THE RELATIONSHIP OF PROCESS TO OUTCOME IN BRIEF EXPRESSIVE PSYCHOTHERAPY.

Abstract

The literature regarding the relationship of psychotherapy process dimensions to treatment outcome was reviewed in terms of the following four broad questions at least one of which underlies any study of psychotherapy process and outcome: (a) Does psychotherapy work? (b) How does psychotherapy work? (c) Can psychotherapy produce negative effects? (d) Is one kind of psychotherapy better than the others? Evidence was presented supporting the need for further study in these areas, and a single-subjects design was introduced focusing upon the three research questions derived from the review of the literature: (a) Is there a relationship between psychotherapy process dimensions and the immediate outcome of each psychotherapy session? (b) What relationships exist between psychotherapy process dimensions and the eventual treatment outcome? (c) Are there differences between therapists who use the same Focused Expressive treatment model in terms of both process dimensions and client outcome measures? The method utilized to explore these questions involved training six raters, three on the Vanderbilt Psychotherapy Process Scale (VPPS) and three on the Experiencing Scale. In addition, the six subjects, all female arthritis patients, completed the Session Evaluation Questionnaire and a physical pain measure at the end of each session and the SCL-90R at the beginning of each session. There were four sessions of baseline, ten sessions of treatment with the Gestalt-based Focused Expressive Therapy, and four sessions of follow-up. The results indicated that all six subjects reported significantly higher positive feelings and improved psychological function at treatment conclusion as compared to treatment inception. High levels of patient participation were significantly related to reduced patient distress and physical pain, a result supporting the hypotheses. Both therapist-reported and client-reported depth of sessions were significantly positively related to client positive feelings reported at the conclusion of each session. Case-by-case application of clinical significance criteria revealed, however, that two subjects improved much more than did the other four. Differences were found between therapists on the degree of judge-rated dependency and client rated session smoothness as well as on global severity of symptoms at treatment conclusion. Limitations and recommendations for future research were presented.