What Do We know about master therapists?

Ablon JS, Jones EE: How expert clinicians’ prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychotherapy Research 1998; 8:71–83 Summary: A panel of internationally known experts in psychodynamic (PD) and cognitive-behavioral (CB) therapy used the Psychotherapy Process Q-set (PQS) to produce prototypes of an ideal treatment in each of these therapy modalities. Experts rated each of the 100 PQS items (e.g., “patient’s dreams or fantasies are discussed”) according to how well it described an ideally conducted course of therapy that adheres to that therapy’s theoretical principles. The prototypes were then correlated with process and outcome variables in three archived treatment samples, of which two were psychodynamic and one was cognitive-behavioral. The psychodynamic treatments correlated positively and significantly with both the ideal psychodynamic and the ideal cognitive-behavioral prototypes. The cognitivebehavioral treatments correlated highly with the cognitive-behavioral prototype but not with the psychodynamic prototype. The psychodynamic prototype constructed by experts was consistently and positively correlated with outcome in both the psychodynamic and cognitive-behavioral treatment samples. The cognitive-behavioral prototype was not consistently positively correlated with outcome. Comment: This study addresses ideal expert technique in psychodynamic and cognitive-behavioral therapy more than it does the behavior of therapists identified as experts. The most remarkable finding is that the ideal psychodynamic prototype correlated positively with outcome in psychodynamic as well as cognitive-behavioral treatments, whereas the cognitivebehavioral prototype did not correlate consistently with outcome in any of the treatment samples. Although a high degree of adherence to the cognitive-behavioral prototype was demonstrated by the CB therapists, these results suggest that psychodynamic techniques may be more associated with outcome than are CB techniques, even in the CB sample. The results also indicate that PD therapists use a broader range of techniques than do CB therapists. PD therapists appear to be comfortable addressing cognitive themes, treatment goals, extratherapy activities, and new behaviors that patients might try. As the authors note, these findings demonstrate the importance of studying therapy process in addition to outcome. Without investigation into therapy process, we cannot know whether a presumptive cognitive-behavioral treatment actually contains significant psychodynamic ingredients or vice versa. The psychodynamic ingredients may be those most associated with outcome.