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Coyne AE, Constantino MJ, Boswell JF, Gaines AN, Kraus DR. Therapist-Level Moderators of Patient-Therapist Match Effectiveness in Community Psychotherapy. Adm Policy Ment Health 2024:10.1007/s10488-024-01360-8. [PMID: 38565810 DOI: 10.1007/s10488-024-01360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/04/2024]
Abstract
Based on patient-reported outcomes data analyzed at the provider level, there is evidence that psychotherapists can possess effectiveness strengths and weaknesses when treating patients with different presenting concerns. These within-therapist differences hold promise for personalizing care by prospectively matching patients to therapists' historical effectiveness strengths. In a double-masked randomized controlled trial (RCT; NCT02990000), such matching outperformed pragmatically determined usual case assignment-which leaves personalized, measurement-based matching to chance-in naturalistic outpatient psychotherapy (Constantino et al., JAMA Psychiatry 78:960-969, 2021). Demonstrating that personalization can be even more precise, some research has demonstrated that the strength of this positive match effect was moderated by certain patient characteristics. Notably, though, it could also be that matching is especially important for some therapists to achieve more effective outcomes. Examining this novel question, the present study drew on the Constantino et al. (JAMA Psychiatry 78:960-969, 2021) trial data to explore three therapist-level moderators of matching: (a) effectiveness "spread" (i.e., greater performance variability across patients' presenting problem domains), (b) overestimation of their measurement-based and problem-specific effectiveness, and (c) the frequency with which they use patient-reported routine outcomes monitoring in their practice. Patients were 206 adults, randomized to the match or control condition, treated by 40 therapists who were crossed over conditions. The therapist variables were assessed at the trial's baseline and patients' symptomatic/functional impairment and global distress were assessed regularly up to 16 weeks of treatment. Hierarchical linear models revealed that only therapist effectiveness spread significantly moderated the match effect for the global distress outcome; for therapists with more spread, the match effect was more pronounced, whereas the match effect was minimal for therapists with less effectiveness spread. Notably, two therapist-level covariates unexpectedly emerged as significant moderators for the symptomatic/functional impairment outcome; for clinicians who consistently treated patients with higher versus lower average severity levels and who relatedly treated a higher proportion of patients with primary presenting problems of substance misuse or violence, the beneficial match effect was even stronger. Thus, measurement-based matching may be especially potent for therapists with more variable effectiveness across problem domains, and who consistently treat patients with more severe presenting concerns or with particular primary problems, which provides further precision in conceptualizing personalized care.
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Affiliation(s)
- Alice E Coyne
- Department of Psychology, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA.
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
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Constantino MJ, Coyne AE, Gaines AN, Goodwin BJ, Muir HJ, Critchfield KL, Westra HA, Antony MM. Therapist verification of patient self-concepts as a responsive precondition for early alliance development and subsequent introject change. Psychother Res 2023:1-15. [PMID: 38158827 DOI: 10.1080/10503307.2023.2297995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Social psychological research has indicated that people strive for self-consistent feedback and interactions, even if negative, to preserve the epistemic security of knowing themselves. Without such self-verification, any interpersonal exchange may become frustrated, anxiety-riddled, and at risk for deterioration. Thus, it may be important for therapists to meet patients' self-verification needs as a responsive precondition for early alliance establishment and development. We tested this hypothesis with patients receiving cognitive behavioral therapy for generalized anxiety disorder-a condition that may render one's self-verification needs especially strong. We also tested the hypothesis that better early alliance quality would relate to subsequent adaptive changes in and posttreatment level of patients' self-concepts. METHOD Eighty-four patients rated their self-concepts at baseline and across treatment and follow-up, their postsession recollection of their therapist's interpersonal behavior toward them during session 2, and their experience of alliance quality rated after sessions 3-6. RESULTS As predicted, the more therapists verified at session 2 a patient's baseline self-concepts (which trended toward disaffiliative and overcontrolling, on average), the more positively that patient perceived their next-session alliance. Moreover, better session 3 alliance related to more adaptive affiliative and autonomy-granting self-concepts at posttreatment. CONCLUSION Results are discussed within a therapist responsiveness framework.
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Affiliation(s)
- Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Alice E Coyne
- Department of Psychology, American University, Washington, DC, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brien J Goodwin
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Henny A Westra
- Department of Psychology, York University, Toronto, Canada
| | - Martin M Antony
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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Boswell JF, Schwartzman CM, Constantino MJ, Scharff A, Muir HJ, Gaines AN, King BR, Kraus DR. A Qualitative Analysis of Stakeholder Attitudes Regarding Personalized Provider Selection and Patient-Therapist Matching. Adm Policy Ment Health 2023:10.1007/s10488-023-01302-w. [PMID: 37740813 DOI: 10.1007/s10488-023-01302-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
This study explored mental health care patients and therapists' perspectives on using therapists' measurement-based and problem-specific effectiveness data to inform case assignments - a type of treatment personalization that has been shown to outperform non-measurement-based case assignment as usual (Constantino et al., 2021). We conducted semi-structured qualitative interviews with 8 patients (75% women; M age = 33.75 years) and 8 therapists (75% women; M age = 47.50 years). The interview protocols were unique to stakeholder group. Recorded responses were transcribed and qualitatively analyzed by four judges using a blend of consensual qualitative research and grounded theory methods. Derived patient domains included preferred characteristics of a provider, and experiences and suggestions regarding provider selection. Within the domains, most patients expressed an interest in accessing more specific provider information online. Additionally, most patients indicated that both provider outcome track records and personal preference information (e.g., therapist characteristics) should be considered in the therapist selection process. All patients endorsed being comfortable with having the ability to select a provider based on a list of empirically well-matched recommendations. Derived therapist domains included using routine outcomes monitoring for patient-provider matching, referral source and direct patient use of preferred provider lists, and improvements to the provider selection process. Within the domains, all therapists remarked that outcome data would be useful for matching patients to providers; however, most also indicated that outcome data should not be the only factor used in provider selection. All therapists expressed a willingness to be included in preferred provider lists that incorporate track record data. Overall, both patients and therapists held generally positive views toward using therapist effectiveness data to help personalize mental health care. Yet, both stakeholder groups acknowledged that other personalization factors should be considered alongside these data. Based on these results, our team is in the process of implementing patient-therapist match strategies in larger and more diverse mental health care contexts.
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Affiliation(s)
- James F Boswell
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA.
| | - Carly M Schwartzman
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Adela Scharff
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brittany R King
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
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Constantino MJ, Boswell JF, Coyne AE, Muir HJ, Gaines AN, Kraus DR. Therapist perceptions of their own measurement-based, problem-specific effectiveness. J Consult Clin Psychol 2023:2023-65884-001. [PMID: 37104803 DOI: 10.1037/ccp0000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Patient-reported outcomes data reveal differences both in therapists' global effectiveness across their average patient (between-therapist effect) and in treating different problems within their caseload (within-therapist effects). Yet, it is unclear how accurately therapists perceive their own measurement-based, problem-specific effectiveness and whether such self-perceptions predict global between-therapist performance differences. We explored these questions in naturalistic psychotherapy. METHOD For 50 therapists, we drew on data from a mean of 27 past patients (total N = 1,363) who completed a multidimensional outcome measure-Treatment Outcome Package (TOP)-at pre- and posttreatment. For each of 12 outcome domains (e.g., depression, anxiety), TOP data classified therapists as historically "effective," "neutral," or "ineffective." Unaware of their data-driven classifications, therapists rated their perceived effectiveness for each domain. We conducted chi-square analyses to determine whether therapists predicted their own measurement-based effectiveness classifications to a level greater than chance. We then used multilevel modeling to test whether therapists' problem-specific perceptions predicted global between-therapist performance differences. RESULTS For all but one outcome domain, therapists were no better than chance at predicting their measurement-based effectiveness classification. Additionally, controlling for patient baseline impairment, therapists who consistently overestimated their problem-specific effectiveness had patients who reported worse global outcomes than patients whose therapist more accurately estimated their effectiveness. Conversely, therapists who underestimated their problem-specific effectiveness had patients who reported better outcomes than patients whose therapist over- or accurately estimated their effectiveness. CONCLUSIONS Therapist humility may differentiate the most from least globally effective therapists, and this virtue should be cultivated in clinical trainings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York
| | - Alice E Coyne
- Department of Psychological Sciences, Case Western Reserve University
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
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Coyne AE, Constantino MJ, Muir HJ, Gaines AN, Vîslă A. Participant factors as correlates of patients' psychotherapy outcome expectation: A meta-analytic and box-count review. Psychother Res 2023:1-15. [PMID: 37079855 DOI: 10.1080/10503307.2023.2197629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE More positive pre- or early therapy patient outcome expectation (OE) has consistently correlated with better treatment outcomes. Thus, it is important to identify factors that contribute to patients' OE, which can inform therapist responsivity to such risk or facilitative markers. With growing research on OE correlates-centered primarily on patient characteristics/treatment factors and, to a lesser extent, therapist factors-a comprehensive synthesis is warranted to elucidate replicated and mixed associations and stimulate further research. Accordingly, we set a pragmatic cutoff of k ≥ 5 for meaningful empirical aggregation of participant factor-OE associations; otherwise, we conducted box counts. METHOD We searched for articles published through March 2022 that included a clinical sample, a measure of patient's pre- or early treatment OE, and an explicit test of the factor-OE association. RESULTS Patient problem severity, problem chronicity, education, age, and quality of life were meta-analyzed. Greater severity correlated with lower/less optimistic OE (r = -0.13, p < .001) and higher QOL correlated with higher/more optimistic OE (r = 0.18, p < .001). Box counts revealed that few variables had consistent associations with OE. CONCLUSIONS Some factors can help forecast patient OE, though additional research is needed to enhance confidence and clinical meaning.
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Affiliation(s)
- Alice E Coyne
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Andreea Vîslă
- Department of Psychology, University of Zurich, Zurich, Switzerland
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Constantino MJ, Gaines AN, Coyne AE, Boswell JF, Kraus DR. Existential Isolation as a Correlate of Mental Health Problems, Predictor of Treatment Outcome, and Moderator of a Patient-Therapist Match Effect. Journal of Social and Clinical Psychology 2023. [DOI: 10.1521/jscp.2023.42.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Introduction: Ample research has established that interpersonal isolation—the objective separateness from others—is a correlate of maladaptive psychological outcomes. However, existential isolation (EI)—the feeling of aloneness in one's subjective experience—has received less empirical attention. From the limited existing research, higher EI has been associated with greater severity of mental health concerns and more negative beliefs about treatment. Yet, these investigations have largely been conducted with non-clinical samples. Further, virtually no studies have examined EI as a predictor of current psychotherapy outcomes. Moreover, given their risk of holding negative treatment beliefs, it is plausible that therapy would be most effective if more existentially isolated individuals experienced being well matched to their therapist. This study extended EI research to a clinical sample and provided a novel test of EI as a direct predictor of outcome and moderator of a patient-therapist match system in naturalistic psychotherapy. Method: Data derived from a randomized trial comparing the effectiveness of prospectively matching patients (N = 218) to therapists (N = 48) with empirical strengths in treating the patient's specific presenting problem(s) versus case assignment as usual (Constantino et al., 2021). Patients rated EI at baseline and mental health outcomes repeatedly through treatment. We conducted correlations to examine baseline EI-symptom associations and multilevel modeling to test EI as a predictor of symptom change and moderator of the known beneficial match effect on outcome. Results: As predicted, higher EI was associated with greater depression, anxiety, and distress at baseline, as well as poorer therapy outcome across and at the end of treatment. In the expected direction, though not to a statistically significant level, the positive match effect was stronger for patients with higher versus lower EI. Discussion: We discuss research and practice implications at the intersection of social and clinical psychology.
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Coyne AE, Constantino MJ, Ouimette KA, Gaines AN, Atkinson LR, Bagby RM, Ravitz P, McBride C. Replicating patient-level moderators of CBT and IPT's comparative efficacy for depression. Psychotherapy (Chic) 2022; 59:616-628. [PMID: 36048042 DOI: 10.1037/pst0000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although evidence-based psychotherapies, such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), produce comparable average outcomes, it is plausible that some patients who possess one or more specific characteristics may respond better to one over the other. Addressing this what works best for whom question, researchers have tested the moderating influence of patient characteristics on comparative treatment effects (viz. aptitude-treatment interactions [ATIs]). However, few ATIs have emerged or replicated, thereby providing little treatment-selection guidance. Informed by a systematic review of patient ATIs in trials that compared CBT versus IPT for depression (Bernecker et al., 2017), this study aimed to replicate (a) significant ATIs previously established in a single study; and (b) significant ATIs previously examined twice, with only one study demonstrating a moderating effect. Data derived from a trial in which adult outpatients with major depression were randomly assigned to 16 weeks of CBT (n = 41) or IPT (n = 39). Patient characteristics were measured at baseline, and patients rated their depression throughout treatment. Multilevel models revealed one ATI replication; for patients with more self-sacrificing interpersonal problems, CBT outperformed IPT; the reverse was true for patients with fewer such problems. Other moderators either failed to replicate or directionally contradicted prior research. Results help inform optimal treatment matching for some patients, which reflects a type of psychotherapy personalization. However, they also highlight limitations of traditional ATI research and suggest that different methods are needed to inform responsive personalization efforts more expansively and reliably. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Gertz AM, Soffi ASM, Mompe A, Sickboy O, Gaines AN, Ryan R, Mussa A, Bawn C, Gallop R, Morroni C, Crits-Christoph P. Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes. Front Glob Womens Health 2022; 3:815634. [PMID: 35663924 PMCID: PMC9157818 DOI: 10.3389/fgwh.2022.815634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction To develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians. Methods A list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice "best-worst scaling" approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined. Results For 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based "most-preferred" method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93. Conclusions A best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.
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Affiliation(s)
- Alida M. Gertz
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Atlang Mompe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Robert Gallop
- West Chester University, West Chester, PA, United States
| | - Chelsea Morroni
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Medical Research Council (MRC) University of Edinburgh Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Paul Crits-Christoph
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Gaines AN, Constantino MJ, Coyne AE, Boswell JF, Kraus DR. Patient-therapist expectancy convergence and outcome in naturalistic psychotherapy. Psychotherapy (Chic) 2022; 59:584-593. [PMID: 35446083 DOI: 10.1037/pst0000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research on close relationships demonstrates that dyadic convergence, or two people becoming more similar in their experiences and/or beliefs over time, is commonplace and adaptive. As psychotherapy involves a close relationship, patient-therapist convergence processes may influence treatment-specific outcomes. Although prior research supports that patients and therapists tend to converge on their alliance perspectives over time, which associates with subsequent patient improvement, no research has similarly examined belief convergence during therapy. Accordingly, this study focused on patient-therapist convergence in their outcome expectations (OE), a belief variable associated with patient improvement when measured from individual participant perspectives. We predicted both that significant OE convergence would occur and relate to better posttreatment outcome. Data derived from a trial of naturalistic psychotherapy. Patients and therapists repeatedly rated their respective OE through treatment, and patients rated their symptom/functional outcomes at posttreatment. For dyads with the requisite OE data (N = 154), we tested our questions using multilevel structural equation modeling. Counter to our hypotheses, there was no discernable OE convergence pattern over treatment (γ₁₀₀ = 0.01, SE = 0.03, p = .690) and OE convergence was unrelated to outcome at the between-dyad level (γ₀₂₀ = 2.37, SE = 10.28, p = .818). However, on its own, higher early patient OE was significantly associated with better outcome at the between-dyad level (γ₀₅₀ = -0.04, SE = 0.01, p = .007). Results suggest that OE may be more of a facilitative patient versus relational process factor. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Coyne AE, Constantino MJ, Gaines AN, Laws HB, Westra HA, Antony MM. Association between therapist attunement to patient outcome expectation and worry reduction in two therapies for generalized anxiety disorder. J Couns Psychol 2021; 68:182-193. [DOI: 10.1037/cou0000457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gaines AN, Goldfried MR, Constantino MJ. Revived call for consensus in the future of psychotherapy. Evid Based Ment Health 2021; 24:2-4. [PMID: 33234505 PMCID: PMC10231517 DOI: 10.1136/ebmental-2020-300208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 11/03/2022]
Abstract
The emblem of success in psychotherapy research and practice has long been innovation. Although such ingenuity is commendable, it has nonetheless perpetuated fragmentation across the field. At least four decades ago, it was suggested that achieving consensus on what constitutes psychotherapy's theoretical, empirical, and practical 'core' might allow the discipline to evolve beyond its siloed state, as is reflective of mature science. Yet, division remains the rule versus exception, owing in large part to power struggles among disparate schools of therapy and quarrels over whether theory-specific or theory-common factors most account for therapeutic change. We outline here a vision for psychotherapy's future that is defined by consensus rather than disintegration. Namely, we reiterate the need for the field to invest in clinical strategies that transcend ostensibly incompatible theoretical models. We also argue that psychotherapy research should build on the growing evidence for such clinical strategies in an effort to establish core, evidence-based principles of therapeutic change. We then discuss how establishing consensus will require reconciliation among the mounting evidence for flexible, principle-informed practice with the current realities of training, dissemination, and implementation paradigms. Finally, we articulate ways in which practicing clinicians will serve a vital role in carrying out, and amending as needed, actionable efforts toward psychotherapy consensus.
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Affiliation(s)
- Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Marvin R Goldfried
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Constantino MJ, Coyne AE, Goodwin BJ, Vîslă A, Flückiger C, Muir HJ, Gaines AN. Indirect effect of patient outcome expectation on improvement through alliance quality: A meta-analysis. Psychother Res 2020; 31:711-725. [DOI: 10.1080/10503307.2020.1851058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Michael J. Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Alice E. Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brien J. Goodwin
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Andreea Vîslă
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Heather J. Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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