Client-Directed Outcome-Informed Work: An Overview

Steven L. Proctor, Philip L. Herschman

Abstract


Considerable research has amassed to support the contention that irrespective of specific treatment modality and in some instances, treatment provider or format, clients are likely to benefit from psychotherapy.  The psychotherapy literature appears to have shifted its focus from simply evaluating comparative treatments––and the resultant equivalence of outcome––to identifying the hypothesized underlying mechanisms or common factors found to account for client improvement.  An alternative perspective to the traditional philosophy of psychotherapy research and practice, in which researchers strive to delineate disparities between various treatment modalities and identify the most efficacious or effective for a given disorder, involves examining the commonalities.  The common factors perspective is the basis from which the Client-Directed Outcome-Informed (CDOI) approach was derived.  This paper presents a general overview of CDOI and reviews the empirical evidence supporting the relative contribution of the various factors responsible for client improvement.  CDOI may best be conceptualized as an underlying framework from which all clinicians, regardless of theoretical orientation or scientific discipline, may ascribe.  Implications for routine clinical practice are also described.


Full Text:

PDF

References


References

Alvidrez, J., Azocar, F., & Miranda, J. (1996). Demystifying the concept of ethnicity for psychotherapy researchers. Journal of Consulting and Clinical Psychology, 64, 903-908. doi: 10.1037/0022-006X.64.5.903

Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77, 693-704. doi: 10.1037/a0016062

Appleby, L., Dyson, V., Altman, E., & Luchins, D. J. (1997). Assessing substance use in multiproblem patients: Reliability and validity of the Addiction Severity Index in a mental hospital population. Journal of Nervous and Mental Disease, 185, 159-165. doi: 10.1097/00005053-199703000-00005

Assay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56). Washington, DC: American Psychological Association.

Barkham, M., Stiles, W. B., & Shapiro, D. A. (1993). The shape of change in psychotherapy: Longitudinal assessment of personal problems. Journal of Consulting and Clinical Psychology, 61, 667-677. doi: 10.1037/0022-006X.61.4.667

Barth, J., Munder, T., Gerger, H., Nuesch, E., Trelle, S…Cuijpers, P. (2013). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. PLoS Medicine, 10, e1001454. doi: 10.1371/journal.pmed.1001454

Berman, J. S., Miller, C. R., & Massman, P. J. (1985). Cognitive therapy versus systematic desensitization: Is one treatment superior? Psychological Bulletin, 97, 451-461. doi: 10.1037/0033-2909.97.3.451

Bohart, A. (2000). The client is the most important common factor. Journal of Psychotherapy Integration, 10, 127-149.

Bright, J. I., Baker, K. D., & Neimeyer, R. A. (1999). Professional and paraprofessional group treatments for depression: A comparison of cognitive-behavioral and mutual support interventions. Journal of Consulting and Clinical psychology, 67, 491-501. doi: 10.1037/0022-006X.67.4.491

Bringhurst, D. L., Watson, C. W., Miller, S. D., & Duncan, B. L. (2006). The reliability and validity of the Outcome Rating Scale: A replication study of a brief clinical measure. Journal of Brief Therapy, 5, 23-29.

Campbell, A., & Hemsley, S. (2009). Outcome Rating Scale and Session Rating Scale in psychological practice: Clinical utility of ultra-brief measures. Clinical Psychologist, 13, 1-9. doi: 10.1080/13284200802676391

Carroll, L. (1865). Alice’s Adventures in Wonderland. London: Macmillan.

Carroll, K. M., Powers, M. D., Bryant, K. J., & Rounsaville, B. J. (1993). One-year follow-up status of treatment-seeking cocaine abusers: Psychopathology and dependence severity as predictors of outcome. Journal of Nervous and Mental Disease, 181, 71-79. doi: 10.1097/00005053-199302000-00001

Castonguay, L. G., Goldfried, M. R., Wiser, S., Rague, P. J., & Hayes, A. M. (1996). Predicting the effect of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology, 64, 497-504.

Chan, F., Shaw, L., McMahon, B., Koch, L., & Strauser, D. (1997). A model for enhancing rehabilitation counselor-consumer working relationships. Rehabilitation Counseling Bulletin, 41, 122-134.

Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R., & Donovan, D. M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65, 588-598. doi: 10.1037/0022-006X.65.4.588

Crits-Christoph, P. (1992). The efficacy of brief dynamic psychotherapy: A meta-analysis. The American Journal of Psychiatry, 149, 151-158.

Cuijpers, P., Donker, T., Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943-1957. doi: 10.1017/S0033291710000772

Driessen, E., Van, H. L., Don, F. J., Peen, J., Kool, S…Dekker, J. M. (2013). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: A randomized clinical trial. The American Journal of Psychiatry. 170, 1041-1050. doi: 10.1176/appi.ajp.2013.12070899

Duncan, B. L., & Miller, S. D. (2000a). The client’s theory of change: Consulting the client in the integrative process. Journal of Psychotherapy Integration, 10, 169-187. doi: 10.1023/A:1009448200244

Duncan, B. L., & Miller, S. D. (2000b). The heroic client: Doing client directed, outcome informed therapy. San Francisco, CA: Jossey-Bass.

Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy (rev. ed.). San Francisco, CA: Jossey-Bass.

Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D. A., Reynolds, L. R…Johnson, L. D. (2003). The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3, 3-12.

Duncan, B. L., Sparks, J. A., & Miller, S. D. (2000). Recasting the therapeutic drama: A client- directed, outcome-informed approach. In F. M. Dattilio & L. J. Bevilacqua (Eds.), Comparative treatments for relationship dysfunction (pp. 301-324). New York, NY: Springer.

Duncan, B. L., Sparks, J. A., Miller, S. D., Bohanske, R. T., & Claud, D. A. (2006). Giving youth a voice: A preliminary study of the reliability and validity of a brief outcome measure for children, adolescents, and caretakers. Journal of Brief Therapy, 5, 71-87.

Hamilton, K. E., & Dobson, K. S. (2002). Cognitive therapy of depression: Pretreatment patient predictors of outcome. Clinical Psychology Review, 22, 875-893. doi: 10.1016/S0272-7358(02)00106-X

Heather, N., Whitton, B., & Robertson, I. (1986). Evaluation of a self-help manual for media- recruited problem drinkers: Six month follow-up results. British Journal of Clinical Psychology, 25, 19-34. doi: 10.1111/j.2044-8260.1986.tb00667.x

Hogan, B. E., Linden, W., & Najarian, B. (2002). Social support interventions: Do they work? Clinical Psychology Review, 22, 381-440. doi: 10.1016/S0272-7358(01)00102-7

Hope, D. A., Heimberg, R. G., & Turk, C. L. (2010). Managing social anxiety: A cognitive behavioral approach (2nd ed.). New York: Oxford Press.

Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51, 1059-1064. doi: 10.1037/0003-066X.51.10.1059

Hubble, M. L., Duncan, B. L., & Miller, S. D. (1999). The heart and soul of change: What works in therapy. Washington, DC: American Psychological Association.

Jarrett, R. B., Eaves, G. G., Grannemann, B. D., & Rush, A. J. (1991). Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: A preliminary report. Psychiatry Research, 37, 245-260. doi: 10.1016/0165-1781(91)90061-S

Johnson, L. D., Miller, S. D., & Duncan, B. L. (2000). The Session Rating Scale 3.0. Chicago: Authors.

Joyce, A. S., Wolfaardt, U., Sribney, C., & Aylwin, A. S. (2006). Psychotherapy research at the start of the 21st century: The persistence of the art versus science controversy. Canadian Journal of Psychiatry, 51, 797-809.

Kadden, R., Carroll, K. M., Donovan, D., Cooney, N., Monti, P., Abrams, D., et al. (1999). Cognitive-behavioral coping skills therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. NIAAA Project MATCH Monograph Series, Volume 3 (NIH Publication No. 94-3724). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.

Knight, K., Hiller, M. L., Broome, K. M., & Simpson, D. (2000). Legal pressure, treatment readiness, and engagement in long-term residential programs. Journal of Offender Rehabilitation, 31, 101-115. doi: 10.1300/J076v31n01_07

Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyher, J., Elkin, I., Watkins, J., et al. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Project. Journal of Consulting and Clinical Psychology, 64, 532-539. doi: 10.1037/0022-006X.64.3.532

Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New York: Basic Books.

Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians routinely to track patient outcome? A meta-analysis. Clinical Psychology, 10, 288-301. doi: 10.1093/clipsy.bpg025

Lidren, D. M., Watkins, P. L., Gould, R. A., Clum, G. A., Asterino, M., & Tulloch, H. L. (1994). A comparison of bibliotherapy and group therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology, 62, 865-869. doi: 10.1037/0022-006X.62.4.865

Luborsky, L. (1994). Therapeutic Alliances as Predictors of Psychotherapy Outcomes: Factors Explaining the Predictive Success. In A. Horvath and L. Greenberg (Eds.), The Working Alliance: Theory, Research and Practice (pp. 38-50). New York: John Wiley & Sons.

Luborsky, L., Diguer, L., Seligman, D. A., Rosenthal, R., Johnson, S., Halperin, G…Schweizer, E. (1999). The researcher’s own therapeutic allegiances – A “wild card” in comparisons of treatment efficacy. Clinical Psychology: Science and Practice, 6, 95-106. doi: 10.1093/clipsy.6.1.95

Luborsky, L., Rosenthal, R., Diguer, L., Andrusyna, T. P., Berman, J. S…Krause, E. D. (2002). The Dodo bird verdict is alive and well – mostly. Clinical Psychology: Science and Practice, 9, 2-12. doi: 10.1093/clipsy.9.1.2

Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that "Everyone has won and all must have prizes"? Archives of General Psychiatry, 32, 995-1008. doi: 10.1001/archpsyc.1975.01760260059004

Markarian, Y., Larson, M. J., Aldea, M. A., Baldwin, S. A., Good, D…McKay, D. (2010). Multiple pathways to functional impairment in obsessive-compulsive disorder. Clinical Psychology Review, 30, 78-88. doi: 10.1016/j.cpr.2009.09.005

McGee, M. D., & Mee-Lee, D. (1997). Rethinking patient placement: The human service matrix model for matching services to needs. Journal of Substance Abuse Treatment, 14, 141- 148. doi: 10.1016/S0740-5472(96)00122-5

McLellan, A. T., Alterman, A. I., Metzger, D. S., Grissom, G. R., Woody, G. E…O’Brien, C. P. (1994). Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: Role of treatment services. Journal of Consulting and Clinical Psychology, 62, 1141-1158. doi: 10.1037/0022-006X.62.6.1141

McLellan, A. T., Arndt, I. O., Metzger, D., Woody, G. E., & O’Brien, C. P. (1993). The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association, 269, 1953-1959. doi: 10.1001/jama.1993.03500150065028

McLellan, A. T., Grissom, G. R., Zanis, D., & Randall, M. (1997). Problem-service “matching” in addiction treatment: A prospective study in four programs. Archives of General Psychiatry, 54, 730-735. doi: 10.1001/archpsyc.1997.01830200062008

McManus, I. C. (1992). Models of mental illness. In I.C. McManus (Ed.), Psychology in medicine (pp. 252-259). Oxford: Butterworth-Heinermann.

Meier, P. S., Barrowclough, C., & Donmall, M. C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: A critical review of the literature. Addiction, 100, 304- 316. doi: 10.1111/j.1360-0443.2004.00935.x

Miller, S. D., & Duncan, B. L. (2000a). Paradigm lost: From model-driven to client-directed, outcome-informed clinical work. Journal of Systemic Therapies, 19, 20-34.

Miller, S. D., & Duncan, B. L. (2000b). The Outcome Rating Scale. Chicago: Authors.

Miller, S. D., Duncan, B. L., Brown, J., Sparks, J. A., & Claud, D. A. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of brief visual analog measure. Journal of Brief Therapy, 2, 91-100.

Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: Norton.

Miller, S. D., Duncan, B. L., & Hubble, M. A. (2002). Client-directed, outcome-informed clinical work. In F. W. Kaslow (Ed.), Comprehensive Handbook of Psychotherapy: Integrative/Eclectic (vol. 4; pp 185-212). Hoboken, NJ; John Wiley & Sons Inc.

Miller, S. D., Duncan, B. L., Sorrell, R., & Brown, G. S. (2005). The Partners for Change Outcome Management System. Journal of Clinical Psychology, 61, 199-208.

Miller, W. R., & Taylor, C.A. (1980). Relative effectiveness at bibliotherapy, individual and group self-control training in the treatment of problem drinkers. Addictive Behaviors, 5, 13-24. doi: 10.1016/0306-4603(80)90017-9

Montgomery, E. C., Kunik, M. E., Wilson, N., Stanley, M. A., & Weiss, B. (2010). Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? Bulletin of the Menninger Clinic, 74, 45-62. doi: 10.1521/bumc.2010.74.1.45

Nunnally, J. C. (1978). Psychometric theory (2nd Ed.). New York: McGraw-Hill.

Reese, R. J., Norsworthy, L. A., & Rowlands, S. R. (2009). Does a continuous feedback system improve psychotherapy outcome? Psychotherapy: Theory, Research, Practice, Training, 46, 418-431.

Rogers, C. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework. In S. Koch (Ed.), Psychology: A study of a science: Formulations of the person and the social context (Vol. 3). New York: McGraw Hill.

Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy: “At last the Dodo said, ‘Everybody has won and all must have prizes.’” American Journal of Orthopsychiatry, 6, 412-415.

Saggese, M. L. (2005). Maximizing treatment effectiveness in clinical practice: An outcome- informed, collaborative approach. Families in Society, 86, 558-564.

Seligman, M. E. (1995). The effectiveness of psychotherapy. American Psychologist, 50, 965-974. doi: 10.1037/0003-066X.50.12.965

Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752-760. doi: 10.1037/0003066X.32.9.752

Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore: Johns Hopkins University Press.

Stevens, S. E., Hynan, M. T., & Allen, M. (2000). A meta-analysis of common factor and specific treatment effects across the outcome domains of the phase model of psychotherapy. Clinical Psychology: Science and Practice, 7, 273-290. doi: 10.1093/clipsy.7.3.273

Stiles, W, Shapiro, D., & Elliot, R. (1986). Are all psychotherapies equivalent? American Psychologist, 41, 165-180. doi: 10.1037/0003-066X.41.2.165

Strupp, H. H., & Hadley, S. W. (1979). Specific vs nonspecific factors in psychotherapy: A controlled study of outcome. Archives of General Psychiatry, 36, 1125–1136. doi: 10.1001/archpsyc.1979.01780100095009

Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “all must have prizes.” Psychological Bulletin, 122, 203-215. doi: 10.1037/0033-2909.122.3.203


Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 The New School Psychology Bulletin

© The New School Psychology Bulletin | editors@nspb.net