Construing Psychotherapy Outcomes

Tue, 02 Apr 1996 04:07:23 -0600 (CST)

This is a request for advice, suggestions, and idea-sharing.
I'm currently writing about some of the common difficulties in
assessing outcomes in psychotherapy. Outcomes are often not
clear-cut and can vary depending on whether measures are symptom-
based, patient global assessments, therapist global assessments,
or (less frequently) assessments made family and friends. I have
a number of questions that I'm hoping will be of special interest
from a constructivist perspective:
1) Personal and social constructivism might take very
different positions about which outcome measures to select.
From a personal construct perspective, it is important to
account for discrepancies (e.g., when a patient feels
satisfied but the clinician sees little "structural"
change). How might a PCT therapist resolve these
2) The existence of differing perspectives for outcome
assessment is reflective of the fact that the very notion of
"outcome" is value-laden. How would a PCT therapist or
researcher make these difficult value choices in a society
of scarce resources in need of "objective" demonstrations of
effectiveness? Which values?
** 3) Would a PCT therapist necessarily be tied to patient
measures (whatever they are)? My guess is that the
patient's perception of the treatment might be more heavily
weighted from a PCT perspective (compared to other
theoretical orientations). Would anyone disagree?
** 4) If so, then how does the PCT researcher deal with the
issue of patient "biases" in outcome ratings? For example,
reactivity to measures or inflated self-reports due to
expectancy biases might be explained differently from a PCT
perspective than from the traditional psychometric approach.
From a PCT approach, expectancies for "cure" might not be
seen as a bias at all. But what is it? Should factors such
as expectancy be separated from "treatment interventions"
that are administered by the PCT therapist?
5) Can specific treatment strategies be identified for a
personal construct therapy? References for previous
attempts to do this? Would it be theoretically consistent
to consider a personal construct therapy treatment manual?
Anyone willing to share ideas, opinions, expertise?

Tim Anderson
Department of Psychology
Vanderbilt University
Nashville, TN 37240