The present status of outcome studies: A reply to Frank.

Abstract

Frank has argued that therapy outcome depends more on client and therapist characteristics than on therapeutic methods. Based on this assertion, Frank has suggested that researchers should direct their attention to the identification of relevant client and therapist characteristics. The aim of this article is to challenge Frank's argument and to offer an alternative direction for clinical researchers that emphasizes the development of more potent psychological procedures. Frank (1979) has recently given a rather pessimistic view of the current state of knowledge regarding the effectiveness of psychological interventions. He offers several generalizations to summarize the findings of past therapy outcome research: (a) All forms of psychotherapy are somewhat more effective than informal or unplanned help; (b) one form of therapy has rarely been shown to be significantly more effective than any other; (c) most clients who show initial improvement maintain it; and (d) therapeutic success lies more in the qualities of the client, therapist, and their interaction than in the therapeutic method. Frank argues that since therapeutic success depends primarily on client and therapist characteristics, clinical researchers should direct their attention to the identification of relevant attributes of clients and therapists. He suggests that future research explore the relationship between client characteristics (e.g., locus of control), therapist characteristics (e.g., degree of therapist participation), and therapy outcome.The directions for future research suggested by Frank are based on several erroneous generalizations regarding the present state of knowledge on psychological change. The aim of the present article is to challenge Frank's original generalizations and to offer an alternative direction for clinical researchers.To support the generalization that therapies rarely differ in effectiveness, Frank cites two widely publicized articles on psychotherapy outcome (Sloane, Staples, Cristol, Yorkston, &

The Contribution of Arousal and Performance in Reducing Spider Avoidance

“…In any event, the presence of a therapist effect underscores the need to analyze therapist and client variables as suggested by Kazdin and Herson (1980). The data also lend support to Telch's (1981) contention that the influence exerted by non-specific therapy factors may be inversely related to the potency of therapeutic interventions. As shown in this study, with a more powerful treatment the therapist factor was entirely overridden.…”

Reply to Telch.

“…Although the efficacy of certain techniques can be improved, and failure to demonstrate that techniques are related to important differences in outcome may simply reflect inadequate research designs, the weight of evidence is that the effectiveness of techniques depends on their appropriateness to personal characteristics of patient and therapist, whose interactions are the major determinants of outcome. Telch (1981) presents a persuasive argument for the position that attempts at improving the potency of existing techniques are more promising than efforts to potentiate the therapeutic aspects of the therapeutic relationship through research on relevant attitudes of patient and therapist and their interactions. He points out that studies showing that outcomes of most techniques for most conditions are not significantly different are inconclusive because of methodological flaws.…”