A comparative outcome study of individual, group, and conjoint psychotherapy.

Sixty-four outpatients were assigned to individual, group, or conjoint psychotherapy with experienced private clinicians. The length of the treatments ("cognitive insight" or "affective insight" therapies) averaged 26.8 sessions. To examine comparative outcomes, patients and significant others were assessed on both general outcome measures (eg, symptoms, target complaints) and mode-specific indexes (eg, private self-awareness, interpersonal functioning, and family environment). The most notable finding was the significant improvement of the sample as a whole at both termination and follow-up (average, 31 weeks). When differential outcomes did appear, they were more often attributable to differences among therapists and to interactive effects (ie, a particular fit between specific patient characteristics and a specific mode of therapy) than to main effects for any single therapy. The findings also demonstrated the importance of a systems approach to understanding fully the effects of psychotherapy because the patient's view of the family, the significant other's view of the patient, and the significant other's own adjustment tended to vary together, regardless of the mode of treatment.

Influence of life events on outcome in psychotherapy.

The life events occurring to 64 outpatients participating in a psychotherapy outcome study were assessed for the 6 months before intake, during therapy itself, and during a follow-up period that averaged 7.2 months. Events were identified using a combined checklist and interview methodology. The impact of events was assessed by examining their predictive validity above and beyond that attributable to a set of demographic and clinical variables (sex, age, socioeconomic status, chronicity, and history of prior treatment). The major findings were that: a) life events did have a significant influence, but only at intake and termination and not at follow-up; b) "negative" events were more useful than the total number of events in predicting status; and c) when life events did have predictive power, the average increase in explained variance attributable to events was 13.4 per cent.

Dimensions of life stress in psychiatric patients.

A combined checklist and interview methodology was developed to assess the occurrence of life events among psychiatric patients. In addition to identifying events, patients were asked to rate them on 11 dimensions assumed to be important in mediating the impact of life stress. A factor analysis of ratings of 479 events from 64 patients, yielded three factors, reflecting the desirability of events, perceived control over their occurrence, and the readjustment required by events. However, ratings of social support available for help in coping with events and prior experience with similar events did not load on any of these factors. These dimensions should be treated as separate and potentially important influences. Three judges, blind to the patients' ratings, also made "normative" judgements of a subset of 154 events on the dimensions of desirability, control, and readjustment. Agreement among judges and between judges and patients was high with regard to desirability and control but low when rating readjustment. Judges tended to overestimate the amount of readjustment as described by patients.