The phase model of psychotherapy outcome: Domain-specific trajectories of change in outpatient treatment.

OBJECTIVE: The Phase model of psychotherapy outcome assumes a log-linear trajectory of change and allows predictions about the three outcome domains of Well-being, Symptoms, and Interpersonal functioning. Although the model has been partly validated, little is known about the types of trajectories in the specific domains and about the transferability of the model to treatments of longer duration. This study tested whether the domain-specific change trajectories followed a log-linear curve as postulated by the Phase model. Furthermore, it was examined whether the speed of change differed between the domains. METHOD: Growth curves were modeled using hierarchical linear modeling on an outpatient sample (N = 351), with treatment duration averaging 52 sessions. RESULTS: A log-linear curve best explained the change trajectories of the domains Well-being and Symptoms as well as the Global score of psychopathology, whereas Interpersonal functioning tends to improve in a linear pattern. Estimated slopes were biggest for Well-being and smallest for Interpersonal functioning. CONCLUSIONS: In the present study, the predictions of the Phase model concerning multidimensional phases were validated. The finding that trajectories of change are not uniformly log-linear, but either log-linear or linear in a domain-specific manner, is partly inconsistent with the model. Clinical or methodological significance of this article: This article extends previous research in the field of psychotherapeutic change by providing results from the modeling of change trajectories in psychotherapeutic treatments with larger amounts of sessions (i.e., more than 20 sessions). Our findings of domain-specific different shapes (i.e., log-linear for Well-Being and Symptoms and linear for Interpersonal functioning) and speed (i.e., fastest for Well-Being and slowest for Interpersonal function) of trajectories of psychotherapeutic change may be clinically applied by means of guidelines for therapists to plan and adapt their treatments. In addition to content-related aspects of a continuous adjustment of treatment goals (e.g., merely symptom-oriented or focusing on interpersonal change) and interventions, this adaptive planning is also related to health care considerations (e.g., may justify longer treatments if therapy goals target several domains of change).

[The Phase Model of Psychotherapeutic Outcome: Validation of the "Questionnaire for the Evaluation of Psychotherapeutic Change Processes" (FEP)]. / Das Phasenmodell therapeutischer Veränderung: Validierung des Fragebogens zur Evaluation von Psychotherapieverläufen (FEP).

Sufficiently theoretically founded and validated measures in German language to assess psychotherapeutic change are rare. The German Questionnaire for the Evaluation of Psychotherapeutic Change Processes (FEP) was designed on the basis of the Phase model of psychotherapeutic outcome. In the present study, the psychometric properties of the FEP and especially its factorial structure are validated. Psychometric values were calculated and confirmatory factor analyses were performed (outpatient sample, N=427). Itemindices, reliability - with exception of retest-reliability - and validity reached overall good to very good values. The best model-fit indices were obtained for the 3-factor-structure corresponding to the FEP-subscales Well-being, Symptoms and Interpersonal relations which represent the dimensions postulated by the Phase model. The FEP proved to be a psychometrically well-founded transdiagnostic measure of outcome and change which represents multidimensional phases of change. Its application in outcome monitoring is recommended.

Relevance of therapy goals in outpatient cognitive-behavioral and psychodynamic psychotherapy.

OBJECTIVE: Against a background of sparse research and contradictory findings, the present study investigates determinants of psychotherapy goals and predictive value for therapy success in outpatient psychotherapy. METHOD: The sample consisted of 473 patients from a university-based polyclinic and their corresponding 103 therapists. Goals were coded with the Bern Inventory of Treatment Goals (BIT-T). RESULTS: The results show that goal congruence between therapists and patients is relatively small. Theoretical orientation had a significant influence on the complexity of goal structure and goal preferences. With regard to the prognostic validity, only patients' problem- and symptom-focused goals enabled the prediction of treatment success independent of basic therapeutic variables. CONCLUSIONS: These findings underline the importance of consideration of patients' individual treatment goals in clinical practice and underpin the relevance of therapy goals for future psychotherapy research.