Self-efficacy has been demonstrated repeatedly to be an important and even essential element for effectiveness in all health care. It is clear, however, that it can never be a substitute for real change in terms of physical and neurological functioning. The element in efficacy of personal expectations is always essential, must surely be present for health care effectiveness, but cannot be a substitute for real change in bodily functioning.
The initial work of Carl Rogers where accountability in health care was based on personality change in the client which was carried out at the Menninger Foundation, the University of Pennsylvania, and reviewed in The Annual Review of Psychology by Snyder (1950) represents the first scientific approach to assessing change in relation to psychotherapy. Then during the 1960s and 70s there was a focus on not whether psychotherapy works, but which specific procedures are more effective in dealing with specific problems (VandenBos, 1996; and Consumer Report, 1995). Beginning in the 1980s emphasis was placed on a comparison of different treatments for particular clinical problems. Highly detailed therapy manuals served as the basis for identifying treatment mode, and AXIS I from the DSM-IV served as the means for defining problem categories (American Psychiatric Association, 1994).
The 1995 Consumer Report
The Consumer Report (CR) (Seligman, 1995) represents a continuation of mental health services utilization research begun in 1960. The University of Michigan Survey Research Center conducted a survey of a representative cross sectional household sample of American 21 years of age and older based on area-sampling probability methods to evaluate the presence of psychological distress. Data were collected from 2,460 respondents during 90 minute interviews conducted in respondents' homes. For the 1995 CR study approximately 184,000 randomly selected CR subscribers received the form of the survey that included questions related to mental health services. The data was based on the 22,000 surveys returned of which 6,900 reported having sought help for emotional problems, which included all health care providers except for clergy. Most of the respondents who received psychological therapy were satisfied with their treatment and thought it had improved the quality of their lives. Moreover, the longer the treatment continued, the greater the level of satisfaction.
Efficacy Versus Effectiveness
The Consumer Report is said to have been focused largely on efficacy and being devoid of effectiveness (Reiss and Price, 1996). It should be noted, however, that effectiveness can not exist without personal satisfaction of individuals involved, and which always must include efficacy. This is true because the personal satisfaction of the patient is always a necessary requisite for success. The question of whether efficacy can exist without effectiveness is another matter; since persons involved in therapy typically have reality deviating problems, and false perceptions may be the rule.
The Cassel Assessment Battery
The Cassel assessment battery was designed specifically to evaluate change in relation to five factors that are critical in the effectiveness paradigm. They may be used in concert as a total battery, requiring less than three hours time of patient, or as individual tests or assessment instruments for assessing specific areas of human functioning and development.:
1. Global Functioning - The Global Functioning Test (GST),
2. Need Gratification - The Need Gratification Test (NEEDS),
3. Cognitive Feelings - The Cognitive Feeling Test (CFT),
4. Emotional Feelings - The Emotional Feeling Test (EFT), and
5. Voluntary Control - The Voluntary Control Test (RELAX).
Change in Personal and Social Demeanor
The first two assessment batteries have to do with cognitively oriented therapy, and where rational emotive elements characterize the process, Each one deals with a specific aspect of human functioning and development as clearly demonstrated by factor validity of 15 independently organized factors of the 16 part scores in the two tests. …