility beliefs, and outcome expectations for five different depression treatments—behavioral activation, cognitive therapy, interpersonal psychotherapy, pharmacotherapy, and psychodynamic psychotherapy. Adult psychotherapy clients (N = 98) were asked to complete an online survey that included the Reasons for Depression Questionnaire, a brief description of each of the five treatment options, and credibility, expectancy, and preference questions for each option. On average, the participating clients rated pharmacotherapy as significantly less credible, having a lower likelihood of success, and being less preferred than the four types of psychotherapy. In general, interpersonal psychotherapy was also rated more negatively than the other types of psychotherapy. However, these findings depended somewhat on whether the participating client was personally experiencing depression. Credibility beliefs, outcome expectations, and preferences for pharmacotherapy were positively associated with biological beliefs for depression; however, the other hypothesized relationships between etiological beliefs and treatment attitudes were not supported. Although the study is limited based on the specific sample and treatment descriptions that were used, the results may still have implications for psychotherapy research, training, and practice.

Clinical errors that can occur in the treatment decision-making process in psychotherapy.

Clinical errors occur in the psychotherapy decision-making process whenever a less-than-optimal treatment or approach is chosen when working with clients. A less-than-optimal approach may be one that a client is unwilling to try or fully invest in based on his/her expectations and preferences, or one that may have little chance of success based on contraindications and/or limited research support. The doctor knows best and the independent choice models are two decision-making models that are frequently used within psychology, but both are associated with an increased likelihood of errors in the treatment decision-making process. In particular, these models fail to integrate all three components of the definition of evidence-based practice in psychology (American Psychological Association, 2006). In this article we describe both models and provide examples of clinical errors that can occur in each. We then introduce the shared decision-making model as an alternative that is less prone to clinical errors.

The relationship between trainee therapists’ and clients’ initial expectations and actual treatment duration and outcomes.

The purpose of this study was to examine the relationship between trainee therapists’ and clients’ duration and outcome expectations and actual treatment duration and outcomes for clients. Eleven therapists-in-training completed measures of duration and outcome expectations for clients in general at the start of the study. After the intake sessions, trainee therapists and their clients (N = 34) completed the same expectation questions applied to the specific case. Results indicated that clients’ expectations and student therapists’ specific case expectations were significantly more positive than student therapists’ general expectations for psychotherapy. Results further indicated that taken together, trainee therapists’ (general and specific) and clients’ expectations did not significantly predict actual treatment duration; however, they were able to significantly predict treatment outcomes, explaining 11% of the variance in client change. Student therapists’ specific expectations were the only significant unique predictor of change. These results suggest that therapists should be aware of their own expectations when working with clients in order to make sure that any negative beliefs do not impact the quality of care that they provide.