A pan-theoretical conceptualization of client involvement in psychotherapy.

OBJECTIVE: The present paper attempts to differentiate client involvement from other, similar process variables and presents a pan-theoretical conceptualization of client involvement. METHOD: A modified Delphi poll was conducted with 20 experienced clinicians and researchers. In two rounds of data collection, the experts completed a questionnaire designed to elicit their feedback on whether a variety of involvement items were representative of our pan-theoretical definition of client involvement. RESULTS: The results of the survey provide insight into which types of client activities are good representations of client involvement. CONCLUSION: We propose that client involvement can be understood as being comprised of behavioral, cognitive, and emotional elements, and we provide concrete examples of these activities.

Predicting who benefits most from cognitive-behavioral therapy for anxiety and depression.

OBJECTIVES: We examined core features of patient suitability for cognitive-behavioral therapy (CBT) and their ability to predict CBT outcomes. METHOD: A sample of 256 outpatients diagnosed with depression and anxiety disorders were assessed using the Suitability for Short-Term Cognitive Therapy (SSCT) scale. Therapists rated patients' symptom severity using the Clinical Global Impression scale before and after therapy. RESULTS: A factor analysis of the SSCT scale yielded 2 factors: (a) Capacity for Participation in CBT Process and (b) Attitudes Relevant to the CBT Process. A multiple regression analysis revealed that only Capacity for Participation in CBT Process uniquely predicted improvement at termination. CONCLUSIONS: These findings highlight the importance of assessing the suitability of CBT for individual patients. Specifically, patients with greater capacity to identify and articulate thoughts and feelings and to share them in a nondefensive, focused way benefit most from CBT.

The association between positive outcome expectancies and avoidance in predicting the outcome of cognitive behavioural therapy for major depressive disorder.

OBJECTIVES: Although cognitive behavioural therapy (CBT) is an empirically supported treatment for major depressive disorder (MDD), individual differences in the effectiveness of CBT have been observed. Preliminary evidence suggests that positive outcome expectancies for treatment predict better therapy outcomes (Constantino, Arnkoff, Glass, & Smith, 2011); however, researchers have not examined whether avoidance, an important predictor of depressive symptoms (Ottenbreit & Dobson, 2004), may play an important role in this association. In the present study, we examined whether the association between positive outcome expectancies and therapy outcome is associated with patients' levels of avoidance. DESIGN: Data were collected as part of a prospective, longitudinal study. METHODS: The sample consisted of 51 patients diagnosed with MDD who underwent CBT. Prior to treatment, clinicians rated patients on their levels of avoidance and positive outcome expectancies. A self-report rating of positive outcome expectancies was also obtained, and the Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996) was completed pre- and post-treatment. A hierarchical regression analysis was conducted to examine the association between positive outcome expectancies and avoidance for predicting changes in depressive symptoms after CBT. RESULTS: For patients with lower levels of positive outcome expectancies, lower levels of avoidance predicted greater improvement after CBT and higher levels of avoidance predicted poorer treatment outcomes. CONCLUSIONS: These findings suggest that the impact that lower positive outcome expectancies have on therapy outcome can be attenuated if patients do not avoid dealing with emotionally difficult material in session.