Another Look at the Nonspecific Hypothesis of Therapeutic Effectiveness

This study examined the effects of specific factors, that is, of well-defined therapist actions and techniques and patient behaviors and attitudes, on psychotherapy outcome. Forty patients diagnosed as suffering from stress-response syndromes following a traumatic event or a bereavement were treated in a brief, 12-session psychodynamic psychotherapy. Transcripts of therapy hours were rated with a Psychotherapy Process Q Sort designed to provide a standard language for the description and classification of the therapy process. Results demonstrated that specific factors were indeed predictive of treatment outcome, though usually in interaction with patient pretreatment disturbance level. The characteristics of process that predicted successful outcome with less and more disturbed patients paralleled the long-recognized distinction between "expressive" and "supportive" approaches. The data suggest that patient change is far more complex than the nonspecific hypothesis of therapeutic effectiveness implies. The view is presented that the failure to identify consistent correlations between specific aspects of process and treatment outcomes is the product of the attempt to find simple, direct associations, to the neglect of more complex research conceptualizations of process that adequately reflect the interaction of multiple influences in clinical treatments.