Moving targets: Patients' changing complaints during psychotherapy.

Abstract

Previous psychotherapy research typically assessed patients' target complaints before or shortly after the first therapy hour and then reassessed for change and improvement at termination on the same original problems. Authors of even the earliest articles, however, conceptualized target complaints as presenting problems that undergo a process of constant redefinition throughout the course of psychotherapy. Using a standardized assessment procedure recommended by Mintz (1977), the present study therefore followed 44 patients in time-limited marital or family therapy at a university outpatient clinic and offered them the opportunity to list new target complaints at subsequent assessment points in addition to the initial session. More than half of the patients (56%) reported new problems, and when these arose, they were significantly correlated with outcomes. Implications for comparative-competitive psychotherapy studies, as well as process and outcome research are offered in conclusion.In the first sentence of their seminal article, Battle et al. (1966) identified target complaints as "presenting" complaints (p. 184). They argued that "the process of constant definition, redefinition, and clarification proceeds throughout a course of psychotherapy" and that "the initial complaints may shift in focus and scope, or disappear altogether and be replaced by others which may go through the same process" (p. 185).Subsequent research using target complaints, however, has rarely incorporated the possibility that target complaints may shift. Nearly all published studies to date have assumed that patients' focal concerns do not change across the process of psychotherapy. The initial problems are presumed to be the only relevant issues from the first hour until the last. To date, change has typically beenThe authors acknowledge the helpful comments of Alvin 3. Straatmeyer, Hendnka Vande Kemp, Anita Lehmann Sorenson, 3. Craig Yagel, and two anonymous reviewers who read earlier versions of this article.Requests for reprints should be sent to

The description of concerns

“…However, from the 1960s onwards a number of American authors have proposed procedures based on the unde®ned use of`target complaints'. They include Battle et al (1966) and Sorenson, Gorsuch, and Mintz (1985). The clinician asks ®rst for one problem, and then for another, until there is a list.…”

Zur Festlegung und Veränderung von Therapiezielen in psychiatrisch-psychotherapeutischen Behandlungen

“…In einer Untersuchung an 44 Patienten wurden Therapieziele im Verlauf der psychotherapeutischen Behandlung erfasst [11]. 56% der Patienten formulierten im Verlauf der Behandlung neue Ziele.…”

“…Der Zuwachs an Autonomie und die flexiblere Gestaltung von Beziehungen, die sie im zweiten Behandlungsteil erlebte, war nicht nur objektiv, sondern auch subjektiv für die Patientin ein Erfolg. Dies entspricht dem Befund aus der Literatur, dass im Verlauf formulierte Ziele wichtig für das Gesamtergebnis sind [11]. Auf dem Hintergrund des Transtheoretischen Modells von Prochaska [10] kann interpretiert werden, dass die Patientin hinsichtlich ihrer Symptome (oberste Veränderungsebene) in die Action-Phase kam und es ihr durch die Symptomreduktion gelang, auf der nächst tieferen Veränderungsebene (interpersonelle Konflikte) neue Ziele zu formulieren und anzugehen.…”

Systematic Evaluation to Improve the Quality of Patient Care: From Hope to Hopeful

“…Clients bring multiple problems to treatment, the problems change as treatment begins, and new problems emerge (e.g., Sorenson, Gorsuch, & Mintz, 1985). The complexity of treatment cases (e.g., comorbidity, disruption of the family) has been used as one argument about why one might not use EBTs, although therapeutic change is not undermined or impeded by complex and comorbid cases (Doss & Weisz, 2006;Kazdin & Whitley, 2006).…”