Who Will Benefit from Psychotherapy? Predicting Therapeutic Outcomes

Who Will Benefit from Psychotherapy? Predicting Therapeutic Outcomes

Who Will Benefit from Psychotherapy? Predicting Therapeutic Outcomes

Who Will Benefit from Psychotherapy? Predicting Therapeutic Outcomes

Excerpt

When a patient and therapist meet for psychotherapy, how predictable are the patient's ultimate benefits? Most therapists are certain that psychotherapy is not just an unpredictable adventure. Yet after 75 years of formal psychotherapy practice, the tested knowledge when we began the Penn Psychotherapy Project was still unable to affect clinical practice (Luborsky, 1969). Little was known about the pretreatment qualities of the patients who are most likely to benefit, the therapists who are most facilitating, and the best matches of patients and therapists. Little was known of the during-treatment qualities of the patient-therapist interactions that are most helpful. Although the guidelines clinical wisdom offered therapists contained useful observations, not many had been adequately tested. It is the purpose of the Penn project and of this book to review the tested knowledge about these topics and to add more. This work should make it more necessary for practicing psychotherapists to learn more from the offerings of psychotherapy research (Cohen, Sargent, & Sechrest, 1982).

We hoped in the Penn project to identify the factors that influence the outcomes of psychotherapy, to evaluate the success of our predictions, and ultimately to use the knowledge of the predictive measures to better understand the nature of psychodynamic psychotherapy.

We were most interested in the form of treatment called most broadly psychodynamic psychotherapy—also called in this book psychoanalytic or psychoanalytically oriented psychotherapy—because it was and still is the most common type of outpatient psychotherapy provided in private practice and clinic settings (Feldman et al., 1958); in Henry, Sims, and Spray (1973) the therapists surveyed included not only psychiatrists but psychoanalysts, clinical psychologists, and social workers. Seventy-one percent of the 3,400 therapists considered themselves to have some form of psychoanalytic orientation as their main mode of treatment.

Despite rumors of its demise, evidence is plentiful that the preference for the psychodynamic orientation not only survives but prospers. A more recent report from a national survey of clinical psychologists (Norcross, Prochaska, & Gallager, 1987) found that 21% of the sample preferred the "psychodynamic orientation"—a term reflecting a spectrum of orientations that have been influenced mostly by the psychoanalytic one. Second . . .

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