Therapist responsiveness and patient engagement in therapy

Abstract

This study tests the hypothesis that therapist responsiveness in the first two sessions of therapy relates to three measures of early patient engagement in treatment. Using videotapes and data from the NIMH Treatment of Depression Collaborative Research Program (TDCRP), an instrument was developed to measure therapist responsiveness in the first two sessions of Cognitive Behavior Therapy and Interpersonal Psychotherapy. A factor measuring positive therapeutic atmosphere, as well as a global item of therapist responsiveness, predicted both the patient's positive perception of the therapeutic relationship after the second session and the patient's remaining in therapy for more than four sessions. A negative therapist behavior factor also predicted early termination. Factors measuring therapist attentiveness and early empathic responding did not predict the engagement variables.

Diese Studie testet die Hypothese, dass die Responsivität des Therapeuten in den ersten zwei Therapiesitzungen mit drei Maßen frühen Therapieengagements des Patienten zusammenhängt. Unter Nutzung von Videoaufzeichnungen und den Daten des NIHM Treatment for Depression Collaborative Research Programm (TDCRP) wurde ein Instrument zur Messung der Responsivität von Therapeuten in den ersten beiden Sitzungen Kognitiver Verhaltenstherapie und Interpersonaler Therapie entwickelt. Ein Faktor, der die positive therapeutische Atmosphäre misst, sowie ein globales Item der therapeutischen Responsivität, prädizierten sowohl die positive Wahrnehmung der therapeutischen Beziehung nach der zweiten Sitzung durch den Patienten, als auch das Verbleiben des Patienten in Therapie für mehr als vier Sitzungen. Ein Faktor zu negativem therapeutischen Verhalten prädizierte frühe Therapiebeendigungen. Faktoren, die die therapeutische Aufmerksamkeit und frühes empathisches Reagieren messen hingen nicht mit den Engagement Variablen zusammen.

Este estudo testa a hipótese de a responsividade do terapeuta nas duas primeiras sessões de terapia se relacionar com três medidas do envolvimento inicial do paciente na terapia. Utilizando vídeos e informação do Programa de Pesquisa Colaborativa no Tratamento da Depressão (TDCRP) do NIMH desenvolveu-se um instrumento para medir a responsividade do terapeuta na Terapia Cognitivo Comportamental e na Psicoterapia Interpessoal. Um fator que avaliava a atmosfera terapêutica positiva, e um item global da responsividade do terapeuta revelaram-se preditores significativos da perceção positiva do cliente da relação terapêutica após a segunda sessão e da permanência do paciente em terapia por mais de quatro sessões. Um fator do comportamento negativo do terapeuta mostrou-se preditor do término precoce da terapia. Fatores de avaliação da atenção e da resposta empática inicial do terapeuta não se revelaram preditores das variáveis do envolvimento do paciente.

Questo studio verifica l'ipotesi che la responsività del terapeuta nelle prime due sedute di terapia sia collegata a tre misure di un rapido impegno del paziente nel trattamento. Utilizzando videoregistrazioni e i dati provenienti dal NIMH Treatment of Depression Collaborative Research Program (TDCRP), è stato sviluppato uno strumento per misurare la responsività del terapeuta nelle prime due sedute di terapia cognitivo-comportamentale e psicoterapia interpersonale. Un fattore che misura l'atmosfera positiva in terapia, nonché un item globale della responsività del terapeuta, hanno predetto sia la percezione positiva del paziente della relazione terapeutica dopo la seconda seduta sia il rimanere del paziente in terapia per più di quattro sedute. Inoltre, un fattore legato al comportamento negativo del terapeuta era predittivo di una conclusione precoce. I fattori che misuravano l'attenzione del terapeuta e l'iniziale risposta empatica non predicevano le variabili dell'impegno.

本研究旨在檢視治療師在前二次治療的反應程度，與三種測量病人在治療早期 參與情形的測驗結果之間的關連情形的假設。運用來自NIMH 治療憂鬱整合研 究計劃(TDCRP)的治療錄影及資料，發展出一用以測量在認知治療與人際取向 治療的前二次晤談中，治療師的反應性。正向的治療氣氛及治療者的反應性， 都能預測病人第二次晤談後知覺的正向治療關係，及病人持續接受四次以上的 治療。治療師負向行為的因素也能預測提前中止治療。治療師的專注及早期的 同理反應等因素，則無法預測病人參與情形的各變項。

Keywords:

• therapist responsiveness
• patient-therapist relationship
• therapeutic alliance
• early termination

Acknowledgements

The NIMH Treatment of Depression Collaborative Research Program was initiated and supported by the National Institute of Mental Health. The program was funded by cooperative agreements to six participating sites. The three research sites and their Principal Investigators and Project Coordinators were: George Washington University (MH 33762), Stuart M. Sotsky and David R.Glass; University of Pittsburgh (MH33753), Stanley D. Imber and Paul A. Pilkonis, and University of Oklahoma (MH 33760), John T. Watkins and William R. Leber. The three sites responsible for training therapists and their Principal Investigators and Project Coordinators were Yale University (MH 33827), Myrna M. Weissman, Eve S. Chevron, and Bruce J. Rounsaville; Clarke Institute of Psychiatry (MH 38231), Brian F. Shaw and T. Michael Vallis; and Rush Presbyterian-St. Luke's Medical Center (MH 35017), Jan A. Fawcett and Phillip Epstein. The principal NIMH collaborators were Irene Elkin, Coordinator, M. Tracie Shea, Associate Coordinator, Morris B. Parloff, and John P. Docherty. Collaborators in data management and data analysis were C. James Klett, Joseph F. Collins, and Roderic Gillis, V.A. Cooperative Studies Program, Perry Point, MD.

The authors thank Janice Krupnick and Stuart Sotsky for access to the VTAS data and Clara Hill for access to the CSPRS data. They also acknowledge the contribution of Susan Connors-Herrera, Kelly Gartland, Jessie Beebe, and David Orlinsky at various stages of this research.