Interpersonal Behavior and Therapeutic Progress: Therapists and Clients Rate Themselves and Each Other

Abstract

To measure the extent to which progress in psychotherapy can be predicted from the interpersonal styles of therapists and clients, 42 outpatients and their 11 therapists rated themselves and each other on Benjamin's Structural Analysis of Social Behavior (SASB) scales. In addition, therapists rated amount of client change and therapy success-failure, based on the outcome section of the Rogers and Dymond (1954) scale, and clients used the Strupp, Fox, and Lessler (1969) questionnaire to evaluate progress-to-date. Clients also completed the Hopkins Symptom Checklist (HSCL) at the start of therapy and after they had completed at least 6 treatment sessions. Canonical analyses indicated that when optimally weighted, SASB scores can predict at least 65% of the reported progress variance, lending credence to claims that "reflexive social behavior" and "the relationship" are important determinants of certain aspects of therapeutic outcome. Consistent with previous literature, clients reported more satisfaction with therapy when they perceived their therapists as "warm and freeing," but such perceptions were not systematically related to reported symptom reduction. Unfavorable self-concept ratings by therapists and therapist ratings of clients as "helping or protecting," which suggest role reversal, were negatively associated with symptom amelioration.

Anorexic self‐control and bulimic self‐hate: Differential outcome prediction from initial self‐image

“…Research suggests that SASB-rated complementary control-submission interaction is associated with less change in therapy. 43 Such a maintaining role could apply also to positive interpersonal variables like self-protection. Self-protection relates to trusting and relying on others (positive submission), while not taking the initiative oneself.…”

“…Also, helping/protecting patient behavior toward therapists, theoretically corresponding to self-protection, has been shown to strongly relate to less improvement. 43 Thus, patients high in self-protection may engage in more protecting behaviors toward the therapist also, resulting in less change. In summary, dominance-submission interactions neutral or even positive in valence may relate to poorer outcome, which would be interesting to test directly in future research.…”

Interpersonal change as an outcome of time-limited interpersonal therapy.

“…Henry et al (1986) and Svartberg and Stiles (1992) found that corresponding with friendly complementarity along the affiliation dimension was associated with positive therapeutic processes and outcomes, while noncomplementary communications disrupted positive process and outcome. Rudy, McLemore, and Gorsuch (1985) found that complementarity on the affiliation dimension was associated with therapist and client rating therapy as successful, however affiliation complementarity was not a strong predictor of other outcomes including symptom reduction and therapist ratings of the client change. Weinstock-Savoy (1986) found that affiliation complementarity was associated with outcomes as rated by observers, therapists, and clients.…”

List of Tables and Figures

“…While finding factors that compellingly predict therapeutic outcome is difficult and often disappointing (Norcross, 2002), interpersonal process consistently plays an integral role in the course of therapeutic change (Benjamin & Critchfield, 2010). In some studies, as much as 65% of the variance in therapeutic progress has been attributed to interpersonal process and reflexive social behavior (Rudy, McLemore & Gorsuch, 1985) indicating that it is not only a consistent predictor of therapeutic outcome, but also one that is robust. Both empirical research and theory indicate that social behavior and interactions play an important role in the process of psychotherapeutic change.…”

“…In some studies, as much as 65% of the variance in therapeutic progress has been attributed to interpersonal process and reflexive social behavior (Rudy, McLemore & Gorsuch, 1985) indicating that it is not only a consistent predictor of therapeutic outcome, but also one that is robust. Both empirical research and theory indicate that social behavior and interactions play an important role in the process of psychotherapeutic change.…”