Enhancing mental health and well-being outcomes for psychotherapy and counselling through idiographic analysis: A four-quadrant approach

Mental health and well-being outcomes in psychotherapy and counselling have largely been studied through the use of standardised nomothetic measurement. A key limitation is that nomothetic measurement and current statistical analyses do not necessarily capture the outcomes of the complicated and individual psychotherapy processes. There is an increased interest in the use of idiographic patient-reported outcome measures (I-PROMs), which are uniquely useful because they may explore areas of importance that are unexplored by nomothetic outcome measures. We argue that to optimise the value of I-PROMs, it is necessary to consider their contribution alongside standardised nomothetic measures. However, there are important considerations with respect to whether or not I-PROMs from different clients, or indeed from the same client, can be meaningfully explored at a team/service level, and alongside standardised nomothetic outcomes. We provide worked examples on real client data to show that delineating four quadrants of analysis is important to explore the breadth of information: (a) individual progress on single items, (b) individual progress by aggregated scores, (c) team/service-level progress by goal item/theme and (d) team/service-level progress by aggregated scores.     

正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展,进而识别缺乏治疗进展的个案,并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段,其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果,也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度,拓展正式反馈的使用价值,建立正式反馈系统的本土化常模。     

The Nomothetic-Idiographic Debate in Family Therapy

This essay introduces the terms "nomothetic" and "idiographic" to characterize the current debate about whether the field of family therapy should accumulate and apply knowledge about patterns of adjustment that hold across different families, or whether the field should consider each family as utterly unique, and should tailor interventions solely on the basis of these unique qualities. Embedded in this debate are the arguments for and against quantitative research, disagreements about the value of clinical prediction and interobserver reliability, as well as the issue of whether therapists can rightfully claim to possess "expert knowledge." The essay begins with the personal-professional anecdote that stimulated me to explore this debate in greater depth. It continues with a brief discussion of the historical context of this debate, particularly noting the parallels between the methodological issues in personality research and those facing family therapy. The nomothetic-idiographic debate in family therapy theory, research, and practice is then described. The essay ends with the suggestion that family therapy view nomothetic and idiographic thinking as complementary, and that the field strive to develop an integrated, "idiothetic" approach to family therapy research and practice.     

Individual differences in client reactions to counseling and psychotherapy: A challenge for research

Recent research is reviewed that suggests extensive individual differences in how clients respond to therapeutic interventions and therapist response modes. Three research strategies are proposed as parts of a therapeutic science that aims at both nomothetic generalizations and explications of idiographic meanings, while simultaneously confronting conceptual and methodological complexities arising from client individual differences in response to counseling.     

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.     

Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy.

This study examined treatment outcomes of 86 highly acculturated Hispanic and Anglo substance-abusing adolescents in functional family therapy, testing the hypothesis that ethnic matching of therapist and client is related to better treatment outcomes for clients. Adolescents reported on their substance use pre- and posttreatment on a timeline follow-back interview. Ethnically matched Hispanic adolescents demonstrated greater decreases in their substance use compared with Hispanic adolescents with Anglo therapists. Ethnic match status was not related to treatment outcome for Anglo clients. Thus, the matching hypothesis was supported for Hispanic clients only. The results underscore the importance of greater ethnic diversity among therapists and better cultural competency training for Anglo therapists. More research is needed on individual differences in the effects of ethnic matching.     

Implicit psychophysiology: Effects of common beliefs and idiosyncratic physiological responses symptom reporting

Every individual exhibits unique perceptual, behavioral, and physiological responses within and across a variety of settings. Despite the idiosyncratic nature of responses, we seek to establish theories that generalize across a large number of individuals. A strict idiographic method intensively examines the response patterns of a small number of individuals, whereas a nomothetic approach focuses on common responses across a large number of individuals. In the present investigation, we seek to learn how individuals perceive and report physical symptoms and sensations. We offer a methodology that capitalizes on the unique physiological responses of individuals but, at the same time, assumes that the underlying perceptual processes relevant to symptom reporting are comparable across individuals. Our approach, then, is both idiographic and nomothetic. As will be discussed, this integrative approach has the potential to be applied to a multitude of behaviors and processes that are of interest to social and personality psychologists.     

Individual response profiles in the behavioral assessment of personality

A long-standing problem in the behavioural assessment of personality is the individual specificity of responses. Often, different persons externalize the same trait in different responses. One solution to this problem is to aggregate many different responses. The paper compares the power of response aggregation for predicting self-and other-ratings of personality with two alternative strategies of response selection: the nomothetic strategy of selecting the response with the highest overall predictive power, and the more idiographic strategy of selecting, for each individual, the most extreme response. Seventy subjects were videotaped in a sequence of social situations inducing shyness to various degrees. Five different nonverbal measures of shyness all correlated significantly with the subjects' self- or other-rated shyness, and showed low correlations across subjects and a substantial cross-situational consistency of response profiles. Response aggregation and both strategies of response selection were found to be equally powerful in predicting the subjects' self- and other-ratings of shyness from the five behavioural responses. Therefore, these findings somewhat dampen the hope often expressed in recent theoretical discussions of personality assessment that more respect for the individual case may improve nomothetic assessment procedures.     

Assessing Achievement Goals in Sport: Caveats for Consultants and a Case for Contextualization

This paper advises practitioners of the limitations of employing nomothetic research tools for the idiographic assessment of athletes' achievement goal orientations. Consultants are encouraged to appreciate the scoring trends of the Task and Ego Orientation in Sport Questionnaire (TEOSQ; Duda & Nicholls, 1992) and the Perceptions of Success Questionnaire (POSQ; Roberts, Treasure, & Balague, 1998) and to recognize that the measures may not bestow them with accurate and meaningful information on an athlete's motivational responses in the contexts of competition and practice. The contextual sensitivity of the TEOSQ and the POSQ is explored empirically among a sample of 179 high-level team and individual athletes. Repeated measures ANOVAs with follow-up paired t -tests illustrated how performers' goal orientations for competition differed significantly from their overall sport goal orientation. The findings are discussed with reference to the implications for practitioners and the development of appropriate contextual assessments of achievement goals at nomothetic and idiographic levels.     

Bringing Back the Person into Behavioural Personality Science Using Big Data

Behaviour and the individual person are important but widely neglected topics of personality psychology. We argue that new technologies to collect and new methods to analyse Big (Behavioural) Data have the potential to bring back both more behaviour and the individual person into personality science. The call for studying the individual person in the history of personality science, the related idiographic/nomothetic divide, as well as attempts to reconcile these two approaches are briefly reviewed. Furthermore, different meanings of the term idiographic and some unique selling points that emphasize the importance of idiographic research are highlighted. A nonexhaustive literature review shows that a wealth of behaviours are considered in extant personality studies using such Big Data but only in a nomothetic way. Against this background, we demonstrate the potential of Big Data collection and analysis with regard to four idiographic research topics: (i) unique manifestations of common traits and the resurgence of personal dispositions, (ii) idiographic prediction, (iii) intraindividual consistency versus variability of behaviour and (iv) intraindividual personality trait change through intervention. Methodological, ethical and legal pitfalls of doing Big Data research with individual persons as well as potential countermeasures are considered.     

THE EGALITARIAN RELATIONSHIP IN FEMINIST THERAPY

Feminist therapy has revolutionized clinical practice and offered a model of empowerment for all therapy approaches. However, the long-assumed claim that feminist therapists are more likely to engage in power-sharing behaviors with their clients has not been supported by published quantitative research. In the current study, 42 female therapists who were asked whether or not they self-identified as feminist therapists completed measures assessing their use of feminist therapy behaviors (Feminist Therapy Behavior Checklist) and power-sharing behaviors (Therapy with Women Scale). One of each therapists' current female clients completed measures assessing her perceptions of both treatment collaboration (Working Alliance Inventory) and power-sharing behaviors (Client Therapy with Women Scale). As hypothesized, participants who identified as feminist therapists were more likely to report engaging in power-sharing behaviors when compared to participating therapists who did not. Furthermore, as hypothesized, clients of feminist therapists were more likely to report that their therapists engaged in power-sharing behaviors.     

Experience Sampling Methods: A Modern Idiographic Approach to Personality Research

Experience sampling methods are essential tools for building a modern idiographic approach to understanding personality. These methods yield multiple snapshots of people's experiences over time in daily life and allow researchers to identify patterns of behavior within a given individual, rather than strictly identify patterns of behavior across individuals, as with standard nomothetic approaches. In this article, we discuss the origin and evolution of idiographic methods in the field of personality and explain how experience sampling methods function as modern day idiographic methods in this field. We then review four primary ways in which experience sampling methods have been used to foster idiographic approaches in personality research. Specifically, we highlight approaches that examine individual differences in temporal and behavioral distributions, situation–behavior contingencies, daily processes, and the structure of daily experience. Following a brief methodology primer, we end by discussing future directions for idiographic experience sampling approaches in personality psychology and beyond.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

A solution-focused approach to working with clients who are suicidal

Self-harm and suicide are amongst the most challenging and frightening problems that therapists and counsellors can encounter in the course of their work. The risk of clients harming themselves in the course of treatment can debilitate the therapists from acting creatively and collaboratively, and make their actions defensive, focused solely on risk assessment rather than therapeutic change.Yet it is precisely a creative and collaborative response, such as that engendered by solution-focused therapy and other models, that is the most likely to facilitate change and re-empower clients to take back charge of their lives. This article describes a solution-focused approach to working with suicidal clients that can be used in conjunction with traditional approaches and which focus on establishing safety as well as assessing risk.Working from this model the clinician shifts to identifying client strengths and coping skills, to collaborating with the client to establish meaningful goals and to helping the client envision a positive future. Arguably, such an approach can increase collaboration between therapist and client and lead to a more client-centred safety plan.     

Helping construct desirable identities: a self-presentational view of psychotherapy

The author reviews the research demonstrating not only that clients withhold personal information and reactions from their therapists but also that such discretion is associated with positive therapy process ratings and outcomes. These results run counter to traditional approaches to psychotherapy, which demand a high degree of openness from clients. These puzzling findings can be explained by conceptualizing psychotherapy as a self-presentational process, wherein clients come to benefit from therapy by perceiving that their therapists have favorable views of them. Creating these favorable impressions can involve clients' hiding some undesirable aspects of themselves from their therapists. The author offers findings from the psychotherapy and social-psychology literatures in support of this view and makes suggestions concerning what clients and therapists might optimally reveal in therapy.     

Depressogenic inferential styles, negative events, and depressive symptoms in youth: an attempt to reconcile past inconsistent findings

Research examining the diathesis-stress component of the hopelessness theory (HT) in youth has provided mixed support for the theory. One explanation for inconsistent findings is the failure to consider relationships among the three inferential styles posited to serve as vulnerability factors by the theory. The weakest link hypothesis posits that an individual is as vulnerable to depression as his/her most depressogenic inferential style (DIS) makes him/her. A second explanation is that researchers have operationalized "high stress" from a nomothetic, as opposed to an idiographic, perspective. The current study tested the diathesis-stress component of the HT in 230 third-grade and 152 seventh-grade schoolchildren using both a weakest link and an idiographic approach towards analysis. Children completed measures assessing depressive symptoms and DISs. Children subsequently completed measures assessing depressive symptoms and negative events once a week for 6 weeks. Hierarchical linear modeling and time-lagged analyses indicated that a depressogenic weakest link was associated with greater elevations in depressive symptoms following elevations in stress.     

Repurposing process measures to train psychotherapists: Training outcomes using a new approach

Aims: First, this paper presents the rationale for a novel approach to training counsellors in which measures for psychotherapy process research are taught to students before moving on to teaching basic empathic reflections and interventions. The rationale for this is that client process measures can be re‐purposed to help orient and sensitise trainees to key in‐session moments. Second, we present a training outcome study that assesses the effectiveness of this approach. Method: Using an experiential‐integrative therapy approach, a 13‐week training program was used to teach psychotherapy skills and process research measures to22 clinical graduate students taken from two cohorts. As part of the course, trainees conducted several single sessions with volunteer clients on four separate occasions. Training outcomes were measured using both trainee and client reports. Results: Compared to baseline, therapists reported significant and steady gains (all p's<.05) in session management, reducing their anxious self‐awareness, and in improved sense of self‐efficacy, with the latter having the largest effect (partial Eta Sq.=.381). Discussion: While the findings provide some support for a new training strategy, a dismantling design is needed next to more closely examine the process‐measure approach to training.     

A Case Study Illustrating Therapist-Assisted Internet Cognitive Behavior Therapy for Depression

Randomized controlled trials show that therapist-assisted Internet cognitive behavior therapy (ICBT) is efficacious in the treatment of depression. Given that this is a novel way of delivering cognitive behavior therapy, however, clinical service providers may have questions about how to provide therapist-assisted ICBT in clinical practice, particularly with respect to therapist assistance. To exemplify this approach, we present a case study of an older adult male who received 12 modules of therapist-assisted ICBT for depression over the course of 5 months. Highlights of the therapeutic exchanges that occurred over email are provided to illustrate the type of information clients may share with therapists and the nature of therapist assistance. Treatment progress was assessed via self-report questionnaires measuring depression, anxiety, and adjustment. Consistent with the research evidence, significant improvement was observed on all symptom measures at posttreatment. Satisfaction with the therapist-assisted ICBT program and a strong therapeutic alliance was also reported. The case will expand clinician understanding of therapist-assisted ICBT and may serve to stimulate clinician interest in the provision of therapist-assisted ICBT. Future research directions stemming from this case are presented.     

The Challenge of Integrity: A Commentary on the Critique by Edwards and Lowis

Capps' idiographic analysis of Augustine's Confessions is discussed in terms of Allport's possible contradiction in stating idiographic goals while embracing nomothetic theory and techniques. The necessity of a methodological complementarity for this type of work is stressed to reduce subjective bias. The question of Augustine's religious orientation is then extended to include recent ideas. As interesting as idiographic treatments are, their most productive use may be for theory development to which nomothetic analyses are applied.     

Individual differences in metacontrast: An impetus for clearly specified new research objectives in studying masking and perceptual awareness?

While the majority of perceptual phenomena based research on consciousness is implicitly nomothetic, some idiographic perspective can be sometimes highly valuable for it. It may turn out that after having had a closer look at individual differences in the expression of psychometric functions a need to revise some nomothetic laws considered as the general ones arises as well. A study of individual differences in metacontrast masking published in this issue superbly illustrates this. A myriad of urgent research objectives emerges out of this study, most of them important both for clearing up the still messy theoretical picture on visual masking and for the beginning of asking whether perceptual awareness mechanisms are so universal at all. In this commentary the problems pertinent to this issue are discussed.