progress, to address new problems or issues that
have arisen in the interim, and to solidify the
gains that have been made.
It is important to evaluate with clients the
progress they have made (Lambert, 2007). Thera-
pists should also compile data and make notes on
progress in order to evaluate the quality of their
own efforts or the agency’s services and continue
to improve services to clients. The most reliable
data, of course, will come from formally designed
research projects (described in the following sec-
tion). However, clinicians and individual agencies
owe it to themselves and their clients to evaluate
the success of their own efforts.
Stages of Change
Prochaska and colleagues (e.g., Prochaska & Nor-
cross, 2002) have argued that it is also important to
recognize the client’sstage of changeregardless of the
treatment being administered. From this perspec-
tive, a client’s behavior change is seen as a process
that involves a progression through a set sequence
of stages:
Precontemplation: At this stage, the client has no
intention of changing his or her behavior
in the near future. Clients at this stage of
change have typically come in for treat-
ment because of outside pressure to do so
(e.g., court-ordered, pressure from family,
etc.). Prochaska and Norcross estimate that
50 to 60% of clients or patients are in this
stage.
Contemplation: At this stage, a client is aware
that a problem exists but has not yet
committed him- or herself to trying to
make changes. It is estimated that 30 to
40% of clients or patients are in this stage.
Preparation: Here, a client intends to make a
change in the near future.
Action: At this stage, clients are changing their
maladaptive behaviors, emotions, and/or
their environment. It is estimated that
10 to 20% are in this stage.Maintenance: At this stage, the client works on
preventing relapses and on furthering the
gains that have been made during the
action stage.
Termination: Here, the client has made the
necessary changes, and relapse is no longer
a threat.
The importance of this conceptualization of
the change process is twofold. First, it highlights
to clinicians that not all clients are at the point
where they are ready to commit to make changes
in their lives. In these situations, the goals in therapy
involve“moving”the client through the precon-
templation, contemplation, and preparation stages
to the action stage. Once at the action stage, the
“active ingredients”of the treatment can be admin-
istered and are more likely to have an effect. Thus,
an assessment of each client’s stage of change is
important. Second, Prochaska and Norcross
(2002) note that because certain“processes”char-
acterize each stage, clinicians should attempt to use
only those interventions that match or complement
the processes of that stage. For example, a clinician
with a client who is at the precontemplation stage
should attempt to raise the client’s awareness of his
or her behavior and the problems it is causing,
highlighting the advantages of making changes as
well as the potential benefits of psychotherapy. If
successful, the client can then be led from the pre-
contemplation to the contemplation stage.Psychotherapy Research
In this last section, we briefly review the methods of
psychotherapy research, the results of several major
outcome studies, and the recent trends in psycho-
therapy research. More extensive reviews and
books on methods of psychotherapy research are
available for the interested reader (e.g., Lambert &
Ogles, 2004).
In 1952, Eysenck produced a report suggesting
that psychotherapy with“neurotics”was no more
effective than no therapy at all (see Box 11-5).
Investigators took this and related work (Eysenck,PSYCHOLOGICAL INTERVENTIONS 333