Some comments on empirically supported treatments.

A number of developments have occurred in the field of psychotherapy in recent years. One pertains to the emphasis on empirically supported or validated therapies for specific psychiatric disorders. Although this emphasis on empirical support is a positive one, the creation of numerous forms of therapy for specific psychiatric categories, and the possible implication that training in such therapies becomes the basis for accreditation of university programs, is viewed critically. A focus on forms of psychotherapy also tends to diminish the importance of patient and therapist characteristics in producing positive outcomes. Future research needs to ascertain the variables that actually produce positive patient change.

Issues and methods in psychotherapy process research.

Some of the problems and issues that have characterized process research in psychotherapy are discussed, as is the complexity of research that attempts to combine process and outcome adequately. The diversity of topics studied, the variety of scales used, the individual theoretical constructs investigated, the investigation of single process variables, and the relative lack of replication have made integration of findings difficult. It is suggested that more than one therapeutic orientation be studied in a specific project in order that some type of control be included. Although statistically significant correlations between selected process variables and measures of outcome have been secured, proof of causality remains to be demonstrated.

Giving up on child psychotherapy: who drops out? Comment on Weisz, Weiss, and Langmeyer.

Some critical comments are offered with regard to the use of the designation psychotherapy dropout in the article by Weisz, Weiss, and Langmeyer (1987). It is proposed that individuals who do not begin a course of psychotherapy should not be viewed as dropouts. Reference is also made to problems of generalization.

The process of change in cognitive therapy and pharmacotherapy for depression. Changes in mood and cognition.

Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N = 14) or pharmacotherapy (N = 14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy.

Relationship of missed psychotherapy appointments to premature termination and social class.

The problem of missed appointments in psychotherapy has received little empirical study. Consequently, this problem was studied in relation to several demographic and actuarial variables. Lower socio-economic status was found to be related to missed appointments and to premature termination. Missing appointments was also found to be related to dropping out of treatment. Possible reasons for these findings are discussed and suggestions offered for reducing premature termination.