Larry E. Beutler

Patterns of symptomatic recovery in psychotherapy.

Using the psychotherapy dosage model in which effect was probability of recovery, this study compared treatment response rates for psychological symptoms. Symptom checklists were administered to 854 psychotherapy outpatients at intake and during treatment. Sixty-two symptoms were grouped into 3 classes on the basis of probit analysis results. Chronic distress symptoms demonstrated the fastest average response rate, whereas characterological symptoms demonstrated the slowest. Acute distress symptoms showed the highest average percentage of patients recovered across doses. A typical outpatient needed about a year of psychotherapy to have a 75% chance of symptomatic recovery. The model holds promise for establishing guidelines for the financing of psychotherapy.

Identification of Beck Depression Inventory items related to multiple sclerosis

The percentage contribution of each item on the Beck Depression Inventory (BDI) to the total BDI score was compared across patients with multiple sclerosis (MS), patients diagnosed with major depressive disorder, and normal college students. We considered an item to be confounded by MS-related symptoms if its percentage contribution to the total BDI score was significantly greater in the MS group than the major depression and control groups. Items measuring work difficulty, fatigue, and concerns about health met this criterion. These items accounted for 34, 17, and 19% of the total BDI score in the MS, major depression, and control groups, respectively. Using the 18-item BDI (BDI-18) which resulted from excluding the 3 confounded items, MS patients found to be were more depressed than controls but less depressed than the major depression group. The identification of signs of depression not confounded with MS which could be substituted for confounded signs was also discussed.

Identifying Empirically Supported Treatments What If We Didn't?

The conclusion of the Division 12 Task Forces report on empirically supported treatments raises 3 questions: (a) Is it desirable for the profession to specify what treatments are effective? (b) Do the criteria, either selected by the Task Force or modified by others, represent a reasonable way of identifying effective treatments? (c) Would different and less controversial conclusions have been reached if the criteria used were broadened to include naturalistic and quasi-experimental studies? It is concluded that the Task Forces selection of criteria, particularly as modified by D. L. Chambless and S. D. Hollon (1998), was a reasonable response to these pressures. Findings from studies using less stringent and controlled research designs suggest that the proposals may have resulted in less palatable conclusions than those offered in its original report.

The Strength of the Therapeutic Alliance in Three Treatments for Depression

The present study used the Working Alliance Inventory (WAI) and the Barrett-Lennard Relationship Inventory (BLRI) to examine the nature of the therapeutic alliance in three treatments for depression, Focused Expressive Psychotherapy, Cognitive Therapy, and Supportive/SelfDirected Therapy. Three main findings emerged. First, although intended to measure different aspects of the therapeutic relationship, the WAI, the BLRI, and their subscales were found to intercorrelate highly, indicating that they may all measure essentially the same underlying construct, Strength of the Therapeutic Alliance. Second, as suggested by Strupp, the strength of the therapeutic alliance early in therapy was found to be a good predictor of its strength at the end of therapy. Third, no significant difference was found in the strength of therapeutic alliance among the three forms of therapy. Contrary to what might have been expected, the therapeutic alliance was no weaker in Supportive/Self-Directed Therapy than in Cognitive Thera...

Interactions between psychotherapy procedures and patient attributes that predict alcohol treatment effectiveness:: A preliminary report

This study examined interactions between patient attributes and therapist interventions on alcoholism treatment outcome. Process analyses of an early psychotherapy session from either cognitive-behavioral (CBT) or family systems (FST) therapy and baseline patient information (N=47) were used to measure theory-based therapy and patient variables. Hierarchical linear regression was used to test the effect of each patient-therapy interaction on changes in drinking behavior. Two disordinal interactions were predictors of alcohol use during the maintenance phase of treatment. Patients high in emotional distress did best when their therapy addressed emotional experiences, and the converse was observed for patients low in distress. Patients high in reactance had better drinking outcomes when their therapy was nondirective, and patients low in reactance improved more with directive therapy. In contrast to the interactions between patient attributes and the therapy process, the interactions between patient attributes and treatment model (CBT versus FST) were not reliable predictors of alcohol use.

Introduction to the special section: the case for training in the provision of psychological therapy.

Recent trends, such as the national health care initiative, have brought into focus the importance of identifying the qualifications of those who provide mental health services. This special section explores the research evidence for the value of professional training among those who provide psychological therapy. The set of articles describe what is known about the relationship to therapeutic efficacy of professional training, training in ethnic diversity, and clinical supervision. These articles suggest that professional training enhances clinical efficacy, especially if type of training, setting of practice, and nature of patient problems are considered. They also suggest that supervision and specific training in ethnic diversity enhance knowledge and sensitivity among psychotherapists. It is anticipated that this special section will promote a dialogue about these conclusions.

Making assessment relevant to treatment planning: The STS clinician rating form

This article reports on the development of a computerized, clinician-based method of assessing patient variables that contribute to differential assignment of psychotherapy models. In the current health care environment, omnibus personality tests and current state measures are both expensive and insensitive to most of the empirically defined patient characteristics that have been identified as indicators of different treatment qualities. Moreover, reliance on patient self-report introduces a variety of distortions and limits predictive studies and follow-up assessments to those who are cooperative. These factors limit the usefulness of the currently available procedures. Aptitude-Treatment-Interaction (ATI) research has revealed differential effects of manualized cognitive, interpersonal, and insight-oriented treatments as a function on a select number of relatively specific personality and symptom qualities. A cost- and time-efficient method of measuring these dimensions could increase the power of treatment by identifying in advance those that are likely to be most effective for a given patient. The STS (Systematic Treatment Selection) Clinician Rating Form is a relatively brief, clinician-based measure of a variety of patient dimensions, including subjective distress, various aspects of coping style, and resistance traits. Current data reveal good interrater reliability and adequate levels of discriminant and convergent validity.

What Is and Can Be Attributed to the Therapeutic Relationship

This paper reviews findings from two studies that support the contentions of the Generic Model of Psychotherapy that therapeutic outcome must be viewed as arising from a complex interaction of common and specific factors. Patient, therapy, and relationship factors are shown to selectively add to the variance predicted in psychotherapy outcome studies. Moreover, an inspection of procedures that are common to two different therapies, and those that are unique to these approaches reveal that both contribute to outcome and do so in ways that suggest the presence of both synergistic and inhibiting effects.

Emotion Recognition in Psychotherapy: Impact of Therapist Level of Experience and Emotional Awareness

Accurately identifying another persons emotional state is an ability that may be necessary for a psychotherapist to empathize with a patient and that may be required for obtaining valid and reliable psychotherapy process ratings in research. Accuracy of identifying emotions and of rating emotional intensity expressed by a patient was studied in a comparison of 36 experienced therapists and 36 undergraduate psychology students who intended to become psychotherapists. Representative segments of a psychotherapy session were presented in one of three ways to tease apart the relative importance of verbal and nonverbal cues in making accurate ratings. Accuracy was judged against ratings supplied by two experienced and prestigious clinicians based on the same therapy sample. Results indicated that although therapists were more accurate than nontherapists in identifying emotions, they did not differ in the accuracy of rating emotional intensity. Moreover, accuracy of ratings was found to be less reliant on verbal cues among psychotherapists than among nontherapists. Finally, levels of participants personal awareness of their own emotions had a positive impact on the accuracy of identifying specific emotions but not on the accuracy of rating their intensity.

Manualizing flexibility: the training of eclectic therapists.

Manualized training has become the standard for psychotherapy research and is rapidly becoming adopted in clinical and counseling psychology training programs. However, it is still unclear whether manualization improves outcomes, and there is evidence that manualized training reduces nonspecific therapist qualities and attenuates clinical judgment. Prescriptive and integrative models of psychotherapy are designed to increase therapist flexibility. This article describes some current and anticipated efforts to teach therapists to flexibly use therapeutic procedures without losing some of the advantages of manualization.