Consensus in patient-therapist interactions. A measure of the therapeutic relationship related to outcome.

This paper discusses consensus between patient and therapist as a measure of the quality of the psychotherapeutic relationship. Consensus is defined by two interpersonal concepts, agreement and understanding, and two intrapersonal concepts, congruency and experienced consensus. 162 patients and their therapists in a Dutch Center for Comprehensive Mental Health Care were rated on the degree of consensus. Two patient self-report outcome measures and one reported by the therapist were related to consensus. The three consensus measures that predicted outcome after 6 months were understanding by the therapist as well as agreement and experienced consensus by the patient. This result suggests that a complementary patient-therapist relationship favors a good psychotherapy result. The instruments in this paper provide a means to measure consensus during the process of psychotherapy. This is a feasible way to both monitor progress and improve the chances of a successful outcome.

Psychotherapeutic outcome: measuring reliable clinical change.

Psychotherapeutic research is generally carried out to investigate the effectiveness of specific techniques with selected, often homogeneous samples of patients. This leads to problems when applying research findings to the clinical reality where the patient population is heterogeneous. In this study, we examine psychotherapy outcome in a natural treatment setting using criteria established by Jacobson and his colleagues for measuring improvement in psychotherapy, reliable change and clinical significance. Outcome was evaluated in a sample of 117 Dutch ambulatory mental health center patients with the SCL-90 Symptom Checklist and the Target Complaints List. On both instruments improvement rates varied greatly and were only moderately correlated. Our findings suggest that a more limited application of the Jacobson criteria derived from selected samples is warranted when applied in a general patient population.

The social ecology of anxiety. Theoretical and quantitative perspectives.

Experience sampling is a relatively new research approach that captures relevant variations in experience and symptoms in the course of everyday life. In this paper, a socioecological frame of reference that integrates psychological, historical, cultural, and developmental theories about anxiety phenomena will be illustrated using quantitative descriptions of anxiety and avoidance behaviors gathered with the Experience-Sampling Method. The interaction between anxiety symptoms and the environment in which they occurred is explored in a case study that points to possibilities for future research and the establishment of therapeutic approaches that are optimally suited to the individual patient.