Publications: 1995
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Hardy, G.E., Barkham, M., Shapiro, D.A., Reynolds, S., Rees, A., & Stiles, W.B. (1995). Credibility and outcome of cognitive-behavioural and psychodynamic-interpersonal psychotherapy. British Journal of Clinical Psychology, 34, 555-569. Depressed psychotherapy clients ( N = 117) rated the treatment principle credibility of cognitive-behavioural (CB) and psychodynamic-interpersonal (PI) before they were randomly assigned to receive either eight or 16 sessions of one of these treatments, and they rated their expectations of the treatment to which they were assigned immediately before (initial credibility) and immediately after their first session (emergent credibility). Results indicated that before they were assigned to a treatment, clients rated CB treatment principle credibility higher than PI treatment principle credibility. After assignment, however, clients rated initial credibility similar regardless of whether they were assigned to CB or PI therapy, and their ratings of emergent credibility increased to a similar degree from immediately before to immediately after the first session in both treatments. Clients' endorsement of CB and PI treatment principle credibility predicted improvement in PI therapy but not improvement in CB therapy. Initial and emergent credibility of clients' assigned treatment predicted improvement for clients who received eight sessions of therapy, but not for clients who received 16 sessions of therapy. The implications of these findings are discussed.
Hardy, G.E., Barkham, M., Shapiro, D.A., Stiles, W.B., Rees, A., & Reynolds, S. (1995). Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression. Journal of Consulting and Clinical Psychology, 63, 997-1004. Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd e.; DSM-III ; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder -- that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients) -- whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference post treatment and at 1-year follow-up. Among those who received CB therapy, post treatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients.
Shapiro, D.A. (1995). Finding out how psychotherapies help people change. Psychotherapy Research, 5, 1-21. The central goal of psychotherapy research is to achieve an understanding of the change mechanisms giving rise to clients' clinical improvement. Efforts towards this goal have been thwarted by the paradox of demonstrably different methods yielding broadly similar outcomes. Four approaches to the resolution of this paradox are described, and illustrated with reference to the work of the Sheffield group. A multi-method approach to comparative process-outcome research is advocated, which is best implemented by collaboration amongst investigators. Based on the Presidential Address to the annual meeting of the Society for Psychotherapy Research, York, UK, June 1994.
Shapiro, D.A., Rees, A., Barkham, M., Hardy, G., Reynolds, S., & Startup, M. (1995). Effects of treatment duration and severity of depression on the maintenance of gains following cognitive-behavioural and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 63, 378-387. One hundred four clients completed a mailed follow-up 1 year after completing 8 or 16 sessions of treatment, either cognitive-behavioral (C) or psychodynamic-interpersonal (PI) psychotherapy. Although mean scores on outcome measures at 1 year suggested that gains were, in general, well maintained, only 29% of clients were asymptomatic on all 3 occasions of testing (end of treatment, 3 months and 1 year later) without recourse to further treatment. However, only 11% of those asymptomatic at end of treatment experienced relapse or recurrence of depression, albeit on the limited evidence of just two follow-up assessments. The results of comparisons among treatment conditions at 1 year differed substantially from those obtained earlier: Eight-session PI treatment now appeared less efficacious than the other 3 treatment conditions, and there was now no measurable benefit of16-session over 8-session CB, irrespective of initial severity of depression. These findings confirm the importance of follow-up in evaluation of psychotherapies for depression.
Stiles, W.B., & Shapiro, D.A. (1995). Verbal exchange structure of brief psychodynamic-interpersonal and cognitive-behavioral psychotherapy. Journal of Consulting and Clinical Psychology, 63, 15-27. A verbal exchange is a set of 2 people's co-occurring speech-act categories that accomplish some subtask within an interpersonal encounter. Factor analysis of verbal response mode (speech act) frequencies in 1,630 segments (each approximately 10 to 12 min) drawn from the brief psychodynamic-interpersonal or cognitive-behavioral treatment of 39 mainly depressed clients identified 6 exchanges in each treatment -- 4 that were the same in both treatments (Revealing, Storytelling, Explaining, and Enquiring) and 2 that distinguished each treatment (Exploring and Interpreting in psychodynamic-interpersonal treatment; Prescribing and Reframing in cognitive-behavioral treatment). The exchanges showed distinctive temporal patterns across segments of sessions and across sessions of each time-limited treatment. The verbal exchange is a midsize concept that links atomistic verbal codes with clinical or theoretical concepts.
Stiles, W.B., Shapiro, D.A., Harper, H., & Morrison, L. (1995). Therapist contributions to psychotherapeutic assimilation: An alternative to the drug metaphor. British Journal of Medical Psychology, 68, 1-13. A psychotherapist's verbal interventions may be understood as promoting a client's eventual improvement by facilitating developmental change processes within the client. This approach is an alternative to the traditional search for statistical links between aggregates of therapist interventions and global outcome measures. Our approach employs models of clients' assimilation of problematic experiences within problem domains and therapists' implementation of theoretically specified aims. In an empirical illustration, one client's change within a particular problem domain and its links with therapist interventions were assessed qualitatively across the course of brief psychodynamic-interpersonal treatment.
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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