T. Mark Harwood

Resistance/Reactance Level

Psychotherapists from all professions and perspectives periodically struggle to effectively manage a patients resistance to change. This article provides definitions and examples of patient-treatment matching applied to patient resistance or reactance. We report the results from an original meta-analysis of 12 select studies (N = 1,102) on matching therapist directiveness to patient reactance. Our findings support the hypothesis that patients exhibiting low levels of trait-like resistance respond better to directive types of treatment, while patients with high levels of resistance respond best to nondirective treatments (d = .82). Limitations of the research reviewed are noted, and practice recommendations are advanced.

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.

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.

Antiscientific attitudes: What happens when scientists are unscientific?

Scientists sometimes engage in quite unscientific behavior in order to influence their peers or to obtain secondary gain. We explore some of the causes and consequences of these acts, using examples of different ways in which antiscientific attitudes are manifest among scientists.

Commentary on Greene and Ablon: What does the MTA study tell us about effective psychosocial treatment for ADHD?

Expanded on many of the points raised in the article by Greene and Ablon (this issue), which highlights many of the shortcomings of the Multimodal Treatment Study providing reasoned criticism of the design and some of its conclusions. However, we primarily comment on treatment matching and an alternative model of treatment matching, Systematic Treatment Selection (STS; Beutler & Clarkin, 1990). Our latest version of STS, prescriptive psychotherapy (Beutler & Harwood, 2000), is briefly described as it may apply to the treatment of attention deficit hyperactivity disorder.