A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 x 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.

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RITVA ERKOLAHTI, JORMA PIHA, MICHAEL MALING Erkolahti R, Piha J, Maling M. Treatment practices in adolescent psychiatric inpatient care. Nord J Psychiatry 1998;52:519 -526. Oslo. ISSN 0803-9488.The comparison of adolescent psychiatric inpatient care in Finland and in the Chicago area, in the United States (US), provides an interesting opportunity to learn from similarities and differences in current treatment practices between the two countries. In this study we have compared the treatment programs in two very differently based service systems. Many similarities could be found, but the diagnostic system, the length of hospital treatment (Finland, mean 20.7 months; US, mean 2.1 months) and the use of medication (Finland, 39%; US, 64%) differed in these two countries. The results seem to reflect differences in the philosophy and management of the units. The service system has an impact on these factors because inpatient treatment is an expensive and limited resource.Adolescent psychiatry, Cross-cultural, Inpatient treatment, Ser6ice system.