A Phase Model of Psychotherapy Outcome: Causal Mediation of Change

A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has be...

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Bibliographic Details
Published in:Journal of consulting and clinical psychology 1993-08, Vol.61 (4), p.678-685
Main Authors: Howard, Kenneth I, Lueger, Robert J, Maling, Michael S, Martinovich, Zoran
Format: Article
Language:English
Subjects:
Adult
Ambulatory Care
Biological and medical sciences
Case Conceptualization
Change
Concept Formation
Conceptualization
Coping
Female
Human
Humans
Life Functioning
Life Satisfaction
Male
Medical sciences
Mental Disorders - diagnosis
Mental Disorders - psychology
Mental Disorders - therapy
Mental Health
Models, Psychological
Outcomes
Personality Inventory
Problem Conceptualization
Psychiatric Status Rating Scales
Psychological Studies
Psychology
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychotherapies. Psychological and clinical counseling
Psychotherapy
Symptoms
Therapy
Treatment Outcome
Treatments
Well Being
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Summary:A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis 2 × 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.
ISSN:0022-006X
1939-2117
DOI:10.1037/0022-006X.61.4.678