Prediction of Therapeutic Process and Outcome: Examining Observer Ratings of Client Characteristics
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Date
2012-06
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The Ohio State University
Abstract
Cognitive Therapy (CT) for depression has been established as an efficacious treatment, but less is known about how patient characteristics might be involved in the process of change in CT. In this study, I examined the role of pre-treatment client characteristics in the course of CT for depression. Ratings of client characteristics, for 66 adult clients diagnosed with Major Depressive Disorder, were made using thin-slice video segments (< 1 min) taken from patients’ intake evaluations. All ratings were made by trained undergraduates and evaluated to ensure inter-rater reliability. I examined these ratings as predictors of subsequent therapeutic alliance, dropout, and symptom improvement. The therapeutic alliance, or the collaborative bond between therapist and client, is perhaps the most commonly examined therapeutic process variable. The alliance has a small, but reliable association with symptom change. Given this association and the considerable attention given to the therapeutic alliance, I planned to examine the relation of client characteristics to the alliance along with two important outcome variables: treatment dropout and symptom improvement. Clients rated high in therapy interest and emotionality had a significantly lower risk of dropout. Clients rated high in extraversion had significantly steeper slopes of symptom change, indicating a greater response to treatment. Conversely, clients rated high in avoidant traits experienced significantly less symptom change over the course of treatment. Significant correlations between ratings of client traits and clients’ alliance scores were also found. Overall, these results attest to the importance of considering ratings of client traits in future process outcome studies and the utility of the thin slice methodology.
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Keywords
client characteristics, process-outcome, cognitive therapy, depression