PSYCHOTHERAPY OUTCOME AS A FUNCTION OF THERAPIST-PATIENT MATCHING ON SELECTED VARIABLES.
AuthorCALVERT, SHARON JANE.
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PublisherThe University of Arizona.
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AbstractIt was proposed that the optimal matching of psychotherapy approach to selected patient characteristics results in improved treatment outcome. Three patient dimensions were identified as contributing specific predictive power in determining the effectiveness of several types of treatment: symptom complexity, style of psychological defense, and reactance potential. Symptom complexity level was held relatively constant by studying a sample of psychiatric inpatients, who were admitted to a teaching hospital for short-term care and treated in individual psychotherapy by psychiatric residents and psychology interns. Patient defensive style was assessed in terms of an internalization/externalization ratio, derived from patient MMPI scores, and was hypothesized to differentially affect outcome depending on the degree of patient-therapist match in terms of an internalized versus externalized focus of therapeutic approach. Patient reactance potential was assessed by the Control Wanted subscale of the FIRO-B, and was hypothesized to be optimally matched by varying levels of therapy directiveness. Therapeutic approach was assessed by scores on the Theoretical Orientation Questionnaire. Outcome was assessed by three independent sources: therapist discharge ratings of global improvement, pre- and posttreatment patient ratings on a standardized symptom index, and nurses' ratings of ward behavior at the beginning and end of treatment. These measures constituted the dependent variables in a series of multiple regression analyses, which also included a number of patient background and collateral treatment variables as potential predictors. Results indicated that, after accounting for pretreatment levels of disturbance, the match between patient defensive style and internal/external focus of therapeutic approach was a significant predictor of treatment outcome. The degree of patient-therapist match on this dimension accounted for 9% and 8% of the variability in posttreatment measures of patient symptomatology and ward behavior, respectively. Matching with respect to patient reactance potential and therapy directiveness was not seen to affect outcome, and no effects due to matching were observed for therapists' ratings. Results are discussed in terms of validity and reliability of the ratings, problems in assessment from the different vantage points of patient/therapist/observer, and biases deriving from the use of self-report instruments.