Publications: 1996
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Barkham, M., Rees, A., Shapiro, D.A., Stiles, W.B., Agnew, R.M., Halstead, J., Culverwell, A., & Harrington, V.M.G. (1996). Outcomes of time-limited psychotherapy in applied settings: Replicating the Second Sheffield Psychotherapy Project. Journal of Consulting and Clinical Psychology, 64, 1079-1085. In a replication and extension of the Second Sheffield Psychotherapy Project (SPP2), a collaborative psychotherapy project (CPP) was carried out at 3 sites within the National Health Service of the United Kingdom. Clients ( N = 36) stratified at 3 levels of severity of depression were randomly assigned to one of 2 treatment approaches ( psychodynamic-interpersonal or cognitive-behavioral) of 2 time limited durations (8 or 16 sessions). Gains in both treatment approaches were approximately equivalent and were similar for CPP and SPP2 clients when measured at the end of treatment. However, CPP clients did not maintain their gains to the extent that the SPP2 clients did at 3-month and 1-year follow-up assessments. In the CPP, clients given 16 sessions showed a statistically significant advantage over clients given 8 sessions on some measures at some assessments; in the SPP2, similar effects were noted only among some subgroups of clients.
Barkham, M., Rees, A., Stiles, W.B., Shapiro, D.A., Hardy, G.E., & Reynolds, S. (1996). Dose-effect relations in time-limited psychotherapy for depression. Journal of Consulting and Clinical Psychology, 64, 927-935. Criteria for reliable and clinically significant improvement were applied to standard and individually tailored outcome measures data from 212 depressed clients who had been randomly assigned to receive either 8 or 16 sessions of time-limited psychotherapy. The data were used to address 2 questions: (a) Is the dose-effect curve for psychological symptoms negatively accelerated? and (b) is there a differential rate of response for acute, chronic, and characterological/interpersonal components of depression? The results supported the differential rate of response of different components of depression and suggested qualifications to the acute, chronic, and characterological/interpersonal components and evidence that both supported and qualified previous suggestions that the dose-effect curve is negatively accelerated.
Reynolds, S., Stiles, W.B., Barkham, M., Shapiro, D.A., Hardy, G.E., & Rees, A. (1996). Acceleration of changes in session impact during contrasting time-limited psychotherapies. Journal of Consulting and Clinical Psychology, 64, 577-586. Following the suggestion that therapeutic change is accelerated in time-limited psychotherapy, this study investigated the across-session patterns of session impact in the treatments of 117 depressed clients who were randomly allocated to 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy. After each session, all clients completed the Session Evaluation Questionnaire and 75 of the clients completed the Session Impacts Scale. Session ratings indicated that sessions were perceived increasingly positively on most impact dimensions (e.g., session depth and smoothness, relationship with the therapist, feelings of understanding and problem solving, postsession positive mood) as treatment progressed. Early in treatment, PI therapy sessions were less smooth (i.e., more tense and uncomfortable) and less focused on problem solving, but PI sessions changed more rapidly than CB sessions on these dimensions, so that later in treatment, sessions of both treatments were equivalently positive. In both treatments, the trend toward more positive sessions was more rapid (i.e., the across-session slope was steeper) in 8-session treatments than in 16-session treatments. Such accelerated changes in session impact may reflect the suggested acceleration of therapeutic change associated with shorter time limits.
Shapiro, D.A. (1996). "Validated" treatments and evidence-based psychological services. Clinical Psychology: Science and Practice, 3, 256-259. In commenting on Garfield's critique of the report of the Task Force on Promotion and Dissemination of Psychological Procedures, some of his observations are amplified, before discussing three strategic questions: (a) Why do we focus on treatment methods? (b) What is to be done about "unvalidated" methods? (c) How can evidence-based psychological treatment services be developed? It is concluded that a listing of "validated" treatments cannot serve as a rational and dependable basis for evidence-based psychological treatment services.
Stiles, W.B., Startup, M., Hardy, G.E., Barkham, M., Rees, A., Shapiro, D.A., & Reynolds, S. (1996). Therapist session intentions in cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Counseling Psychology, 43, 402-414. Theories of psychotherapy are implemented by therapists' intentional actions within sessions. This study examined the structure and construct validity of the Therapist Session Intentions (TSI) form. Ten therapists rated their therapeutic intentions following each of 2,305 therapy sessions of cognitive-behavioral or psychodynamic-interpersonal therapy in the Second Sheffield Psychotherapy Project. Seven conceptually coherent clusters of intentions, or therapeutic foci, were identified: treatment context, session structure, affect, obstacles, encouraging change, behavior, and cognition-insight. Contrasting patterns of therapeutic focus across treatments and changes in focus across sessions within treatments appeared conceptually coherent. Correlations across a subsample of sessions confirmed correspondences of the TSI foci with dimensions found previously in observers' ratings.
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