they clinical psychologists, psychiatric social work-
ers, psychiatrists, or psychoanalysts). In the Con-
sumer Reports study (“Mental Health,” 1995),
people who saw a mental health professional rather
than a family physician for their psychological prob-
lems reported greater progress and more satisfac-
tion with their treatment. However, psychologists,
psychiatrists, and social workers all received simi-
larly high satisfaction ratings from consumers.
Thus, at this time, data do not seem to support
the superiority of one mental health profession
over others in terms of effectiveness and client
satisfaction.
To this point, we have surveyed a variety of
patient and therapist variables that are commonly
assumed to be related to outcome in psychotherapy.
As noted in our discussion, many of these assump-
tions are unsupported by psychotherapy research
findings. Table 11-3 lists some common assump-
tions about psychotherapy outcome that currently
have little or no empirical support.
Course of Clinical Intervention
There are so many forms of intervention, along
with so many different kinds of problems, that it
is impossible to describe with precision a sequence
of procedures that will apply equally well to every
case. However, a general description of the typical
sequence describes most forms of psychological
treatment.Initial Contact
When clients first contact the clinic or enter the
clinician’s office, they often do not know exactly
what to expect. Some will be anxious; others, per-
haps, suspicious. Some do not clearly understand
the differences between medical treatment and psy-
chotherapy. Others may be embarrassed or feel
inadequate because they are seeking help. Parents
who seek therapy for their child often do not knowT A B L E 11-3 Common, but Unfounded, Assumptions Regarding the Relationship Between
Patient/Client and Therapist Variables and Psychotherapy Outcome
Assumption Evidence
- Older patients have worse outcomes. No strong support for this assumption (Clarkin & Levy, 2004;
Garfield, 1994; M. L. Smith et al., 1980) - Only highly motivated patients achieve good
outcome.
Mixed support (Garfield, 1994)- Women patients achieve better outcomes. In general, biological sex appears unrelated to outcome (Sue
et al., 1994; Zane et al., 2004) - Ethnic minority patients consistently achieve
worse outcome.
No support for this assumption (Sue et al., 1994; Zane et al.,
2004)- Patients of high socioeconomic status achieve
better outcome.
No relationship between social class and outcome (Garfield,
1994)- Older therapists produce better outcomes. No relationship between therapist age and outcome (Beutler
et al., 1994, 2004) - Women therapists produce better outcomes. Mixed support (Beutler et al., 1994, 2004)
- Therapists matched with patients according to
their ethnicity produce better outcomes.
Effect is equivocal (Beutler et al., 1994, 2004)- Therapists who have undergone their own
personal therapy produce better outcomes.
Mixed results (Beutler et al., 1994, 2004)- More experienced therapists produce better
outcomes.
Mixed results (Beutler et al., 1994, 2004; Lambert & Ogles, 2004;
M. L. Smith et al., 1980)PSYCHOLOGICAL INTERVENTIONS 329