An examination of clients' in-session changes and their relationship to the working alliance and outcome

Abstract

The objective of the current study was to investigate the psychometric properties of the Client Task Specific Change Measure–Revised (CTSC-R), a measure of clients' in-session changes, and to determine whether the CTSC-R predicted outcome over and above the therapeutic alliance in a study of 66 clients treated with process-experiential psychotherapy or cognitive–behavioural therapy for depression. The measure showed high internal consistency and item–total correlations. Principal-axis factoring, followed by oblique rotation, showed that the measure comprised two factors: (a) behaviour change and (b) awareness and understanding. Clients' CTSC-R scores changed over the course of psychotherapy and predicted change in depression at the end of therapy over and above the therapeutic alliance, explaining an additional 13% of the variance in outcome on the Beck Depression Inventory. Limitations of the study and future directions for research are discussed.

Abstract

Das Ziel der vorliegenden Studie war es, die psychometrischen Merkmale des “Client Task Specific Change Measure–Revised” (CTSC-R) – ein Messinstrument um Veränderung der Klienten innerhalb der Sitzungen zu messen – zu untersuchen und zu entscheiden, ob das CTSC-R über die therapeutische Allianz hinaus das Therapieergebnis vorhersagt. Dafür wurden 66 Klienten untersucht, die mit Prozess-erlebensorientierte Therapie oder mit Kognitiver Verhaltenstherapie für Depressionen behandelt wurden. Das Instrument zeigte hohe interne Konsistenz und Item-Total-Korrelationen. Eine Hauptachsenanalyse, gefolgt von einer obliquen Rotation, ergab, dass das Instrument zwei Faktoren umfasst: (a) Verhaltensveränderung und (b) Bewusstsein und Verständnis. Die CTSC-R Werte der Klienten veränderten sich im zeitlichen Verlauf der Therapie und sagten Veränderung in der depressiven Symptomatik zum Ende der Therapie, über die therapeutische Allianz hinaus, vorher, was zu einer 13%-tigen zusätzliche Varianzaufklärung im Beck-Depressions-Inventar führte. Einschränkungen der Studie und zukünftige Forschungsansätze werden diskutiert.

Abstract

L'objectif de cette étude était d'investiguer les propriétés psychométriques de la Mesure du Changement de Tâche Spécifique-Révisée (CTSC-R), une mesure des changements des clients en séance, et de déterminer si le CTSC-R prédisait les résultats plus et au-delà de l'alliance thérapeutique dans une étude de 66 clients traités à l'aide d'une thérapie processuelle-expérientielle ou une thérapie cognitive-comportementale pour la dépression. La mesure a montré une consistance interne et des corrélations item-total élevées. Une analyse en composante principale suivie d'une rotation oblique a mis en évidence deux facteurs: (a) changement comportemental, et (b) prise de conscience et compréhension. Les scores CTSC-R changeaient au cours de la psychothérapie et prédisaient le changement de la dépression à la fin de la thérapie plus et au-delà de l'alliance thérapeutique, expliquant 13% de variance additionnelle dans les résultats à l'Inventaire de Dépression de Beck (BDI). Les limitations de l’étude et les directions de recherches futures sont discutées.

Abstract

O objectivo do presente estudo foi investigar as propriedades psicodinâmicas do Client Task Specific Change Measure–Revised (CTSC-R), uma medida das mudanças do cliente dentro da sessão e determinar se o CTSC-R predizia os resultados terapêuticos em relação à aliança terapêutica num estudo de 66 clientes tratados através de psicoterapia experiencial e terapia cognitivo comportamental para a depressão. A medida mostra uma concistência interna elevada e correlaç[otilde]es itens – total. A análise de factores psincipais, seguida de uma rotação oblíqua mostrou que a medida continha dois factores a) mudança comportamental e b) consciência e compreensão. Os resultados dos clientes no CTSC –R mudaram ao longo do curso da terapia e predisseram a mudança na depressão no final da terapia em relação à aliança terapêutica, explicando mais 13% da variância nos resultados do Beck Depression Inventory. As limitaç[otilde]es do estudo e direcç[otilde]es futuras da investigação são discutidas.

Abstract

L'obiettivo del corrente studio era di studiare le proprietà psicometriche del Client Task Specific Change-Revised (CTSC-R), che risulta essere una misura effettuata sui pazienti in una fase di cambiamento e per determinare se il CTSC-R predice un risultato maggiore rispetto all'alleanza terapeutica in uno studio di 66 pazienti trattati con una psicoterapia esperienziale o con la terapia cognitivo-comportamentale per la depressione. Lo strumento ha mostrato una elevata coerenza interna e buone correlazioni item-totale. L'analisi fattoriale eseguita con il metodo degli assi principali, seguita dalla rotazione obliqua, ha dimostrato che il test era composto da due fattori: (a) modificare i comportamenti e (b) la consapevolezza e la comprensione. Il punteggio al test dei pazienti cambia con il corso della psicoterapia e predice cambiamenti nella depressione e spiega un ulteriore 13% della varianza nel risultato sul Beck Depression Inventory. Le limitazioni dello studio e le direzioni future per la ricerca sono discussi di seguito.

Abstract

Keywords:

• cognitive–behavioural therapy
• depression
• experiential/existential/humanistic psychotherapy
• outcome research
• process research
• alliance
• brief psychotherapy
• postsession outcome
• change processes

Acknowledgements

This research was supported by Research Grant 410-97-0525 from the Social Sciences and Humanities Research Council of Canada awarded to Jeanne C. Watson. A version of this article was presented at the 35th Annual Meeting of the Society for Psychotherapy Research, Rome, Italy. We thank the reviewers for their very helpful comments and suggestions.