VS

Psychotherapy Research by Ablon and Jones


INTRODUCTION 

  • Psychodynamic and CB theories 

    • Very different techniques for therapy 

    • Often contradictory 

    • Differences in the effects of treatment 

      • Not been the case → no systemic differences in the effectiveness 

    • Explanation for lack of differences in effectiveness 

      • Share underlying common features that are responsible for the equivalent effects of the two treatments

        • Presence of therapeutic or working alliance 

      • The factors responsible for predicting the outcome are associated with or theoretically related to a particular form of therapy 

    • To determine the specific factors that are responsible for promoting patient change, the treatment process itself must be studied 

  • Recent comparative study of psychotherapy process 

    • Using the psychotherapy process q-set (PQS)

    • Identified extensive differences in the process in psychodynamic and CBT 

  • Factor analysis yielded → process factor of →   f 10 Q-items that appeared to be conceptually associated with psychodynamic technique

    • “psychodynamic technique

      • significantly correlated with successful outcome in both psychodynamic and cognitive-behavioural therapies

    • Cognitive behavioural technique

      • not significantly correlated with successful outcome in either psychodynamic or cognitive-behavioural therapies

  •  cognitive-behavioural therapists might be using psychodynamic strategies, and that it is these techniques that are responsible for promoting patient change

  • Limitation of the study

    •  the process factors termed “psychodynamic” and “cognitive-behavioural” technique were generated from the data set without an external criterion to establish whether the factors did in fact represent these two treatments 


  • These prototypes of an ideal psychodynamic and cognitive-behavioural therapy process were created using the PQS by panels of expert clinicians representing the two orientations

    • The degree to which a therapist adheres to the prototype in a given hour can be measured quantitatively and correlated with outcome in order to identify the active ingredients in the therapy process


DEVELOPMENT OF PROTOTYPES 

  1. Method

  • Expert panels of psychodynamic (N=11) and CB therapists (N=10) were comprised of leading theoreticians 

  • Each member → responsible for training therapists in their orientation and most had published work concerning their approach to psychotherapy

  • PQS

    • 100 items that are tied to specific actions, behaviours and statements 

    • Good reliability and validity 

    • Pantheoretical → create prototypes of different types of therapy using the same instrument 

→ prototypes of different therapeutic approaches can be directly compares 

  • Each member → rate each of the 100 items of the Q-set questionnaire on a scale from 1 to 9, according to how characteristic each item was of their understanding of an ideally conducted course of therapy that adheres to the principles of their theoretical perspective


  1. Results

  • Coefficient alpha reliabilities → high for both psychodynamic (.94) 

  1. Q- prototype of ideal psychodynamic psychodynamic psychotherapy 

  2. Q - prototype of ideal CBT *** notes on your own, later 


APPLICATION OF PROTOTYPES 

  1. Method

  • Verbatim transcripts of' selected therapy sessions for each patient in the samples described above were rated using the PQS

  • obtain one score per Q-item for each patient

  • When reliability was below .50 (Pearson product-moment correlation coefficient), a third rater was added. Interrater reliability (Pearson product-moment correlation coefficient) ranged from .68 to .90, with a mean reliability of .86

  1. Results

  • Negative correlation indicates that, on average, the treatment sessions in the cognitive-behavioural sample did not conform to the psychodynamic prototype

  • Some elements of a psychodynamic process still may have been present in these sessions

  • The psychodynamic prototype was significantly associated with positive outcome on three of the six outcome measures with a trend in the positive direction on an additional measure. 

  • The cognitive-behavioural prototype was significantly associated with positive outcome on only one outcome measure and showed little or no association with the other five measures


DISCUSSION 

  • Observer Q-sorts were positively correlated with the cognitive-behavioural prototype in both psychodynamic treatments samples

  • A question arose as to what, clinically speaking, might constitute a cognitive behavioural intervention in a psychodynamic treatment and vice versa

  • The therapist was interpreting warded-off wishes, but the discussion also clearly centred on cognitive themes

    • For example, the patient’s belief that she is omnipotently responsible for her mother

  • Descriptive analyses indicated that the therapists tried to correct problems in the therapeutic alliance by increasing their adherence to the cognitive-behavioral techniques prescribed by the manual. This increased adherence, however, further strained the alliance