LETTER TO THE EDITOR
General Misconceptions
Regarding Patient-Therapist
Characteristics and
Psychotherapy Outcome
Sir,
Past researchers have highlighted the patient and
therapist-related factors that are apparently associated
with client improvement or better psychotherapy
outcome. Current, empirical research has validated few
of these assumptions; on the other hand, it has
presented quite contrary findings about most of these
existing suppositions. It has been assumed that the
association between the self image of the patient, nature
of attachment, and some demographic characteristics of
the client and therapist affect the patient-therapist
relationship and therapeutic outcome. For instance,
empirical evidence supported the positive relationship
between self-image of the patient and therapeutic
outcome.1 Likewise, secure attachment to therapist is
found to be associated with the improvement of patient's
symptoms, interpersonal problems, and global
functioning. Whereas, higher levels of self-criticism
predicted poorer outcome in terms of symptom severity
among patients.2 It has been shown that the outcome of
a psychotherapeutic process is often influenced by
some non-specific factors, such as, the personal
characteristics of the patients, therapist and the positive
feelings that arise in the patient.3 Moreover, it is also
commonly assumed that age, gender, socio-economic
status, and level of motivation of patients; and similarly,
age, gender, experience of therapist are deemed to be
important in therapeutic outcome. However, there is little
or no empirical support for these presumptions.
From the patients' perspective, it is normally accepted
that older patients have worse treatment outcomes as
compared to younger patients and only highly motivated
patients attain favourable outcome. Research evidences
exhibited no solid support for this assumption and there
are mixed types of findings regarding the motivation and
therapy outcome.4 It is also assumed that women
patients, and patients with high socio-economic status
accomplish better outcome; whereas, ethnic minority
patients showed poor outcome. However, in general,
many studies showed that biological sex appears
unrelated to therapeutic outcome and there is no
802
relationship between social class and outcome. Besides,
there is also no empirical support for this assumption
that ethnic minority patients consistently achieve worse
outcome.4
From the therapists' perspective, there are certain
assumptions about the therapists and therapeutic
relationship outcome. For instance, it is commonly
assumed that older, more experienced and women
therapists produce better treatment outcomes. Quite
contrary, empirical evidences demonstrated no
relationship between therapists' age and therapeutic
outcome. However, there are mixed findings that more
experienced therapists produce better outcomes or
women are better therapists. There is also a strong
belief that therapists matched with patients as per their
ethnicity, deliver better outcomes, and that therapists
who have undergone their own personal counselling or
therapy produce better outcomes. Empirical evidences
showed equivocal or mixed nature of findings. Hence,
the emerging picture suggests that the quality of the
client-therapist alliance is a reliable predictor of positive
clinical outcome that is independent of the variety of
psychotherapy approaches, outcome measures, and
socio-demographics of the clients and therapists.5
REFERENCES
1. Ryum T, Vogel PA, Walderhaug EP, Stiles TC. The role of selfimage as a predictor of psychotherapy outcome. Scand J
Psychol 2015; 56:62-8.
2. Feenstra DJ, Laurenssen EM, Hutsebaut J, Verheul R,
Busschbach JJ. Predictors of treatment outcome of Inpatient
Psychotherapy for Adolescents with personality pathology.
Personal Ment Health 2014; 8: 102-14.
3. Strupp HH. Implications of the empirically supported treatment
movement for psychoanalysis. Psychoanal Dialogues 2001;
11:605-19.
4. Trull JT, Prinstein JM. Psychological interventions. Clinical
psychology 2013; 8th ed , pp. 311-342: Wadsworth, Cengage
learning.
5. Ardito RB, Daniela R. Therapeutic alliance and outcome of
psychotherapy: Historical excursus, measurements, and
prospects for research. Front Psychol 2011; 2:270.
Naeem Aslam
Lecturer, National Institute of Psychology, Quaid-i-Azam
University, Islamabad.
Correspondence: Mr. Naeem Aslam, Lecturer, National
Institute of Psychology, Quaid-i-Azam University, Islamabad.
E-mail: [email protected]
Received: February 19, 2016; Accepted: April 22, 2016.
Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (9): 802