Process transforms inputs to determine outcomes: Therapists are responsible for managing process.

Krause, Merton S.; Lutz, Wolfgang

doi:10.1111/j.1468-2850.2009.01146.x

Cited by 40 publications

(40 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our assessment of within-session practice elements was also limited to a focus on provider behavior, as opposed to more complex measurement of the interaction between therapist and client behavior. Given that psychotherapy is a dynamic, interactive endeavor, examining therapist behaviors alone provides just one perspective on therapeutic processes (Krause & Lutz, 2009). In an effort to complement this single perspective, we included youth and parent ratings of therapeutic alliance in the models, but only child alliance for only one outcome (i.e., inconsistent parenting) was associated with change.…”

Section: Discussionmentioning

confidence: 99%

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Garland

Accurso

Haine‐Schlagel

et al. 2014

Journal of Clinical Child & Adolescent Psychology

View full text Add to dashboard Cite

Objective Most of the knowledge generated to bridge the research - practice gap has been derived from experimental studies implementing specific treatment models. Alternatively, this study uses observational methods to generate knowledge about community-based treatment processes and outcomes. Aims are to (1) describe outcome trajectories for children with disruptive behavior problems (DBPs), and (2) test how observed delivery of a benchmark set of practice elements common in evidence-based (EB) treatments may be associated with outcome change, while accounting for potential confounding variables. Method Participants included 190 children ages 4–13 with DBPs and their caregivers, plus 85 psychotherapists, recruited from six clinics. All treatment sessions were video-taped and a random sample of four sessions in the first four months of treatment was reliably coded for intensity on 27 practice elements (benchmark set and others). Three outcomes (child symptom severity, parent discipline, and family functioning) were assessed by parent report at intake, four, and eight months. Data were collected on several potential covariates including child, parent, therapist, and service use characteristics. Multi-level modeling was used to assess relationships between observed practice and outcome slopes, while accounting for covariates. Results Children and families demonstrated improvements in all three outcomes, but few significant associations between treatment processes and outcome change were identified. Families receiving greater intensity on the benchmark practice elements did demonstrate greater improvement in the parental discipline outcome. Conclusion Observed changes in outcomes for families in community care were generally not strongly associated with the type or amount of treatment received.

show abstract

Section: Discussionmentioning

confidence: 99%

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Garland

Accurso

Haine‐Schlagel

et al. 2014

Journal of Clinical Child & Adolescent Psychology

View full text Add to dashboard Cite

show abstract

“…Although there were marked differences in the process of therapy between participants, it was almost unanimous that it would be adapted when working within a time limit. Understanding the significance of these changes in process is, however, difficult in light of the ambiguity in what makes psychotherapy helpful (Dallos & Vetere, 2005), as well as in how process relates to outcome (Krause & Lutz, 2009; Stiles, 2009).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic process in the context of third party determined time limits

Wright

Simpson-Young

Lennings

2012

Clinical Psychologist

View full text Add to dashboard Cite

Background: Psychological services are increasingly provided within a context in which third party payers impose limits on the number of sessions available to the client and therapist. Considerable research has addressed the effect of time limits on therapeutic outcomes, while effects on therapeutic process have received less attention. This article reports on research that assessed the perceived impact of externally determined time limits on therapeutic process from the perspective of practicing psychologists. Methods: This study used a concurrent triangulation mixed‐methods design. Study 1 was a repeated measures questionnaire that was both qualitative and quantitative in nature, and Study 2 utilised qualitative semi‐structured interviews. Twenty‐seven Australian psychologists treating clients within externally imposed time limits were interviewed, and 85 completed a questionnaire to obtain their perspective on the impact of time limits on the therapeutic process. Results: Therapeutic approach was impacted by time limits, including choice of therapeutic modality, shifts in problem definition and approach, and increased directiveness, prompting concern about a focus on symptom removal over facilitating maintenance of treatment gains. Conclusions: This research contributes to an understanding of how temporal constraints influence treatment, and managed care funding policies may need to be considered in the light of this understanding.

show abstract

“…Although the study of principles and mechanisms of change is a promising avenue for research, it has been suggested that progress may be limited by the unsuitability of some quantitative methodologies to the study of the complex process of psychotherapy. Counter to the causal assumptions of the RCT methodology (Jadad & Enkin, ), several researchers have suggested that the process and outcomes of psychotherapy are causally entangled and influence one another (Budd & Hughes, ; Krause & Lutz, ). It has been noted that despite efforts to standardise the influence of various factors through treatment manualisation, clients and therapists find ways to vary their interactions to produce optimal outcomes (Budd & Hughes, ; Krause & Lutz, ).…”

Section: Limited Progress In Differentiating Treatment Effectivenessmentioning

confidence: 99%

“…Counter to the causal assumptions of the RCT methodology (Jadad & Enkin, ), several researchers have suggested that the process and outcomes of psychotherapy are causally entangled and influence one another (Budd & Hughes, ; Krause & Lutz, ). It has been noted that despite efforts to standardise the influence of various factors through treatment manualisation, clients and therapists find ways to vary their interactions to produce optimal outcomes (Budd & Hughes, ; Krause & Lutz, ). Additionally, the process of randomising participants to treatment conditions has minimised the importance of client's informed decision making about selecting treatments and therapists that suit them (Budd & Hughes, ; Stiles, Barkham, Connell, & Mellor‐Clark, ).…”

Section: Limited Progress In Differentiating Treatment Effectivenessmentioning

confidence: 99%

Improving knowledge about the effectiveness of psychotherapy

Donald

Carey

2017

Psychother Politics Int

View full text Add to dashboard Cite

Quantitative methods and methodologies have dominated research on the efficacy and effectiveness of psychotherapy. The value of the quantitative paradigm is reflected in the criteria used to establish empirically supported treatments. However, quantitative research, including randomised control trials (RCTs), may not be ideally suited to establishing the effectiveness of the complex process of psychotherapy. The process and outcomes of psychotherapy have been regarded as causally entangled; the client's and therapist's efforts to responsively regulate the therapeutic process should be seen as being integral to outcomes rather than a source of confounding variance. Qualitative research may provide additional insights into the process of how psychotherapy is effective, due to its ability to explore phenomena from multiple perspectives. This is particularly important as research has suggested that qualitative differences in treatments can be masked beneath quantitatively equivalent outcomes. As a result, a continued overreliance on quantitative research may limit the discipline's overall ability to account for and differentiate the effectiveness of psychotherapies. This article proposes that, in order to address this limitation, (i) the criteria for how psychotherapies are considered effective should be expanded to include factors such as the efficiency of treatments, rates of change, and reliability of change; (ii) and that qualitative research be used adjunctively to assess and explore the dimensions of the expanded criteria. The development of a methodologically integrative multidimensional assessment of treatment effectiveness will provide a more informative tool to guide clinical decision making and policy.

show abstract

Process transforms inputs to determine outcomes: Therapists are responsible for managing process.

Cited by 40 publications

References 35 publications

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Therapeutic process in the context of third party determined time limits

Improving knowledge about the effectiveness of psychotherapy

Contact Info

Product

Resources

About