Academic journal article American Journal of Psychotherapy

Assessment of Patient and Therapist Perspectives of Process: A Revision of the Vanderbilt Psychotherapy Process Scale

Academic journal article American Journal of Psychotherapy

Assessment of Patient and Therapist Perspectives of Process: A Revision of the Vanderbilt Psychotherapy Process Scale

Article excerpt

The present study was designed to revise the Vanderbilt Psychotherapy Process Scale (VPPS), an external-rater completed measure, into both patient and therapist-rated versions. The VPPS was altered into two versions by using simple pronoun changes and then submitted to a principal components analysis in order to identify component factors. This procedure resulted in two identical forms of the VPPS, one completed by the therapist (VPPS-T) and one completed by patients (VPPS-P). These scales have identical items and factor structures. Preliminary results suggest that the VPPS-P and VPPS-T may be useful measures of psychotherapy process when perspectives of session activity is desired from both patients and therapists.

In 1967, Orlinsky and Howard (1) published their article, "The Good Therapy Hour," which was an empirical examination of psychotherapy process and outcome variables. This project was intended to "search out the essentials of the psychotherapy process by empirical means, to penetrate the complex issue of therapy evaluation, and to elucidate the criteria which patients and therapists use as they weigh, judge, and integrate their therapy approaches" (p. 621). In short, Orlinsky and Howard attempted to quantify the key characteristics of the therapeutic relationship and interaction in order to predict which factors lead to a "good" hour of psychotherapy. This research was not only one of the first to examine the "active ingredients" of psychotherapy, but it pioneered a research methodology to investigate therapy process in an empirical manner.

To accomplish the somewhat daunting task of quantification of psychotherapy process, a Therapy Session Report (TSR) scale was developed to be completed by both therapist and patient (1). This scale measured such aspects of the interaction as the content of the session, assessment of the relationship, affective responses by both therapist and patient, and the motivation of both participants. The TSR has been used in a number of studies of psychotherapy process specifically examining premature psychotherapy termination (2), early session process in psychodyamic psychotherapy (3), psychotherapy with personality disordered patients (4), and process differences in both long- and short-term psychotherapy (5).

In recent study of psychodynamic psychotherapy process and outcome (6), the TSR was used to evaluate what variables of the therapeutic bond predict treatment outcome and session productivity. Examining patient self-report of symptoms and well-being, as well as session process and productivity, this researcher found that the quality of the session was related to both patient motivation and perception of the therapy as a "friendly and affirmative" (p. 215) environment. Furthermore, in this study, patients' perceptions of being heard and understood in the therapeutic communication was more related to symptom reduction and distress. While this study is important in that it examined the relationship between therapeutic alliance and session productivity and symptom reduction, it only examined these processes from the patient's perspective and did not examine change in psychotherapy process over time.

In 1974, utilizing the TSR as inspiration, Strupp et al. developed the Vanderbilt Psychotherapy Process Scale (VPPS), a measure to more objectively assess outcome-related psychotherapy process variables. Unlike the TSR, the VPPS was designed to be completed by an external rater. The VPPS was intended to be a more objective measure of psychotherapy process variables than the TSR. Items for the VPPS were selected to be unrelated to any particular psychotherapy orientation, descriptive rather than evaluative, and unidimensional (7).

Since 1974, the VPPS has been through a number of revisions (7). The number of items has been reduced and the level of item ambiguity has been decreased. Recent researchers reported eight factorally and rationally derived subscales of the VPPS that account for 64 of the 80 items (7). …

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