No abstract

Despite clear demonstrations by process researchers of systematic differences in therapists' techniques, most reviews of psychotherapy outcome research show little or no differential effectiveness of different psychotherapies. This contradiction presents a dilemma to researchers and practitioners. Numerous possible solutions have been suggested. Some of these challenge the apparent equivalence of outcome, arguing that differential results could be revealed by more sensitive reviewing procedures or by more differentiated outcome measures. Others challenge the seeming differences among treatments, arguing that, despite superficial technical diversity, all or most therapies share a common core of therapeutic processes. Still others suggest that the question of equivalence is unanswerable as it is usually posed but that differential effectiveness of specific techniques might be found at the level of brief events within therapy sessions. In spite of their diversity, many of the proposed solutions converge in calling for greater precision and specificity of theory and method in psychotherapy research.

The Session Evaluation Questionnaire (SEQ) was used to measure the perspectives of 17 novice counselors and their 72 clients on 942 individual counseling sessions along two evaluative dimensions-depth and smoothnessand two dimensions of postsession mood-positivity and arousal. A components-of-variance analysis showed that, from both perspectives, SEQ ratings varied greatly from session to session; ratings were only modestly predictable from differences among counselors or among counselor-client dyads. However, averages across 6-10 sessions would permit adequately reliable differentiation among dyads-for example, for comparisons with outcome measures.-Correlations Between corresponding counselor and client dimensions ranged from moderate to negligible, whether calculated across sessions, across clients, or across counselors. Novice counselors' judgments of session depth and value may bear little relation to their clients' evaluations. On the other hand, counselors' comfort in sessions and postsession positive mood were moderately predictive of client reactions.

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.4% White; average age=40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n=1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r=-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement.

The authors attempted to replicate and extend D. M. Kivlighan and P. Shaughnessy's (2000) findings of (a) 3 distinctive patterns of alliance development across sessions and (b) a differential association of one of these, a U-shaped quadratic growth pattern, with positive treatment outcome. In data drawn from a clinical trial of brief psychotherapies for depression (N ϭ 79 clients), the authors distinguished 4 patterns of alliance development. These matched 2 of Kivlighan and Shaughnessy's patterns, but not the U-shaped pattern, and none was differentially associated with outcome. However, further examination of the data identified a subset of clients (n ϭ 17) who experienced rupture-repair sequences-brief V-shaped deflections rather than U-shaped profiles. These clients tended to make greater gains in treatment than did the other clients.