PATIENT AND THERAPIST TREATMENT GOALS RELATED TO PSYCHOTHERAPY OUTCOME

Abstract

This study investigated those factors involved in the interaction between patient and therapist initial and changing goals which affect psychotherapy outcome, where a new measure was developed, entitled Level of Intrapsychic Orientation: A continuum, on which patient and therapist goals could be ranked and then compared in terms of their level of intrapsychic orientation. Intrapsychic orientation was defined as the degree to which goals reflected an increased concern with interpersonal relatedness and a gradually increasing level of personal responsibility taken for both the complaint and its eventual solution.;The primary statistical analysis involved Pearson Product Moment Correlations, where two major factors: (1)level of goal achievement for patient and therapist, and (2)initial and later difference scores in level of intrapsychic orientation of patient and therapist goals were correlated with three outcome measures (patient and therapist ratings of outcome and an empathy score). The sample was drawn from a postgraduate training institute, where sixty-six patient-therapist dyads were studied which included twenty-one males and forty-five females who ranged in age between twenty and fifty years old.;Results showed that patient and therapist rating of outcome is related most significantly to the achievement of their goals and significantly, but less so, by the difference between patient and therapist in the level of intrapsychic orientation of goals desired. Discussion focused on the major similarities and differences between patient and therapist perceptions of what factors allowed for the most successful outcome. A homeostatic model was proposed to explain the inverse relationship found between patient and therapist initial levels of intrapsychic orientation, where the higher the intrapsychic orientation of the patient's initial goals, the lower the intrapsychic orientation of the therapist's initial goals and vice versa. This proposal suggested that therapists seek to provide a balance that levels off the intrapsychic orientation in order to bring something new into the patient's perceptual world.;In conclusion, it was inferred that patients differed most from their therapists in (1)their need for a stable object, and (2)their proposed need for an initial difference between patient and therapist levels of intrapsychic orientation where the patients later moved towards the therapist's level of intrapsychic orientation. This level of inference led to the proposal of the presence of two different developmental lines along which patient and therapist pursue their respective goals during the treatment process.