Factors of treatment success in psychotherapy: a within-therapist analysis of early session processes.

IF 2.3 Q3 PSYCHOLOGY, CLINICAL
Yan Zhu, Mark J Hilsenroth
{"title":"Factors of treatment success in psychotherapy: a within-therapist analysis of early session processes.","authors":"Yan Zhu, Mark J Hilsenroth","doi":"10.4081/ripppo.2025.848","DOIUrl":null,"url":null,"abstract":"<p><p>While psychotherapy is generally effective, outcomes can vary significantly across patients, even when treated by the same therapist. This study employed a mixed-methods design to examine early indicators of treatment success by analyzing contrasting outcomes within individual therapists' caseloads. Treatment success was determined by patients achieving a clinically significant change on the Brief Symptom Inventory's Global Severity Index (BSI-GSI). The Reliable Change Index (RCI) was used to calculate these changes, adjusting to account for measurement error and regression to the mean. Unsuccessful cases are defined as those with no reliable change or deterioration. Data from six patients treated by three psychodynamic therapists were analyzed (each therapist having one successful and one unsuccessful case). Quantitative analyses of psychological assessments and early treatment measures, along with qualitative analyses of third session transcripts, were conducted. In successful cases, the patients reported higher levels of depression, interpersonal distress, and social avoidance/anxiety, but also greater personal insight prior to the treatment. Patients in successful cases also rated lower session smoothness compared to their therapists' ratings early in treatment. These divergent views are likely due to higher ratings of therapists' exploration of uncomfortable feelings in the successful treatment sessions. In addition, these external raters observed that in the successful cases, therapists employed higher overall levels of psychodynamic-interpersonal techniques during the third session than in their unsuccessful cases. Results highlight the importance of how initial severity and emotional expression in the early stage of psychotherapy may help lay the foundation for successful treatment outcomes.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research in Psychotherapy-Psychopathology Process and Outcome","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4081/ripppo.2025.848","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
引用次数: 0

Abstract

While psychotherapy is generally effective, outcomes can vary significantly across patients, even when treated by the same therapist. This study employed a mixed-methods design to examine early indicators of treatment success by analyzing contrasting outcomes within individual therapists' caseloads. Treatment success was determined by patients achieving a clinically significant change on the Brief Symptom Inventory's Global Severity Index (BSI-GSI). The Reliable Change Index (RCI) was used to calculate these changes, adjusting to account for measurement error and regression to the mean. Unsuccessful cases are defined as those with no reliable change or deterioration. Data from six patients treated by three psychodynamic therapists were analyzed (each therapist having one successful and one unsuccessful case). Quantitative analyses of psychological assessments and early treatment measures, along with qualitative analyses of third session transcripts, were conducted. In successful cases, the patients reported higher levels of depression, interpersonal distress, and social avoidance/anxiety, but also greater personal insight prior to the treatment. Patients in successful cases also rated lower session smoothness compared to their therapists' ratings early in treatment. These divergent views are likely due to higher ratings of therapists' exploration of uncomfortable feelings in the successful treatment sessions. In addition, these external raters observed that in the successful cases, therapists employed higher overall levels of psychodynamic-interpersonal techniques during the third session than in their unsuccessful cases. Results highlight the importance of how initial severity and emotional expression in the early stage of psychotherapy may help lay the foundation for successful treatment outcomes.

心理治疗成功的因素:早期治疗过程的治疗师内部分析。
虽然心理治疗通常是有效的,但即使由同一位治疗师治疗,不同患者的结果也会有很大差异。本研究采用混合方法设计,通过分析个别治疗师病例量的对比结果来检查治疗成功的早期指标。治疗成功取决于患者在简短症状量表的整体严重程度指数(BSI-GSI)上实现临床显著改变。使用可靠变化指数(RCI)来计算这些变化,并根据测量误差和回归均值进行调整。不成功病例被定义为没有可靠的变化或恶化。分析了三位心理动力治疗师治疗的6例患者的数据(每位治疗师有一个成功病例和一个不成功病例)。对心理评估和早期治疗措施进行定量分析,并对第三次会议记录进行定性分析。在成功的案例中,患者报告了更高水平的抑郁、人际困扰和社交回避/焦虑,但在治疗前也有更大的个人洞察力。与治疗师在治疗早期的评分相比,成功病例的患者对疗程顺利度的评分也较低。这些不同的观点可能是由于治疗师在成功的治疗过程中对不舒服感觉的探索得到了更高的评价。此外,这些外部评判员观察到,在成功的案例中,治疗师在第三次会议中使用的心理动力学-人际关系技术的总体水平高于不成功的案例。结果强调了心理治疗早期初始严重程度和情绪表达的重要性,这可能有助于为成功的治疗结果奠定基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
3.80
自引率
18.50%
发文量
28
审稿时长
10 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信