Predicting Patient Outcomes in Psychotherapy
Prediction of patient outcomes in psychotherapy has been a focus of considerable interests, particularly for the mental disorders. Some concerns have been raised under the banner of therapists’ factors or variables that affect the outcomes of psychotherapy. Alternatively, answers may be sought on individual therapists having better results with a known demographic outlay of patient or with certain common disorders. Furthermore, researches have been conducted and analyzed done on the particular variable and factors that contribute to fit any of the three specifics alternatives mentioned herein (Horvath et at., 2011).
However, it is important that these characteristics contribute to any of the fit, and they include demographic characteristics, training characteristics, belief systems and finally, personality characteristics. Examples of demographic characteristics that come into play include gender, age, religion, race and amongst others while training features that come into play include degree, the number of years of experience, training and among others while belief is majorly centered on orientation.
Most of the literature that examine the relationship between patient’s age and treatment outcome have been founded on naturalistic and uncontrolled studies, and these tend to report that the age of the patient with respect to the treatment outcome and mode is not significantly related to the outcome of therapy (Falkenström et al., 2014). On the other hand, other researchers that have focused on the manner in which the therapists and patients ages come to intersect affect the treatment mode. Even though there is another research that have reported the close correlation between fitting therapist to treatment mode, an overall conclusion has been consistently focused on the difference that comes into play between the treatment outcomes and the therapist, which is a weak predictor of psychotherapy outcomes.
Clinical studies have purported to affirm the conclusion using a sample of adults, children, and adolescents, and in those studies, the therapists and treatment outcomes vary significantly. Researchers that have examined the impacts of the therapist gender on treatment mode, patient outcomes and have produced conflicting results. A comparative literature review confirmed that the data that presently exist support the hypotheses that contradict the many fits, on matching patient to treatment mode, matching patient to therapists and matching therapist to treatment mode.
Arnow et al. (2013) determined the factors that contribute to successes of fit of a patient to treatment mode have always been based on empirical process research. The chances of achieving good hit always seem high when certain factors are coordinated, and which include disorder to the treatment mode, treatment model to the patient, patient, and the therapist, and finally, the disorder and the therapist. Whenever model displays the legitimate basis, then it has to be stretched by some other crucial variables, such as providing a match between education attainment or even gender. Consequently, these will depend on the therapist belief system on a human being; the sex and level of education are prone to common lines of thinking.
Often, women are perceived as emotional, irritable and displaying needs that are more social. On the contrary, a patient might have a particular goal in treatment, and hence, preference directed toward the therapist. Often, such an idea may be correlated with a given though of an impending therapy, and which is I in accordance with nosological theory, which is related to behavioral, phenomenology and system theory (Horvath, et al., 2011). Matching in the therapeutic process has long been associated with psychoanalysis, a long-standing tradition compared to the others. Psychoanalytic system attains a permanent transformation in patient symptoms, and the positive outcomes need the use of interventions that are therapeutic that have sufficient time to be spent in active and caring therapeutic relationship.
Information on the progress of systems alone cannot lead to positive transformations; it all depends on the technical knowledge and experience of the analysts. The experience defined herein refers to the connection that might exist between a therapist and the patient, and the treatment (Horvath, et al., 2011). . The counter-transference in the present therapeutic processes involves a focus on early translations of the dominant in the activated transference connection that exists and the manner in which they remain important points of discussion. Moreover, the patient’s experiences with a psychoanalyst encompass affect regulation and affect perception by a psychoanalyst. In particular, the control of positive against the negatives effects leads to a hit in treatment. Importantly, the control of a child’s emotion normally reveals certain parallels to a psychoanalytic connection.
The mother provides a room for monitoring of not only the positive energy but also the negative feelings as well, through an unwavering interest in her child (Arnow et al., 2013). Therefore, the child comes to recognize own personal emotion from the connection of the mothers facial dispositions. Similarly, a patient can experience parallel emotions, and a therapist needs to have a clue on the externalized yet internal conflicts, and then work his or her way up in containing with the help of the patient, an effort that is needed, and attitude facilitated by the basic instinct of the patient.
The positive effect on the patient-therapist matching seems to be the fundamental ingredient for every other treatment plan (Falkenström et al., 2014). The treatment methods that deal with externalization processes are often visualized on a case-by-case study and then based on complete therapy on a client that has a diagnosed summarization disorder. For instance, Mrs. A is thought to have completely felt out of her depth, and then got disappointed by her family and physicians. Then, the woman did not perceive of herself as a contributor to the solution. In the case, a complete therapy works through motivation of the patient. Three motivation states can be stated and differentiated into customer, complainant and visitor (Horvath, et al., 2011).
As a visitor that is clearly involved, the client perceives her role without any conflicts, and he is not motivated to transform his behavior. Second, as a complainant, she acknowledges her problems, and then she cannot perceive of herself as a contributor to the solution. Finally, as a customer, she is motivated to transform her behavior, and this is because she perceives of herself as both a contributor to the problem and solution. Complete or systemic therapist’s goal is to apply interventions that invite visitor and the complainant to transform into the customer. Hence, the patient-therapist connection is not directed in the way of a deficit-orient patient mode, where the patient is out rightly depending on the therapist (Falkenström et al., 2014).
Therefore, the customer interacts with the therapist in a similar way as a customer interacts with a contractor, which in short implies, the therapist becomes a contractor. The formation of a good solid connection is the foundation on which a firm space is created by the availability of the therapist and the interest and motivation of the patient towards self-efficacy (Falkenström et al., 2014). Consequently, the self-efficacy systems relate to the complete therapy resource development. The result becomes a positive change in personal outlook and a transformation of the patient’s ‘I am helpless’ being replaced by ‘I can achieve my set goals and targets.’ Furthermore, the transformation can have a positive impact on physical afflictions.
In Miss K, the focus could be on increasingly placing psychotherapy as the above-stated safe and trusting location. The lady seems to suffer from acute stress, which is the result of certain physical symptoms, and her stress tolerance and self-efficacy, plus the lady’s resource activation has multiplied considerably through mindful physical activities, skills training and comprehension of own externalization mechanisms. An inner safe place can develop, and amongst other things, through imagination. It should be in a location where the client has full confidence and secure. Also, the place must ensure a sought of safety externally against the therapy (Gibbons et al., 2009). The connection to the therapist must be constant safe control in which the patients’ progresses personal experience and undergoes positive transformations, and these can internalize for the long term, which is fundamental as an interested object (Beutler et al., 2012).
Another case study, assuming it is Miss U, who was treated in personal psychology infant and teenage analysis. The fit on the relationship is very fundamental to the rigorous course of the disease and the many traumatic troughs (Gibbons et al., 2009). Hence, a variance connection can be complicated by the variation of the symptoms of Miss U desperate show the reduction of the intolerable inside tensions the results of aggressive fantasies and own developed destructive behavior that blocked a transference relationship for a while. Consequently, a therapist was then prevented from acting and then felt unable to offer treatment. In the therapeutic relationship, it is particularly crucial to deduce such dynamics at the earliest time possible, Further; an early processing of negative energy shall be made possible for containing and holding externalizing and projective processes. Psychoanalytic systems can only expand when the therapist approaches are in tandem with positive effect, openness, and interest.
In general, and in accordance with the several theories that have been set forth, patients’ variables have been known to produce large size effect on the huge number of patient treatment as well as relationship, and other matching variables that have been subjected to psychotherapy studies. Patient elements, in particular, distress, coping style, impairment, have a moderate to significant influence on outcomes, and these independent from the therapeutic alliance and other independent fitting treatment variables. Equally, the impacts on the therapeutic alliance have always been comparatively minimal, when analyzed from the moderate effect size (Falkenström et al., 2014).
The preceding notion is not to dismiss the strength of treatment plans. For instance, an increase in the intensity of sessions could prove to be a significant player to the outcome when an alliance has been thought of as being present. Nonetheless, devoid of the influence of the interaction of the therapeutic alliance, the outcomes can be mismatched. The value of a therapeutic connection can have minimal influence on the strength of medical intervention, but from Beutler et al. (2012), it can be apparent that activation variable can play a role in the enhancement of the impacts of session intensity. Removal of the variance linked with the value, according to Beutler et al. (2012), can reveal a very complex influence of session strength on the outcome of treatment.
The relationship between the session intensity and outcome can be reversed and intensified multiple times contingent on the role of the therapeutic alliance that is removed. The influence and mutual reaction of the therapeutic alliance and patient resistance and session intensity can be appealing; however, sufficient data have failed to validate any link. Inter-professional education is an evidence-based vehicle for preparing multidisciplinary care teams for the implementation of collaborative care management and shared decision-making. However, the literature on collaborative care and interdisciplinary education within correctional facilities is silent. Therefore, this study seeks to assess the effectiveness of interdisciplinary education for the implementation of collaborative decision making among correctional staff, medical and mental health staff in the delivery of care to mentally ill people with co-morbid medical problems (Arnow et al., 2013).
Patients and clinicians consider continuity of care as an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept and the lack of clarity in its conceptualization and operationalization has been linked to a deficit of user involvement.
Collaborative health care of persons with co-morbid medical and mental illness has shown to be an efficacious method for improving disease control and patient clinical outcomes. Inherent to effective collaborative care management is a shared decision-making process among primary and support care providers and patients. Shared decision-making has been shown to be effective in improving clinical outcomes for disorders as well as patient satisfaction. The literature on the fit in psychotherapy is limited in four critical aspects. On the one hand, there is the Howard and Orlinsky model that is frequently the only model of fit that exists.
Hence, the implication is then that the better relationships feelings and the handling focus match one another, the more positive the outcome of the treatment becomes. What the therapeutic emphasis is seriously engaged on has not been a subject of great depth in literature. They are the particularly the resolute interest in the patient, plus a focus on the effect that leads to successful therapy. The factors are present in the three treatment methods that have been mentioned hereinbefore, and each must contribute to positive results.
Previously, maintenance and show of the positive effects to seemed a hard work towards a patient for a therapist, particularly when considering the last case on this paper. Hence, it is vital that a patient to therapist fit becomes of great importance to training in therapeutic. At such a point, there shall not be any difference in the methods applied, and this is because it is the duty of the therapist as well as that of the clinician to provide a successful treatment to the patient. Then, they have to provide particular interests in the patient all through when the patient acquires relevant skills.
Arnow, B. A., Steidtmann, D., Blasey, C., Manber, R., Constantino, M. J., Klein, D. N., … & Kocsis, J. H. (2013). The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. Journal of consulting and clinical psychology, 81(4), 627.
Beutler, L. E., Forrester, B., Gallagher-Thompson, D., Thompson, L., & Tomlins, J. B. (2012). Common, specific, and treatment fit variables in psychotherapy outcome. Journal of Psychotherapy Integration, 22 (3), 255.
Falkenström, F., Granström, F., & Holmqvist, R. (2014). Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement. Psychotherapy Research, 24(2), 146-159.
Gibbons, M. B. C., Crits-Christoph, P., Barber, J. P., Wiltsey, S., Gallop, R., Goldstein, L. A., … & Ring-Kurtz, S. (2009). Unique and common mechanisms of change across cognitive and dynamic psychotherapies.Journal of consulting and clinical psychology, 77(5), 801.
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9.