Psychological mindedness and treatment outcome

Abstract

This dissertation was designed to empirically examine the nature of psychological mindedness and its relationship to treatment outcome. Psychological mindedness is assumed to be an attribute which current or prospective patients ought to possess in order to effectively engage in the process of, as well as benefit from, all forms of insight-oriented psychotherapy. The conventional view of psychological mindedness tends to emphasize not only its desirable but also its static quality. In fact, it presupposes that much of what is knowable about an individual's psychological mindedness can be quantified prior to his/her involvement in therapy. Scant attention has been paid to the conceptual question of whether a patient's psychological mindedness can be progressively developed during treatment. Is it not conceivable that patients become more psychologically minded about themselves through the process of therapy? Furthermore, should not this enhanced capacity correspond, in turn, to favorable treatment outcome? This dissertation was designed to answer these questions. To that end, the actual in-therapy behavior of twenty-four outpatients was assessed by six independent judges who rated a total of sixty minutes of each subject's behavior at four different points in time. The time periods were selected to represent each quartile of a forty-session treatment protocol. The observers were divided into three teams with each dyad responsible for obtaining ratings from one of three measures of psychological mindedness. These three measures were chosen to tap two dimensions of psychological mindedness; one dimension was that of intellect, the other was affect. It was expected that these components would differentiate subjects, not only in their initial understanding of their behavior, experiences, and presenting problems, but also in the quality of that understanding, specifically as it was expected to change over the course of forty weeks of psychotherapy. The major findings of the study indicated that psychological mindedness was relatively stable and therefore difficult to alter as a function of the treatments provided these subjects, particularly for patients whose initial level of psychological mindedness was low, and that increments in psychological mindedness did not correspond to favorable (i.e., better than baseline) treatment outcome. The clinical implications of these findings were discussed with reference to the theory of therapeutic change which emphasizes the curative aspects of insight acquisition as well as in relation to alternate routes of change. Finally, the study's limitations were reviewed and suggestions for future research were presented.