Publications: 1994
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Agnew, R.M., Harper, H., Shapiro, D.A., & Barkham, M. (1994). Resolving a challenge to the therapeutic relationship: A single-case study. British Journal of Medical Psychology, 67, 155-170. The selection of a case of demonstrated change using a quantitative criterion preceded an exploration of possible change mechanisms in therapy. Between-session variations in the therapeutic relationship revealed by a quantitative measure prompted an intensive qualitative investigation of in-session events. Within these events, the study focused on challenges to the therapeutic relationship and their subsequent resolution. Understanding the resolution of such challenges to the relationship was guided by a rational model derived from the treatment rationale. A tentative account of the process of change is offered, and case replications are required to confirm and extend the findings.
Elliott, R., Shapiro, D.A., Firth-Cozens, J., Stiles, W.B., Hardy, G.E., Llewelyn, S.P., & Margison, F.R. (1994). Comprehensive Process Analysis of insight events in cognitive-behavioral and psychodynamic-interpersonal psychotherapies. Journal of Counseling Psychology, 41, 449-463. Comprehensive Process Analysis (CPA) is an interpretive, qualitative research method for analyzing significant therapy events. CPA was used to analyze 6 client-identified significant insight events in 2 treatments. Two events are presented in depth. The psychodynamic-interpersonal therapy event documented the existence of 2-part significant events and the value of key words. The cognitive-behavioral therapy event illustrated the role of context in transforming small therapy events into significant events. Events in both therapies involved therapist interpretations of recent difficult life events that were delivered in a firm but interactive style. Interpersonal therapy events were distinguished by links to themes from previous sessions and led to awareness of painful emotions. Cognitive therapy events were externalizing reattributions given to more clinically distressed clients. A revised 5-stage microprocess model of the insight is presented.
Field, S.D., Barkham, M., Shapiro, D.A., & Stiles, W.B. (1994). Assessment of assimilation in psychotherapy: A quantitative case study of problematic experiences with a significant other. Journal of Counseling Psychology, 41, 397-406. The development of a methodology for the evaluation of the assimilation model in which both experimental rigor and clinical sensitivity are priorities is described. The methodology was applied to a good-outcome case. The 3-phase methodology comprised (a) the identification of a problematic content domain, (b) the definition of a problematic experience within that domain, and (c) the rating of the experience's changing level of assimilation across randomly ordered passages from selected sessions. Independent sets of raters carried out the tasks of each phase. Results supported the assimilation model's hypothesized progression by which a problematic experience is successfully incorporated into a schema, and the ratings highlighted 1 session in which much of the clinical progress on 1 problem was achieved.
Shapiro, D.A., Barkham, M., Rees, A., Hardy, G.E., Reynolds, S., & Startup, M. (1994). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 62, 522-534. A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions. Published as a Special Feature with commentary.
Shapiro, D.A., Barkham, M., Rees, A., Hardy, G.E., Reynolds, S., & Startup, M. (1994). Looking as strongly as we should in the right places: Reply to Norcross and Rossi (1994). Journal of Consulting and Clinical Psychology, 62, 539-542. In response to Norcross and Rossi's (1994) comment on our article (Shapiro, Barkham, Rees, Hardy, Reynolds, & Startup, 1994), we note that research as reported does not fully represent the processes whereby it was designed and completed. The true statistical power of an investigation reflects all the analyses carried out, not just those that get reported. The power of our analysis was sufficient to address the substantive questions at issue. The importance of these questions does not depend on allegiance to equivalent outcomes of diverse therapies. The outcome phase of the Second Sheffield Psychotherapy Project is but part of its broad strategic approach to advancing our understanding of the mechanisms of change in the psychotherapies.
Stiles, W.B., & Shapiro, D.A. (1994). Disabuse of the drug metaphor: Process-outcome correlations. Journal of Consulting and Clinical Psychology, 62, 942-945. The drug metaphor suggests that if a process component (e.g., interpretation) is an active ingredient of a successful psychotherapy, then administering a relatively high level of it should yield a relatively positive outcome, and levels of the process component and the outcome should be correlated across clients. Measures of 5 theoretically relevant, reliably measured verbal process components were compared with the rate of change in 3 standard symptom intensity measures across the brief treatments of 39 (mainly depressed) psychotherapy clients. The expected significant process-outcome correlations were not found. These results are discussed as they illuminate some misleading assumptions that underlie many conventional studies of psychotherapy process and outcome.
Stiles, W.B., Reynolds, S., Hardy, G.E., Rees, A., Barkham, M., & Shapiro, D.A.(1994). Evaluation and description of psychotherapy sessions by clients using the Session Evaluation Questionnaire and the Session Impacts Scale. Journal of Counseling Psychology, 41, 175-185. Clients' evaluations of their sessions were prominent in factor-based indexes of session impact derived from the Session Evaluation Questionnaire (SEQ) and the Session Impacts Scale (SIS) in a large sample ( N = 2,414 sessions with 218 clients). One or both of the SEQ's independent session evaluation indexes, Depth and Smoothness, were highly correlated with SEQ's postsession Positivity and Good Therapist indexes and with the SIS's Understanding, Problem Solving, and Relationship indexes, as well as with single-item global evaluation scales, Good-Bad and Helpful-Hindering. Only the SEQ's postsession Arousal index and the SIS's single-item Unwanted Thoughts index appeared to be primarily descriptive rather than evaluative. The SIS's Hindering Impacts index's items were endorsed infrequently but might usefully flag problematic sessions.
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