Matching Psychotherapy to the Patient/Client
(Copied verbatim from the Effectiveness Bank alerts from Drug and Alcohol Findings).
This bulletin is devoted to reports from a high-level task force convened by the American Psychological Association to identify effective psychotherapy relationships and ways to adapt therapy to characteristics of patients other than their diagnosis, such as their personalities or cultural backgrounds. The task force commissioned reviews synthesising research on promising ways to match therapeutic approaches to different types of patients, which were published in a special issue (2011, volume 67, issue 2) of the Journal of Clinical Psychology. These reviews and the introductory article are listed below. While not specific to drug or alcohol problems, many of the studies included in the reviews concern these problems and a high proportion of drug or alcohol patients suffer from the mental health problems addressed by the other studies. The reviews offer comprehensive, evidence-based recommendations on how to maximise the benefits of psychosocial therapy.
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WHAT WORKS FOR WHOM: TAILORING PSYCHOTHERAPY TO THE PERSON
Introduces the special issue of the Journal of Clinical Psychology and summarises the conclusions reached by the task force. Prime amongst these was that outcomes demonstrably improved when therapists appropriately adapted their approaches to the reactance/resistance, preferences, culture, and religion/spirituality of their clients.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: STAGES OF CHANGE
Review concludes that the stages of change developed by Prochaska and DiClemente reliably predict how well psychotherapy patients will do, but no adequate studies have tested whether matching therapy to initial stage of change actually improves outcomes.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: PREFERENCES
Review concludes that patients stay longer and do better if they get the type of therapy, type of therapist and type of therapeutic style they prefer.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: CULTURE
Review concludes that mental health services targeted to a specific cultural group were several times more effective than those for clients from a variety of backgrounds, and that more effective treatments had more cultural adaptations.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: COPING STYLE
Review concludes that externalising patients are best matched to psychotherapies focused on skill-building and symptom change, while those characterised by self-criticism and emotional avoidance benefit most from interpersonally focused and insight-oriented approaches.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: EXPECTATIONS
Review concludes that patients who enter psychotherapy with positive expectations about outcomes tend actually to have better outcomes, suggesting that therapists should regularly assess expectations and take steps to enhance them if appropriate.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: ATTACHMENT STYLE
Review concludes that psychotherapy patients who feel secure in and easily form close and trusting intimate relationships have better outcomes, while the reverse is the case for those anxious about close relationships.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: RESISTANCE/REACTANCE LEVEL
Review concludes that patients who characteristically exhibit low levels of resistance to being led by others respond better to directive types of treatment, while patients prone to resist direction respond best to non-directive approaches.
ADAPTING PSYCHOTHERAPY TO THE INDIVIDUAL PATIENT: RELIGION AND SPIRITUALITY
Review concludes that psychotherapy patients who identify with the religious or spiritual orientation of a therapy improve more than if untreated. Generally they also improve more than if treated with secular therapies, but not if these are equivalent in every other way to the religious/spiritual therapy.
