Psychology 644.X  (Assessment)
Assessment of Therapy Progress

Fall Semester, 2005 (First five weeks, August 26-September 23)
9:00 - 12:00 Fridays
William B. Stiles, Instructor

I propose to focus this module on two models for on-going assessment of progress in therapy:

Topic 1. Assimilation of problematic experiences.

Topic 2. Dose-effect relations, patient-focused research, tracking and feedback.

I've constructed a provisional schedule of readings (listed below) along with a more extensive list of resource readings, which we may draw from as needed.

For each class, read the suggested material or equivalent. Prepare a page of reactions to your readings, questions, and notes on interesting or important points and methods; bring this to class to fuel discussion.

Written Work: Assimilation Assessment Exercise

Assess the progress of your client or the client of someone you know. Although you may use any materials available, the basic requirement is a recording of at least one session. Use the materials you have to distinguish (a) the client's dominant voice or perspective and (b) the problematic experience or problematic voice and to assess (c) the degree to which the latter has been assimilated. This exercise will be described in a separate handout and discussed in class.

Reading Schedule

The following are some recommendations, however, you may add or substitute other readings depending on your interests and the ebb and flow of the class.

Week 1. Introduction to the assimilation model.

Stiles, W. B. (2002). Assimilation of problematic experiences. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 357-365). New York: Oxford University Press.

Stiles, W. B., Elliott, R., Llewelyn, S. P., Firth‑Cozens, J. A., Margison, F. R., Shapiro, D. A., & Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy.  Psychotherapy, 27, 411-420.

Stiles, W. B., Morrison, L. A., Haw, S. K., Harper, H., Shapiro, D. A., & Firth-Cozens, J. (1991).  Longitudinal study of assimilation in exploratory psychotherapy.  Psychotherapy, 28, 195-206.

Osatuke, K., Glick, M. J., Gray, M. A., Reynolds, D. J., Jr., Humphreys, C. L., Salvi, L. M., & Stiles, W. B. (2004). Assimilation and narrative: Stories as meaning bridges. In L. Angus & J. McLeod (Eds.), Handbook of narrative and psychotherapy: Practice, theory, and research (pp. 193-210). Thousand Oaks, CA: Sage.

Week 2. Assimilation case studies

Stiles, W. B., Meshot, C. M., Anderson, T. M., & Sloan, W. W., Jr. (1992). Assimilation of problematic experiences: The case of John Jones.  Psychotherapy Research, 2, 81-101.

Honos-Webb, L., Stiles, W. B., Greenberg, L. S., & Goldman, R. (1998).  Assimilation analysis of process-experiential psychotherapy: A comparison of two cases.  Psychotherapy Research, 8, 264-286.

Varvin, S., & Stiles, W. B. (1999). Emergence of severe traumatic experiences: An assimilation analysis of psychoanalytic therapy with a political refugee. Psychotherapy Research, 9, 381-404.

Honos-Webb, L., Surko, M., Stiles, W. B., & Greenberg, L. S. (1999). Assimilation of voices in psychotherapy: The case of Jan. Journal of Counseling Psychology, 46, 448-460.

Knobloch, L. M. Endres,  L. M., Stiles, W. B., &  Silberschatz, G. (2001). Convergence and divergence of themes in successful psychotherapy: An assimilation analysis. Psychotherapy, 38, 31-39.

Osatuke, K., Glick, M. J., Stiles, W. B., Greenberg, L. S., Shapiro, D. A., & Barkham, M. (2005). Temporal patterns of improvement in client-centred therapy and cognitive-behaviour therapy. Counselling Psychology Quarterly, 18, 95-108.

Brinegar, M. G., Salvi, L. M., Stiles, W. B., & Greenberg, L. S. (submitted). Building a meaning bridge: Therapeutic progress from problem formulation to understanding. Manuscript submitted for publication.

Stiles, W. B., Leiman, M., Shapiro, D. A., Hardy, G. E., Barkham, M., Detert, N., & Llewelyn, S. P. (in press). What does the first exchange tell? Dialogical sequence analysis and assimilation in very brief therapy. Psychotherapy Research.

Week 3. Tracking and feedback: Michael Lambert et al.

I asked Mike Lambert what he would recommend reading as an introduction to his work on patient-focused research and he sent 7 articles with some comments:

The one by Vermeersch emphasizes that outcome measures, as distinct from those aimed at diagnosis/personality must be sensitive to change. It is important because it shows the OQ-45 is--but more important it shows the first application of the necessary methodology that should be used.

Vermeersch, D. A., Whipple, J. L., Lambert, M. J., Hawkins, E. J., Burchfield, C. M., & Okiishi, J. C. (2004). Outcome Questionnaire: Is it sensitive to changes in counseling center clients? Journal of Counseling Psychology, 51, 38-49.

The one by myself, Whipple, Bishop, et. al. is important because it shows how we developed and validated two methods for predicting treatment failure. It shows the OQ-45 can predict, but more important two methods for prediction that others can use with other measures.

Lambert, M. J., Whipple, J. L., Bishop, M. .J., Vermeersch, D. A., Gray, G. V., & Finch, A. E. (2002). Comparison of empirically-derived and rationally-derived methods for identifying patients at risk for treatment failure Clinical Psychology and Psychotherapy, 9, 149-164.

The one by Hannon, et al is a bit redundant with the above article, but provides the provocative finding that Clinician/therapist prediction of treatment failure is terrible--thus providing a rationale for a statistical prevention method.

Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., & Sutton, S. W., (2005). A lab test and algorithms for identifying clients at risk for treatment failure Journal of Clinical Psychology, 61, 155-163.

I have also attached three articles on feedback. One is a meta-analysis that is more technical. One is more up to date, but written for clinicians, The one by Harmon shows the future direction of of adding clinical support tools to feedback so as to assist the clinician in problem solving with the at risk case.

Lambert, M.J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288-301.

Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients' progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, 165-174.

Harmon, C. Hawkins, E. J., Lambert, M. J., Slade, K., & Whipple, J. L. (2005). Improving outcomes for poorly responding clients: The use of clinical support tools and feedback to clients Journal of Clinical Psychology, 61,175-185.

Finally, if you want to scare people to death see the paaper by Okiishi, where we examine outcome within therapists--searching for the empirically validated psychotherapist. This hits close to home for practitioners because it raises the whole issue of referral based on outcome by practitioner.

Okiishi, J., Lambert, M. J., Nielsen, S. L., & Ogles, B. M. (2003). Waiting for supershrink: An empirical analysis of therapist effects. Clinical Psychology and Psychotherapy, 10, 361-373.

Week 4. Dose-effect and patient-focused research: Howard, Lueger, Lutz, et al.

Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159-164.

Howard, K. I., Leuger, R. J., Maling, M. S., & Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology, 61, 678-685.

Kopta, S. M., Howard, K. I., Lowry, J. L., & Beutler, L. E. (1994). Patterns of symptomatic recovery in psychotherapy. Journal of Consulting and Clinical Psychology, 62, 1009-1016.

Lutz, W., Martinovich, Z., & Howard, K. I. (1999). Patient profiling: An application of random coefficient regression models to depicting the response of a patient to outpatient psychotherapy. Journal of Consulting and Clinical Psychology, 67, 571-577.

Lueger, R. J., Howard, K. I., Martinovich, Z., Lutz, W., Anderson, E., & Grissom, G., (2001). Assessing treatment progress with individualized models of predicted response. Journal of Consulting and Clinical Psychology, 69, 150–158.

Lutz, W., Leach, C., Barkham, M., Lucock, M., Stiles, W. B., Evans, C., Noble, R., & Iveson, S. (in press). Predicting change for individual psychotherapy clients based on their nearest neighbors. Journal of Consulting and Clinical Psychology.

Barkham, M., Connell, J., Stiles, W. B., Miles, J. N. V., Margison, F., Evans, C., & Mellor-Clark, J. (in press). Dose-effect relations and responsive regulation of treatment duration: The good enough level. Journal of Consulting and Clinical Psychology.

Week 5. Assessment of assimilation.

The following are some manuals and commentaries on methods and concepts that may be useful in your assimilation assessment exercise.

Stiles, W. B., & Osatuke, K. (2000). Assimilation analysis. Unpublished manuscript. Department of Psychology, Miami University, Oxford, Ohio 45056

Honos-Webb, L., Surko, M., & Stiles, W. B. (1998). Manual for rating assimilation in psychotherapy: February 1998 version.  Unpublished manuscript.  Department of Psychology, Miami University, Oxford, Ohio.

Lani, J. A., Glick, M. J., Osatuke, K., Brandenburg, C., Gray, M. A., Humphreys, C. L., Reynolds, D., & Stiles, W. B. (2002). Markers of assimilation manual. Unpublished manuscript. Department of Psychology, Miami University, Oxford, Ohio.

Stiles, W. B., & Angus, L. (2001). Qualitative research on clients' assimilation of problematic experiences in psychotherapy. In J. Frommer & D. L. Rennie (Eds), Qualitative psychotherapy research: Methods and methodology (pp. 112-127). Lengerich, Germany: Pabst Science Publishers. Also published in Psychologische Beiträge, 43, 570-585.

Stiles, W. B., Osatuke, K., Glick, M. J., & Mackay, H. C. (2004). Encounters between internal voices generate emotion: An elaboration of the assimilation model. In H. H. Hermans & G. Dimaggio (Eds.), The dialogical self in psychotherapy (pp. 91-107). New York: Brunner-Routledge.