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Beutler L.E., Harwood M.T., Kimpara S. et al.
Journal of Clinical Psychology: 2011, 67(2), p. 176–183.
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Meta-analytic review commissioned by a US task force concludes that externalising patients are best matched to psychotherapies focused on skill-building and symptom change, while those characterised by self-criticism and emotional avoidance benefit most from interpersonally focused and insight-oriented approaches.
Summary The fit of the patient's coping style Recurrent patterns of behaviour that characterise the individual when confronting new or problematic situations. to the focus of psychotherapy has been suggested as a means of improving treatment outcome. This article reviews the definitions, measures, and previous research surrounding this hypothesis. An original meta-analysis A study which uses recognised procedures to summarise 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. of 12 carefully selected studies (including several concerned with drinking or drug problems) involving 1291 patients resulted in an adjusted weighted average effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of the variability in the outcome across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. of 0.55 in favour of matching externalising Individuals who prefer to embrace novelty and change with activity and assertion. They seek contact with others, enjoy change, and are gregarious in their interactions with their world. Often described as externalising, gregarious, and extroverted. patients to symptom-focused therapies which rely largely on enhancing skill development and encouraging direct symptom change or, alternatively, matching internalising Individuals who protect themselves from stimulation by being self-critical, avoiding change, and withdrawing in the face of anticipated change or discord. They are sensitised and over-reactive to change and prone to be overwhelmed by fear. They seek stability and safety in a focus on internal experiences rather than on the instability and uncertainty of external events. Often described as internalising, avoidant, restrained, or introverted. patients to insight-focused treatments which seek to enhance the patient's insight or awareness. This medium-sized effect indicates that the average, well-matched treatment produced 8% better outcomes than a randomly matched treatment. In other words, the average patient engaged in a therapy well matched to their coping style was better off than 58% of those with a random match. The findings were consistent across all the relevant studies, all of which found interpersonal and insight-oriented therapies are more effective among internalising patients, whereas symptom-focused and skill-building therapies are more effective among externalising patients. Such findings indicate that non-diagnostic patient factors like coping style are important considerations in the selection of effective therapies.
Clinical examples and clinical recommendations are provided, including the recommendation that patients who manifest externalising tendencies can be provided with treatments that are focused on skill-building and symptom change, while those who manifest patterns of self-criticism and emotional avoidance are more likely to benefit from interpersonally focused and insight-oriented treatment. However, even with internalising patients, research suggests there is value in beginning treatment with direct, symptom-focused methods. As the coping style of the patient becomes clear, it may be optimal to switch to a more indirect, insight-focused approach if that patient's style is weighted toward internalising.
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: Preferences
Adapting psychotherapy to the individual patient: Culture
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
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