A Negotiation Approach to Systematic Treatment Selection: An Evaluation of its Impact on the Initial Phase of Psychotherapy

Abstract

Since psychotherapy failures and early dropouts represent a sizable percentage of the clients who start psychotherapy, it is clearly important to devise a methodologically sound and effective process of treatment selection. In this study, a negotiation approach to treatment selection is proposed and situated in the context of an integrative viewpoint on psychotherapy. The preferences of the client, the client's control of the situation of choice, and the compatibility of differing views of client and therapist constitute the typical characteristics of this negotiation approach. The first part of this study gives a careful description of the negotiation approach. The second part examines the influence of the negotiation approach on the dropout rate and on initial therapeutical contacts. Results indicate a significant effect of negotiation on dropout, suggesting that clients who perceive treatment selection as a negotiation process are more successful in their initial therapeutical contacts.

Ideas of cure as a predictor of premature termination, early alliance and outcome in psychoanalytic psychotherapy

“…The results concerning premature termination indicate the importance of negotiating ideas of cure as a part of the initial assessment process, in which patient and therapist should work towards formulating a mutually acceptable therapeutic contract. This conclusion is congruent with the negotiation approach to treatment selection advocated by Vertommen and co‐workers (Bleyen et al , 1998; Van Audenhove & Vertommen, 2000). In the introductory sessions, it seems crucial that the patient's ideas of cure are thoroughly explored and that the therapist is attentive to whether these ideas are in line with the treatment offered.…”

“…Listening carefully to the patient's theory of change and adapting the therapeutic method thereafter may also enhance the quality of the therapeutic relationship. Vertommen and co‐workers (Bleyen, Vertommen, & Van Audenhove, 1998; Van Audenhove & Vertommen, 2000) suggest a negotiation approach to treatment selection. In this approach, the client and the clinician examine the discrepancies and fit between their opinions, preferences and expectations in order to bring differences between them into sharp focus.…”

Integrating Decision Making and Mental Health Interventions Research: Research Directions.

“…The results showed a statistically significant improvement for the intervention group patients for self‐efficacy, tracking of depression symptoms and early warning signs, and planning for coping with high‐risk situations. Likewise, Bleyen, Vertommen, and Van Audenhove (1998) found a “treatment negotiation approach” was associated with a significant positive impact on treatment dropout rates for the intervention group compared to a control group.…”

Psychotherapy role expectations and experiences – Discrepancy and therapeutic alliance among patients with substance use disorders

“…One clinical implication of our findings is the potential benefit of therapists discussing treatment expectations with patients at the onset of therapy. In targeting expectancies, potential discrepancies between patient and therapist will be made visible and thus possible to examine together in a so called negotiation approach to treatment selection (Bleyen, Vertommen, & Audenhove, ; Van Audenhove & Vertommen, ). This approach emphasizes the importance of collaboration and of a joint commitment to how the psychotherapy should be conducted – a process that should start at the beginning of treatment, perhaps even before treatment begins.…”