REBT with Members of the Church of Jesus Christ of Latter-day Saints.

Rational Emotive Behavior Therapy's (REBT's) ABC model proposes that it is B, Beliefs about A, Activating events, not A, Activating events themselves, that create and control C, emotional Consequences. Codified beliefs such as scriptures and creeds are prominent in most religions. Integrating codified religious beliefs with REBT to help D, Dispute irrational beliefs has been studied in REBT for more than 50 years. Broad knowledge of religious cultures, scriptures, creeds, and wisdom literature is likely to help REBTers and other cognitive behavior therapists (CBTers) more effectively treat religious clients. We give a brief overview of the history, culture, doctrine, and scriptures of the Church of Jesus Christ of Latter-day Saints, then give examples of REBT Disputations excerpted from religion integrative sessions with practicing Latter-day Saint clients. We present practice-based evidence for the effectiveness of this approach and offer suggestions for future study and research in integrating religion with REBT and CBT.

Patient financial distress and treatment outcomes in naturalistic psychotherapy.

Although psychotherapy is on the whole an effective health care practice, treatment efficacy for patients with varying levels of reported financial distress is less clear. The purpose of this study was to examine the impact of patient self-reported financial distress on psychotherapy outcomes using a large, naturalistic psychotherapy dataset of college students who sought psychotherapy services (n = 5,078 patients, n = 238 therapists). Multilevel models accounted for the nesting of patients within therapists and treatment outcome was assessed using the Outcome Questionnaire-45. Patients on the whole showed treatment effects in the moderate to large range (d = 0.73). However, patients with higher financial distress at baseline were more likely to drop out of treatment after 1 session and, when controlling for baseline severity, had worse outcomes at the end of treatment. Though the effects were small, these findings held when controlling for age, gender, and treatment length. Further, the relationship between baseline financial distress and treatment retention (but not treatment outcome) varied between therapists, though the effects were also small. Patients' financial distress specifically and social class more generally may be patient contributors to psychotherapy outcome (and therapist effects) that warrant further attention. (PsycINFO Database Record

Unpacking the therapist effect: Impact of treatment length differs for high- and low-performing therapists.

OBJECTIVE: Differences between therapists in their average outcomes (i.e., therapist effects) have become a topic of increasing interest in psychotherapy research in the past decade. Relatively little work, however, has moved beyond identifying the presence of significant between-therapist variability in patient outcomes. The current study sought to examine the ways in which therapist effects emerge over the course of time in psychotherapy. METHOD: We used a large psychotherapy data set (n = 5828 patients seen by n = 158 therapists for 50,048 sessions of psychotherapy) and examined whether outcomes diverge for high-performing (HP) and low-performing (LP) therapists as treatment duration increases. RESULTS: Therapists accounted for a small but significant proportion of variance in patient outcomes that was not explained by differences between therapists' caseload characteristics. The discrepancy in outcomes between HP and LP therapists increased as treatment duration increased (interaction coefficient = 0.071, p < .001). In addition, patients' trajectories of change were a function of their therapist's average outcome as well as the patient's duration of treatment (interaction coefficient = 0.060, p = .040). CONCLUSIONS: Indeed, patterns of change previously described ignoring between-therapist differences (e.g., dose-effect, good-enough level model) may vary systematically when disaggregated by therapist effect.

Are therapists uniformly effective across patient outcome domains? A study on therapist effectiveness in two different treatment contexts.

As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient's change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record

Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting.

OBJECTIVE: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. METHOD: The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen. RESULTS: Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased. CONCLUSIONS: Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record

A lab test and algorithms for identifying clients at risk for treatment failure.

Many branches of medicine rely heavily on lab tests to monitor client treatment response and use this information to modify their treatment. By contrast, those who offer psychological interventions seldom rely on formal assessments (lab tests) to monitor their clients' response to treatment. Data are presented that demonstrate that clinicians rarely accurately predict who will not benefit from psychotherapy. This finding is contrasted with the use of a questionnaire (lab test data) and decision rules on the basis of a client's expected progress. Results have indicated that formal methods of monitoring were able to identify 100% of the patients whose condition had deteriorated at termination, and 85% by the time they had attended three treatment sessions. Practitioners are encouraged to consider formal methods of identifying the deteriorating client.