Swift J.K., Callahan J.L., Vollmer B.M.
Journal of Clinical Psychology: 2011, 67(2), p. 155–165.
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Meta-analytic review commissioned by a US task force concludes that psychotherapy patients (including those treated for substance use problems) stay longer and do better if they get the type of therapy, type of therapist and type of therapeutic style they prefer.
Summary Client preferences are recognised as a key component to evidence-based practice. However, research has yet to confirm the actual influence preferences have on treatment outcomes. In this meta-analysis A study which uses recognised procedures to combine quantitative results from several studies of the same or similar interventions to arrive at composite outcome scores. Usually undertaken to allow the intervention's effectiveness to be assessed with greater confidence than on the basis of the studies taken individually. we summarise results from 35 studies which examined the relationship between preferences and outcomes among adult clients. Overall, clients who were matched to their preferred therapy conditions were less likely to drop out of therapy prematurely and showed greater improvements in treatment outcomes. In particular the improvement in outcomes applied also across the eight relevant studies of substance abuse. This relationship did not significantly differ across different categories of preference based on preferred role, Role preferences involve the behaviours and activities that clients desire themselves and their therapists to engage in while in therapy, eg, preferring the therapist to take an active advice-giving role v. a listening role, preferring that cognitive-behavioural treatment be administered in a group rather than an individual format. preferred therapist Characteristics clients hope their therapists will possess, such as preferring the therapist to have had many years of clinical experience or preferring them to have a similar ethnic background. characteristics, or preferred treatment Specific desires for the type of intervention, eg, for a behavioural v. a supportive approach or psychotherapy rather than pharmacotherapy. approach. However, the design of the study was found to be a significant moderator, with randomised controlled trials showing the largest differences between preference-matched clients and non-matched clients.
These results underscore the centrality of incorporating patient preferences when making treatment decisions. Clinical examples and suggested therapeutic practices are provided. Among the latter are that therapists recognise that hopes and desires for treatment are not universal across all patients. It is important that therapists do not assume they know their clients' preferences, but work with each client to elicit his or her desires and work in conjunction with those preferences. These should be assessed before the start of treatment, re-assessed throughout the therapy process, and accommodated to whenever possible.
commentary This article was in a special issue of the Journal of Clinical Psychology devoted to adapting psychotherapy to the individual patient. For other Findings entries from this issue see:
What works for whom: tailoring psychotherapy to the person
Adapting psychotherapy to the individual patient: Stages of change
Adapting psychotherapy to the individual patient: Culture
Adapting psychotherapy to the individual patient: Coping style
Adapting psychotherapy to the individual patient: Expectations
Adapting psychotherapy to the individual patient: Attachment style
Adapting psychotherapy to the individual patient: Resistance/reactance level
Adapting psychotherapy to the individual patient: Religion and spirituality
Last revised 09 March 2011