摘要
门诊心理治疗是我国心理健康服务体系的一个重要组成部分,对治疗和缓解非精神病性心理障碍具有重要作用。我国门诊心理治疗的效果究竟如何,已有这方面的研究大多集中在门诊调查报告中,由治疗师单方面做简单有效或无效评价;研究内容单一,通常是与药物治疗作比较,缺乏对个体心理治疗效果的研究。本研究采用心理治疗研究中的效果设计取向,在自然状态下对医院个体形式的心理治疗效果进行研究。研究内容包括结果研究和过程研究两部分。
本研究采用问卷法、访谈法和单个案方法等多种方法,对门诊心理治疗的效果、治疗因素和作用机制进行探讨。在修订与编制了两个治疗效果问卷与三个心理治疗会谈成分问卷后,结果研究部分利用问卷调查门诊患者心理治疗满意度及其影响因素,以及对门诊多次治疗患者心理治疗效果进行连续监测,采用生存分析建构门诊心理治疗的剂量效果模型:过程研究部分放在一次会谈中进行考察,根据Lambert(1992)提出的心理治疗效果四因素模型设计泛理论会谈效果模型,并采用结构方程模型探讨和验证一次会谈中四因素如何作用产生治疗效果。最后通过单个案研究对该模型进行验证和诠释。全文旨在对门诊心理治疗效果现状进行调查研究,并为心理治疗理论本土化提供依据。
主要的研究结果如下:
1.结合国内外相关资料自编门诊心理治疗满意度问卷,探索性因素分析表明满意度问卷形成一个因素,即满意度。经检验,问卷具有较好的同质信度和结构效度,临床实用性良好,可作为评估患者对心理治疗是否满意的有效工具。
2.结合国内外相关资料自编门诊心理治疗结果问卷,经检验具有较好的同质信度和重测信度;实证效度佳,能区分正常人群和门诊患者,对治疗改变敏感,与常用诊断量表中度显著相关,患者咨询前后问卷测得的即时效果与患者满意度间相关显著,且三个维度与满意度相关的差异性间接证实问卷具有良好的结构效度;相关程度分析和验证性因素分析也说明问卷具有较好结构效度,可以作为医院门诊心理治疗效果评价的工具。
3.修订期望问卷(CEQ和PEI-R),探索性因素分析表明期望问卷形成三个因素:效果期望、建议-关系期望和听众-赞成期望。问卷信效度经检测显示良好,可以作为评估患者对心理治疗期望的有效工具。
4.修订治疗联盟问卷(WAI-S台湾版),经检验,较好的同质信度、结构效度和实证效度,可以作为评估心理治疗中治疗联盟质量的有效工具。
5.修订会谈评价问卷(SEQ-V台湾版),经检验,较好的同质信度、结构效度和实证效度,可以用来评估患者心理治疗会谈感受。
6.本研究中大多数患者对门诊心理治疗满意。患者的性别、就业状况、诊断情况、既往咨询经历史和是否用药对满意度没有显著影响。患者的年龄、文化程度、家庭状况和收入水平对满意度有显著影响,表现为随年龄增长对心理治疗满意度下降,文化程度为初中及以下患者、家庭状况为独居者和收入水平最低者对心理治疗满意度最低。
7.剂量效果研究生存分析显示本研究中门诊心理治疗效率:5次会谈治疗后有1/4患者达到临床显著效果,9次会谈后半数患者可以获得临床显著效果,17次会谈后将会有3/4患者达到临床显著效果。该数据可供门诊心理治疗师与患者协商会谈次数时作借鉴参考。
8.本研究中患者对心理治疗效果抱有正向期望。在角色期望方面,患者更倾向于寻求建议-关系而不是寻求听众-赞成。性别对期望没有显著影响;年龄越小越渴望寻求建议-关系;教育程度越高,效果期望有增加趋势,而寻求建议-关系期望增加更显著;独居者最倾向于寻求听众-赞成,与配偶和父母居住者最倾向于寻求建议-关系,抱有最大的效果期望;休学者最愿意寻求建议-关系;收入越低越倾向于寻求建议-关系,收入越高越倾向于寻求听众-赞同。神经症更多寻求建议-关系,人格障碍更多寻求听众-赞同;心理障碍越严重,效果期望和寻求建议-关系期望越低;既往没有咨询经历的人抱有更高效果期望,而有咨询经历的人抱有更高角色期望;对既往咨询效果评价越高,所持效果期望越高;没有接受药物治疗患者的效果期望更高,而接受药物治疗者更倾向于寻求建议-关系。
9.本研究中患者评价的治疗联盟总体正向,但与台湾和美国相比仍有差距,有待提高。性别对治疗联盟没有显著影响;年龄越小、教育程度越高、以及收入越低者对联盟评价越高;家庭结构越完整对治疗联盟评价越高,与父母和配偶居住者最高,独居者评价最低;上班上学者对治疗联盟评价好于待业者。神经症评价的治疗联盟最高,而人格障碍评价的治疗联盟最低;心理病理越严重,治疗联盟评价越差;咨询经历有无不影响患者对治疗联盟的评价,但对既往咨询效果评价越高,治疗联盟评价越高;是否用药不影响患者评价的治疗联盟。
10.本研究中患者的会谈评价总体正向,顺畅性评价稍高于深度性。性别和收入对会谈评价没有显著影响;年龄越小会谈评价越高;教育程度越高会谈评价也越高;与父母配偶居住者会谈评价最高,独居者评价最低;休学者对会谈评价最高,而待业者最低。诊断类型对会谈评价无影响;心理病理越严重对会谈顺畅性评价越低;既往没有接受过心理咨询者会谈评价高于有咨询经历者,对既往咨询效果评价越高,对本次会谈评价越高;药物使用对会谈评价无显著影响。
11.本研究证实效果期望是通过治疗联盟为中介对会谈评价产生作用,中介效应大于直接效应。建议-关系期望是通过治疗联盟的完全中介作用对会谈评价产生作用。
12.本研究显示会谈效果模型有较好的拟合度,模型可以接受。根据会谈效果模型得出心理治疗的总效果为单次会谈效果累积,会谈前心理健康状态好的患者通过治疗后获益更多,获益部分是通过期望→治疗联盟→会谈评价中介。期望是通过治疗联盟→会谈评价促进治疗效果,其作用为间接效应。治疗联盟对治疗效果的正效应是通过会谈评价完全中介。会谈评价作为治疗效果的即时指标对其有正预测力。
13.单个案研究中结合定量分析和质性研究,发现对患者治疗改善有帮助的因素是4个:患者资源、治疗关系、干预技术和期望,患者资源通过影响期望,期望影响治疗关系,而治疗关系决定干预技术的使用,它们联合在一起协调一致共同导致治疗改变发生,验证前文提出的会谈效果模型。
Outpatients psychotherapy is an important constituent of the mental health service system in China, which can cure and relieve nonpsychotic mental disorders. However, most of the studies about effectiveness of outpatients psychotherapy in China concentrate in survey design, are evaluated success or not by therapists only, and compare psychotherapy with drug treatment which leading to short of individual psychotherapy. Taking the treatment effectiveness research orientation, the present study use methods of questionnaire, interview and single-case methology to comprehensively and thoroughly discuss the outcome and process of individual psychotherapy for outpatients in naturalistic state.
Firstly, we developed two outcome questionnaires, named Client Satisfaction Questionnaire for Outpatients Psychotherapy and Psychotherapy Outcome Questionnaire for outpatients. Also we revised three processes questionnaires, named Psychotherapy Expectancy Scale, Working Alliance Inventory-Short, and Session Evaluation Questionnaire. Secondly, using outcome questionnaires, the outcome research investigate and evaluate the effect of outpatients psychotherapy from client satisfaction and dose-effect model. Thirdly, using outcome questionnaire and processes questionnaires, the process research construct session effect model by Lambert's four therapeutic factors model(1992).Finally, in order to verify and interpretation session effect model, we use single-case methodology to study favorable factors during counseling. The aim of the study is to investigate psychotherapy effect in naturalistic state, which can provide reference for theory localization.
Then main finding are summarized as follows:
1.According to related data at home and abroad, we developed ourselves client satisfaction questionnaire. Exploratory factor analysis of client satisfaction questionnaire resulted in construction of one factors:satisfaction. It was tested that client satisfaction questionnaire had good internal reliability, content validity, structure validity, and clinical utility, and could be an effective tool evaluating client's satisfaction.
2.According to related data at home and abroad, we developed ourselves psychotherapy outcome questionnaire.It was tested that psychotherapy outcome questionnaire had good internal and test-retest reliability, could distinguish patients from the normal, was sensitive for change, and had convergent validity with common diagnostic instruments. The difference between the score tested before and after one session correlated significantly with the score of client satisfaction questionnaire, which show its good empirical validity. The sub factors' correlation with the score of client satisfaction questionnaire are different which show its good structure validity. Correlation analysis and confirmatory factor analysis of psychotherapy outcome questionnaire also show it good structure validity. It could be an effective tool evaluating psychotherapy outcome.
3.We combine Client expectation questionnaire with Psychotherapy Expectancy Inventory-Revised and revised them as our psychotherapy expectancy questionnaire. Exploratory factor analysis of expectancy questionnaire resulted in construction of three sub factors:outcome expectation, advice-relationship expectation, and audience-approval expectation. It was tested that psychotherapy expectancy questionnaire was reliable and valid, can be an effective tool evaluating client expectancy of psychotherapy.
4.We revised Working Alliance Inventory-Short (WAI-S). Confirmatory factor analysis of WAI-S resulted in construction of one sub factors:alliance. It was tested that WAI-S had good internal reliability, structure validity, and empirical validity, could be an effective tool evaluating psychotherapy alliance for patients.
5.We revised Session Evaluation Questionnaire-V(SEQ-V). Confirmatory factor analysis of SEQ-V resulted in construction of two sub factors:depth and smooth. It was tested that SEQ-V had good internal reliability, structure validity, and empirical validity, could be an effective tool for patients evaluating session experience.
6. We use client satisfaction questionnaire to evaluate the effect of outpatients psychotherapy. Most patients are satisfied with their psychotherapy. Patient's variables, such as gender, employment, diagnosis, the history of previous psychotherapy, and meditation have no statistically significant difference on client satisfaction. In terms of the patients age, it shows the younger the better. In terms of education, it shows the lowest the worst. In terms of family status, the satisfaction of the patients living on their own are worst. In terms of income, the lowest the worst.
7.Using dose-effect design, survival analysis indicated that 25% patients attain clinical significant change(CS) was 5 sessions,50% patients attain CS was 9 sessions, and 75% patients attain CS was 17 sessions. Psychotherapists who negotiates with patients about the length of treatment can refer to these data.
8.We use psychotherapy expectancy questionnaire to evaluate the expectation of patients. Most patients have positive outcome expectation, and patients are more likely to seek advice-relationship than audience-approval.Patient's variables, such as gender, has no statistically significant difference on patients expectation. In terms of age, it shows the younger the more seeking advice-relationship. In terms of education, it shows the higher the education the higher the outcome expectation, and the more seeking advice-relationship. The patients living on their own are more likely to seek audience-approval, and also lower outcome expectation. The patients living with their parents and spouses are more likely to seek advice-relationship, and also higher outcome expectation. The patients who dropout of school are more likely to seek advice-relationship.The higher income the more seeking audience-approval, and the lower income the more seeking advice-relationship. The patients diagnosed as neurosis are more seeking advice-relationship, and the patients diagnosed as personality disorder are more seeking audience-approval. The higher score of psychotherapy outcome questionnaire, the worse of mental status, and the lower of outcome expectation and the less seeking advice-relationship. The patients with no experience of psychotherapy have higher outcome expectation, and the patients with experience of psychotherapy has high role expectation. The patients who valued their previous psychotherapy have higher outcome expectation. The patients without meditation have higher outcome expectation, and the patients with meditation are more likely to seeking advice-relationship.
9.We use WAI-S to evaluate the patients' relationship with their therapists. Most patients have positive relationship with their therapists, but the score are lower than that of Chinese Taiwan and USA.Patient's variables, such as gender, previous psychotherapy experience, and meditation or not has no statistically significant difference on the score of WAI-S.The patients who are younger, higher education, lower income, and living with their parents and spouses give higher score of their WAI-S.The patients who are living on their own, unemployment give lower score of their WAI-S. The patients diagnosed as neurosis give higher score of their WAI-S than personality disorders. The higher score of psychotherapy outcome questionnaire, the worse of mental status, and the lower of the score of WAI-S.The patients who valued their previous psychotherapy have high score of WAI-S.
10. We use SEQ-V to evaluate the session experience of patients. Most patients have positive experience with their session, and give higher score on smooth factor than depth factor. Patient's variables, such as gender, income, diagnosis, and meditation or not have no statistically significant difference on their score of SEQ-V. In terms of the patients age, it shows the younger the better. In terms of education, it shows the higher the better. In terms of family status, the score of SEQ-V of the patients living on their own are worse than that of the patients living with their parents and spouse. In terms of employment, the score of the dropout of school are higher than that of unemployment. The higher score of psychotherapy outcome questionnaire, the worse of mental status, and the lower of the score.The patients without previous psychotherapy experience give higher score than the patients with previous psychotherapy experience, and the patients who valued their previous psychotherapy have high score of SEQ-V.
11.Amos7.0 software was applied to explore the relationships of expectancy, working alliance, and session evaluation. We find that the working alliance mediates the relationship between outcome expectation and session evaluation, and mediation effect is larger than direct effect; the working alliance mediated the relationship between advice-relationship expectation and session evaluation, and it is complete mediation.
12.Amos7.0 software was applied to explore the session effect model.After modifying original model, many fit indices indicated the model fit was satisfactory. The session effect model show us psychotherapy outcome are added by every session effect. The treatment gains(the mental health status before the session) promote expectancy, and expectancy in turn fosters working alliance. Working alliance leads to high session evaluation, and productive sessions are linked to augmentation in mental health status. Positive influences for expectancy, working alliance, and session evaluation were observed, and expectancy and working alliance have no direct effect on mental health status after the session.
13.The single-case methodology combined quantitative and qualitative research, proved four therapeutic factors on the patient:patient resources, working alliance, specific techniques and expectancy. Patient resources influence patient expectancy, and expectancy influence working alliance, and working alliance govern the use of specific techniques. All the four factors linkup and lead to change aligned.
引文
柏涌海,殷雪平.(2008).综合性医院开始心理咨询的历史、现状与展望.医疗管理,28(9),34-36.
程灶火.(2000).心理治疗的发展趋势.中国临床心理学杂志,8,192-194.
崔维珍,王东明,于国勤.(2004).帕罗西汀合并认知行为疗法治疗惊恐障碍疗效分析.山东精神医学,17(4),236-237.
戴王磊.(2001).综合性医院心理门诊5年情况分析.健康心理学杂志,9, 248-249.
范青,季建林.(2006).中国心理咨询的发展及现状.上海精神医学,18(1),45-46.
高洁清,张承芬.(2008).心理治疗中的反馈研究进展.济南大学学报(社会科学版),18(1),87-89.
梁宝勇.(2004).从两种咨询模式看我国心理咨询师的培养.心理科学27,1494-1496.
龚耀先,李庆珠.(1996).我国临床心理学工作现状调查与展望.中国临床心理学杂志,4(1),1-9.
关丹丹,张厚粲,李中权.(2005).差异分数的信度分析.心理科学,28(1),161-163.
何心展,陈传锋,沈斌表.(2002).不同阶层心理健康观念及需求状况的调查研究.应用心理学,8(2),35-38.
洪炜,汤艳清,郭蓄芳.(2004).心理治疗中诊断的概念与意义.中国心理卫生杂志,18595-598.
侯志瑾,弓建华,余淑君,常雪亮.(2008).《中国临床心理学杂志》心理咨询与治疗文章(1993-2007)内容分析.中国临床心理学杂志,16,557-560.
胡庆菊,王继丰,孙红梅.(2006).心理治疗合并阿普唑仑治疗失眠症的对照研究.中国行为医学科学15(4),348.
胡姝婧,江光荣.(2008).心理咨询过程-效果研究现状及展望.心理科学进展,16(4),567-575.
黄希庭,郑涌,毕重增,陈幼贞.(2007).关于中国心理健康服务体系建设的若干问题.心理科学,30(1),2-5.
黄希庭,张志杰.(2005).心理学研究方法北京:高等教育出版社.
黄晓琴,周春秀,章洋.(2006).综合医院心理咨询门诊来访者临床特征研究.安徽医药,10,849-851.
黄雪卡,邓燕华,李少华.(2007).综合医院心理咨询门诊患者心理障碍调查分析.国际医药卫生导报,13(18),133-136.
江光荣.(2003).心理治疗关系之作用机制研究述评。心理科学进展,11(5),555-561。
蒋湘玲.(2006).医院门诊心理咨询与治疗分析.中国热带医学,6,1708-1709.
李成齐.(2006).心理治疗效果的元分析研究综述.国际中华应用心理学杂志,3(1),44-46.
李箕君,张宁,袁勇贵.(2002).不同性别、年龄的来访者对心理咨询的态度比较.健康心理学杂志,10(1),73-75.
李将镐.(1996).对东方心理咨询的模式的探索.心理科学,19,180-182.
林崇德,杨治良,黄希庭.(编).(2003).心理学大辞典.上海:上海教育出版社.
梁宝勇.(2004).从两种咨询模式看我国心理咨询师的培养.心理科学27(6),1494-1496.
刘新民.(2000).关于我国当前心理咨询模式的若干思考.医学与哲学,227(4),48-50.
吕秋云,李雪霓.(2004).心理咨询和心理治疗的现状及面临的挑战.心理与健康,7,4-6.
马惠霞.(2002).循证医学与心理治疗.中国临床康复,6(21),3151-3153.
宁洁,李伟民,卢殿军.(2004).强迫症短程心理治疗前药物铺垫与治疗效果的关系.重庆医学,33(7),1089-1090.
钱铭怡.(2000).心理咨询与心理治疗.北京:北京大学出版社.
秦旻,郑涌.(2009).心理治疗消极后果.心理科学进展,17(3),623-630.
沈启莹,胡燕,李良杰,朱记军,耿德勤.(2008).1023例综合性医院心理咨询者特点分析.徐州医学院学报,28(3),169-172.
施加平,邵亦冰,张英萍,刘宣文.(2008).国内心理治疗效果的文献计量学分析.中国健康心·理学杂志,2,233-235.
孙启武,江光荣.(2008).心理咨询中的期望:概念辨析及理论视角.心理科学进展,16,913-918.
王登峰.(1999).临床心理学(pp.238-240).北京:人民教育出版社.
王丽颖,李晓虹,沈东郁,林涛,黄建军,王倩等.(2007).首都地区心理门诊就诊人群状况调查.中国临床心理学杂志,15,211-213.
汪向东,王希林,马弘.(2000).心理卫生评定量表手册.北京:中国心理卫生杂志社.
王中杰.(2005).咨询师的个人特质对心理咨询效果的影响.中国心理卫生杂志,19(11),787-788.
温忠麟,侯杰泰,马什赫伯特.(2004).结构方程模型检验:拟合指数与卡方准则.心理学报,36(2),186-194.
吴明霞,郑涌,汤万文.(2001).心理治疗效果评价的进展.心理科学进展,151-156.
徐大真,徐光兴.(2007).我国心理健康服务体系模式建构.中国教育学刊,4,5-9.
徐华春,黄希庭.(2007).国外心理健康服务及其启示.心理科学,30,1006-1009.
杨富英,邓慧琨.(2005).996例门诊心理咨询者心理测验结果分析.现代临床医学生物工程学杂志,11,310-312.
杨宏飞.(2002).心理咨询效果评价的组织和概念图式简介.心理科学,25(5),588-590.
杨宏飞.(2005).心理咨询效果评价模型初探.心理科学,28,656-659.
叶斌.(2006).影响力模式:对中国人心理咨询和治疗模式的探索.上海:华东师范大学博士论
文.
曾文星,徐静.(2005).心理治疗:学说与研究北京:北京大学医学出版社.
张宁.(2004).医疗机构心理咨询与心理治疗开展情况及对策.医学与哲学,25(9),72-73.
张宁,李箕君,袁勇贵.(2001a).对心理咨询及咨询师的期望与要求的研究.中国心理卫生杂志,15(4),250-252.
张宁,李箕君,袁勇贵.(2001b).心理咨询的现状调查.健康心理学杂志,9(5),389-391.
张日昇,徐洁,张雯.(2008).心理咨询和治疗研究中的质性研究.心堙料学,31(3),681-684.
张文彤(主编).(2002).SPSS11.0统计分析教程.北京希望电子出版社。
赵耕源,张晋碚,张亚哲,黄铎香,蔡香山,潘集阳等.(1994).综合医院心理咨询的研究.中山医科大学学报,13,68-72.
赵玮琳,吴京平,施穗琴,梁红英.(2000).综合医院1898人次心理咨询分析.19(1),74-75.
郑日昌,张杉杉,张雯.(2000).心理咨询与治疗在中国的发展现状.中国心理卫生杂志,14(1),68.
中国科学院心理研究所.(2008-4-11).城市居民心理健康状况值得关注.光明日报,4.
钟友彬.(1995).心理咨询工作中的医学诊断和心理诊断.中国临床心理理学杂志,3,53-55.
朱亮,刘晓艳.(2007).我国心理咨询的现状与对策探析.合肥工业大学学报(社会科学版),21,146-149.
布洛克,S.著/陈一筠,金锋译.(1992).心理治疗必读.北京:中国社会科学出版社(原著1980年出版).
Mcleod, J.著/潘洁译.(2005).心·理咨询导论.上海:上海社会科学院出版社(原著1998年出版).
Sperry, L.,Carlson, L.,& Kjos, D.著/张莉娟等译.(2006).成为有影响力的治疗师.北京:世界图书出版公司北京公司(原著2003年出版),
Weiner, I. B.著/周博林等译.(2007).心理治疗的法则.成都:四川人民出版社(原著1998年出版).
陈斐娟.(1996).谘商历程中的重要事件、工作同盟与谘商关系分析研究.台湾:彰化师范大学博士论文.
陈庆福(995).谘商员与当事人在谘商过程中的同盟、口语反应模式与晤谈感受之研究.台湾:彰化师范大学博士论文.
洪雅凤.(1998).当事人依附,工作同盟与晤谈感受之相关研究.台湾:彰化师范大学硕士论文.
李锦虹.(2004).量化的探索式心理治疗历程研究回麒.輔仁醫學期刊,2(suppl),13-29.
连廷嘉,徐西森.(2004)谘商历程中谘商员口语反应类型及其当事人反应行为之分析研究:个本土化归类系统的初探研究.中华辅导与谘商学报,15,1-38.
吴秉(?).(2006).过早结案/共同决义结案的個案——谘商员所知觉工作同盟、晤谈感受差異之研
究.台湾:屏東教育大學硕士论文.
谢佩玲,王丽斐.(2007).心理治疗师反移情经验之历程研究.教育心理学报,38(4),461-480.
许育光.(2005).断开与复合-一段治疗关系的叙说、反思与探究.辅导与咨商学报,27(2),33-52.
余鹿桦,陈永庆,张娟凤,黄惠玲,林耀盛,陈九五.(2002).台湾地区谘商与心理治疗效果的集成分析研究.The Kaohsiung Journal of Medical Sciences,1,5-16.
Abouguendia, M., Joyce, A.S.,Piper, W. E.,& Ogrodniczuk, J.S.(2004). Alliance as a mediator of expectancy effects in short-term group psychotherapy. Group Dynamics:Theory, Research, and Practice,8,3-12.
Anderson, A.J.(1999).Methodological approaches in mental health services research and program evaluation. International Journal of Psychosocial Rehabilitation,4,73-92.
Anderson, E. M.,& Lambert, M. J.(2001).A survival analysis of clinical significant change in outpatient psychotherapy. Journal of Clinical Psychology,57,875-888.
Acosta, F. X., Evans, L. A.,Yamamoto, J.,& Skilbeck, W. M.(1983).Preparing low-income Hispanic, Black, and White patients for psychotherapy:evaluation of a new orientation program. Journal of Clinical Psychology,39(6),872-878.
Barber, J.P. (2007). Issues and findings in investigating predictors of psychotherapy outcome: introduction to the special section. Psychotherapy Research,17(2),131-136.
Barber, J.P. (2009). Toward a working through of some core conflicts in psychotherapy research. Psychotherapy Research,19(1),1-12.
Barkham, M.,Connell,J.,Stiles, W.B.,Miles, J.N.V.,Margison, F.,Evans, C.,& Mellor-Clark, J. (2006). Dose-effect relations and responsive regulation of treatment duration:The good enough level. Journal of Consulting and Clinical Psychology,74,160-167.
Barkham, M., Evans, C.,Margison, F.,Mcgrath, G.,Mellor-Clark, J.Milne, D.,& Connell, J.(1998). The rationale for developing and implementing core outcome batteries for rountine use in service settings and psychotherapy outcome research. Journal of Mental Health,7(1),35-47.
Barkham, M.,Margison, F.,Leach, C., Lucock, M.,Mellor-Clark, J.,Evans, C., et al.(2001). Service profiling and outcomes benchmarking using the Core-OM toward practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology,69(2), 184-196.
Baron, R. M.,& Kenny, D. A.(1986). The moderator-mediator variable distinction in social psychological research:conceptual, strategic and statistical considerations.Journal of Personality and Social Psychology,51(6),1173-1182.
Bauer, S.,Lambert, M. J.& Nielsen, S. L. (2004). Clinical significance methods:a comparison of statistical techniques.Journal of Personality Assessment,82(1),60-70.
Bergin, A.E.(1971).The Evaluation of Therapeutic Outcomes, In A.E. Bergin,& S.L. Garfield (Eds.),Handbook of Psychotherapy and Behavior Change:An Empirical Analysis,217-270, New York:John Wiley & Sons, Inc..
Berzins, J.I.,Herron, E.,& Seidman, E.(1971).Patient'role behaviors as seen by therapists:A factor analytic study. Psychotherapy:theory, research and practice,8,127-130.
Beretvas, S.N.,& Kearney, L. K. (2003).A shortened form of the outcome questionnaire:A validation of scores across ethnic groups.Retrieved Sep 4,2007 from http://www. utexas.edu/ student/cmhc/research/rescon.html
Bleyen, K.,Vertommen, H.,Vander Steene, G.,& Van Audenhove. (2001).Psychometric properties of the Psychotherapy Expectancy Inventory-Revised (PEI-R).Psychotherapy Research,11(1), 69-83.
Borkovec, T. D.& Miranda, J.(1999). Between-group psychotherapy outcome research and basic science. Journal of Clinical Psychology,55(2),147-158.
Bordin, E.S.(1979). The generalizability of the psychoanalytic concept of the working alliance, Psychotherapy:Theory, Research and Practice,16,252-260.
Burns, D.D.& Spangler, D.L. (2001a). Can we confirm our theories? Can we measure causal effects? Reply to Kazantzis et al.Journal of Consulting and Clinical psychology,69(6),1084-1086.
Burns, D D.& Spangler, D.L. (2001b). Do changes in dysfunctional attitudes mediate changes in depression and aAnxiety in cognitive behavioral therapy? Behavior Therapy,32,337-369.
Burns, D.D.& Spangler, D.L. (2001c).Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? Journal of Consulting and Clinical Psychology,68(1),46-56.
Busseri, M. A.,& Tyler, J.D. (2003).Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychological Assessment,15,193-197
Bybee, T.S.,Lambert, M.J.,& Eggett, D. (2007). Curves of expected recovery and their predictive validity for identifying treatment failure. Retrieved July 10,2008, from http://psychology. byu. edu/Faculty/MLambert/Assets/BybeeLambertOQ_30%202007.pdf.
Clark, D.M.,Salkovskis, P. M.,Hackmann, A.,et al(1994).A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry,164,759-769.
Conner, M. (2006). A summary of research on the effectiveness of antidepressants and psychotherapy. Portland Oregon, USA:Mentor Research Institute.
Constantino, M.J.,Arnow, B.A.,Blasey, C.,& Agras, W. S.(2005).The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa,.Journal of Consulting and Clinical Psychology,73,203-211.
Constantino, M.J.,& DeGeorge, J.(2007).Believing is see:Clinical implications of research on patient expectations.Retrieved Jan 7,2008 from http://www.divisionofpsychotherapy.org/tag/ expectations/
Conte, H. R., Plutchik, R.,Picard, S.,& Karasu, T. B.(1991).Can personality traits predict psychotherapy outcome? Comprehensive Psychiatry,32(1),66-72.
Conte, H. R.,Ratto, R.& Karasu, T. B.(1996). The psychological mindedness scale:factor structure and relationship to outcome of psychotherapy. The Journal of Psychotherapy Practice and Research,5,250-259.
Collins, L. M.,Murphy, S.A.,& Bierman, K. A.(2004). A conceptual framework for adaptive preventive interventions. Prevention Science,5,185-196.
De Jong, K.,Nugter, M. A.,Polak, M. G.,Wagenborg, J. E. A.,Spinhoven, P.,& Heiser, W.J. (2007).The Outcome Questionnaire-45 in a Dutch population:A cross cultural validation. Clinical Psychology & Psychotherapy,14,288-301.
Devilly, G. J.& Borkovec, T. D (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry,31,73-86.
Docherty, J.P.,& Streeter, M. J.(1996). Measuring outcomes. In:L.I. Sederer & B.Dickey (Eds.), Outcome assessment in clinical practice. Baltimore, M.D.,USA:Williams and Wilkins.
Doss, B.D. (2004). Change the way we study change in psychotherapy. Clinical psychology:science and practice,11(4),368-386.
Elkin, I.,Shea, M.T., Watkins, J.T.,Imber S.D.,Sotsky S.M.,Collins J.F.,Glass D.R.,& Docherty J.P. (1989).National Institute of Mental Health Treatment of Depression Collaborative Research Program:General effectiveness of treatments. Archives of General Psychiatry,46,971-982.
Elliott, R.,& Wexler, M. M.(1994). Measuring the impact of sessions in process experiential therapy of depression:The Session Impact Scale. Journal of Counseling Psychology,43, 456-460.
Erwin, E. (2006). Randomized clinical trials in psychotherapy outcome research. Philosophy of Science,78,135-152.
Field, S.D., Barkham, M.,Shapiro, D. A.& Stiles, W. B.(1994). Assessment of assimilation in psychotherapy:A quantitative case study of problematic experiences with a significant other. Journal of Counseling Psychology,41,397-406.
Fitzpatrick, M.,Iwakabe, S.,& Stalikas, A. (2005). Perspective divergence in the working alliance. Psychotherapy Research,15,69-79.
Fong, C.,Lee, G. K., Lee, E.-J.,Kubota, C.,& Allen, C. A.(2007). Structural equation in modeling in rehabilitation counseling research. Retrieved Sep 17,2009 from http://rcb. sagepub.com/ cgi/content/refs/51/1/44.
Froyd, J.E.,& Lambert, M. J.(1989).A survey and critique of psychotherapy outcome measurement[electronic version].Paper presented at the Western Psychological Association Conference, Reno, NV,1989.
Gary, R.(1996).Outcome assessment of psychotherapy. American Psychologist,51,1005-1006.
Gelso, C.J.,& Carter, J. A.(1994). Components of the psychotherapy relationship:their interaction and unfolding during treatment. Journal of Counseling Psychology,41(3),296-306.
Gibbons, M. B.C.,Crits-Christoph, P.,de la Cruz, C., Barber, J.P.,Siqueland, L.,& Gladis, M. (2003).Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy, Psychotherapy Research,13,59-76.
Glass, C. R.,Arnkoff, D. B.,& Shapiro, S.J.(2001).Expectations and preferences.Psychotherapy, 38(4),455-461.
Gordon, N.S.(2000). Researching psychotherapy, the importance of the client's view:a methodological challenge. The Qualitative Report,4(3).Retrieved June 29,2008 from http: //www. nova.edu/ssss/QR/QR4-3/gordon.html.
Greenberg, L. S.(1986).Change process research. Journal of Consulting and Clinical Psychology, 54(1),4-9.
Greenberg, R. G., Constantino, M. J.& Bruce N.(2006).Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review,26(6),657-678.
Greenfield, T.K.,& Attkisson, C.C.(1989). Steps toward a multifactorial satisfaction scale for primary care and mental health services. Evaluation and Programme Planning,12:271-278.
Gutkin, T. B.(1996). Patterns of consultant and consultee verbalizations:examining communication leadership during initial consultation interviews. Journal of School Psychology,34(3),199-219.
Guthrie, E.(2000a). Enhancing the clinical relevance of psychotherapy outcome research. Journal of Mental Health,9(3),267-271.
Guthrie, E.(2000b).Psychotherapy for patients with complex disorders and chronic symptoms-the need for a new research paradigm. British Journal of Psychiatry,177,131-137.
Haaga, D. A.F. (2004). Being systematic and maybe even scientific about planning psychotherapy research. Clinical psychology:science and practice,11(4),387-390.
Haas, E.& Hill,R. D. (2002). Do early responders to psychotherapy maintain treatment gains? Journal of Clinical Psychology,58,1157-1172.
Hannan, C.,Lambert, M. J.,Harmon, S.C.,Nielsen, S.L.,Smart, D.M.,Shimokawa, K., et al. (2005).A lab test and algorithms for identifying clients at risk for treatment failure.Journal of Clinical Psychology,61,155-163.
Hansen, N.B.,Lambert, M.J.,& Forman, E. M.(2002a). Do early responders to psychotherapy maintain treatment gains? Journal of Clinical Psychology,58,1157-1172.
Hansen, N.B.,Lambert, M.J.,& Forman, E. M. (2002b). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology:Science and Practice, 9(3),329-343.
Harmon, S.C.,Lambert, M. J.,Smart, D.M.,Hawkins, E.,.Nielsen, S.L., Slade, K.,& Lutz, W. (2007). Enhancing outcome for potential treatment failures:therapist-client feedback and clinical support tools. Psychotherapy Research,17(4),379-392.
Hatcher, R.L.& Barends, A.(1996).Patients'view of the alliance in psychotherapy:exploratory factor analysis of three alliance measures.Journal of Consulting and Clinical Psychology,64, 1326-1336.
Hayes, A.M.,Laurenceau, J.-P.,Feldman, G.,Strauss, J.L.,& Cardaciotto, L. (2007).Change is not always linear:The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review,27,715-723.
Herbert, J.D. (2003).The science and practice of empirically supported treatment. Behavior Modification,27(3),412-430.
Herman, S.M.(1998). The relationship between therapist-client modality similarity and psychotherapy outcome.The Journal of Psychotherapy Practice and Research,7,56-64.
Hersoug, A. G,H(?)glend, P.,Monsen, J. T.,& Havik, O.E. (09-01-2009) Development of working alliance over the course of psychotherapy. Psychology and psychotherapy:Theory, Research and Practice.
Hersoug, A. G,H(?)glend, P., Monsen, J. T.,& Havik, O.E. (2001).Quality of working alliance in psychotherapy:therapist variables and patient/therapist similarity as predictors. The Journal of Psychotherapy Practice and Research,10,205-216.
Hersoug, A.G., Monsen, J. T.,Havic, O. E.,& Hoglend,P. (2002). Quality of early working alliance in psychotherapy:diagnosis, relationship and intrapsychic variables as predictors. Psychotherapy and Psychosomatics,71(1),18-27.
Hill, C.E.,& Knox, S.(2009). Processing the therapeutic relationship. Psychotherapy Research, 19(1),13-29.
Holtforth, M. G., Castonguay, L. G.& Borkovec, T. D. (2004).Expanding our strategies to study the process of change. Clinical psychology:science and practice,11(4),396-404.
Horvath, A.(1994).Research on the alliance. In A.Horvath & L. Greenberg (Eds.),The working alliance:Theory, research, and practice (pp.259-286). New York:John Wiley & Sons, Inc.
Horvath, A.O.& Greenberg, L.S.(1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology,36,223-233.
Horvath, A.O.,& Marx, R.W.(1990). The development and decay of the working alliance during time-limited counseling. Canadian Journal of Counseling,24(2),240-259.
Horvath, A.O.,& Symonds, B.D.(1991).Relation between working alliance and outcome in psychotherapy:A meta-analysis.Journal of Counseling Psychology,38,139-149.
H(?)glend, P.(1999). Psychotherapy Research-new findings and implications for training and practice. The Journal of Psychotherapy Practice and Research,8(4),257-263.
Hoglend, P., Amlo, S.,Marble, A.,B(?)gwald, K-P, S(?)rbye,(?).,Sjaastad, M.C.,& Heyerdahl,O. (2006).Analysis of the patient-therapist relationship in dynamic psychotherapy:an experimental study of transference interpretations. American Journal of Psychiatry,163(10), 1739-1746.
Howard, K. I.,Kopta, S.M.,Krause, M. S.,& Orlinsky, D. E.(1986). The dose-effect relationship in psychotherapy. American Psychologist,41,159-164.
Howard, K. I.,Krause, M. S.,Saunders, S.M.,& Kopta, S.M.(1997).Trials and tribulations in the meta-analysis of treatment differences:comment on Wampold et al.(1997).Psychological Bulletin,122,221-225.
Howard, K. I.,Lueger, R. J.,Maling, M. S.,& Martinovich, Z.(1993).A phase model of psychotherapy outcome:causal mediation of change. Journal of Consulting and Clinical Psychology,4,678-685.
Howard, K. L.,Moras, K.,Brill, P. L.,Martinovich, Z.,& Lutz, W.(1996). Evaluation of psychotherapy:efficacy, effectiveness, and patient progress. American Psychologist,51, 1059-1064.
Hubble, M. A.,Duncan, B.L.,& Miller, S.(1999). The heart and soul of change:What works in therapy. Washington, DC:The American Psychological Association.
Johansson, P.,& Hoglend, P. (2007). Identifying mechanisms of change in psychotherapy:mediators of treatment outcome.Clinical Psychology and Psychotherapy,14,1-9.
Joreskog, K.G. (June 22,1999).How large can a standardized coefficient be? Retrieved Jan 19,2010 from http://www.ssicentral.com/lisrel/techdocs/HowLargeCanaStandardizedCoefficientbe.pdf.
Joyce, A. S.,McCallum, M.,Piper, W. E.,& Ogrodniczuk, J.S.(2000). Role behavior expectancies and alliance change in short-term individual psychotherapy. Journal of Psychotherapy Practice and Research,9,213-225.
Joyce, A.S.,Ogrodniczuk, J. S.,Piper, W. E.,& McCallum, M. (2003).The alliance as mediator of expectancy effects in short-term individual therapy. Journal of Consulting and Clinical Psychology,71,672-679.
Joyce, A.S.& Piper, W. E.(1998).Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy. The Journal of Psychotherapy Practice and Research,7, 236-248.
Kadera, S.W., Lambery, M.J.,& Andrews, A.A.(1996). How much therapy is really enough? A session-by session analysis of the psychotherapy dose-effect relationship. Journal of Psychotherapy:Practice and Research,5,1-20.
Kaplan, E. L.,& Meier, P.(1958). Nonparametric estimation from incomplete observations. Journal of the American Statistical Association,53,457-481.
Kaufman, N.K.,Rohde, P.,Seeley, J.R.,Clarke, G.N.,& Stice, E.(2005). Potential mediators of cognitive-behavioral therapy for adolescents with comorbid major depression and conduct disorder. Journal of Consulting and Clinical Psychology,73,38-46.
Kazdin, A.E. (2007). Mediators and mechanisms of change in psychotherapy. The Annual Review of Clinical Psychology,3,1-27.
Kiesler, D. J.(2004). Intrepid pursuit of the essential ingredients of psychotherapy. Clinical psychology:science and practice,11(4),391-394.
Kivlighan,D.M.,& Angelone, E.D.(1991).Helpee introversion, novice counselor use, and helpee-rated session impact. Journal of Counseling Psychology,38(1),25-29.
Kivlighan, D. M.,& Shaughnessy, P. (2000). Patterns of Working Alliance Development:A Typology of Working Alliance Ratings. Journal of Counseling Psychology,47,362-371.
Klee, M. R.,Abeles, N.,& Muller, R. T.(1990). Therapeutic alliance:Early indicators, course, and outcome. Psychotherapy,27,166-174.
Kolden, G. G., Chisholm-Stockard, S.M., Strauman, T. J.,Tierney, S.C.,Mullen, E.A..& Schneider, K. L. (2006). Universal session-level change processes in an early session of psychotherapy:path models. Journal of Consulting and Clinical Psychology,74(2),327-336.
Kopta, S.M., Lueger, R. J.,Saunders, S.M.,& Howard, K. I.(1999).Individual psychotherapy outcome and process research:challenges leading to greater turmoil or a positive transition? Annual Review of Psychology,50,441-469.
Krause, M.S.& Howard, K. I.(1999). "Between-Group Psychotherapy Outcome Research and Basic Science" Revisited. Journal of Clinical Psychology,55(2),159-169.
Lambert, M. J.(1992). Psychotherapy outcome research:Implications for integrative and eclectic therapists. In J.C.Norcross,& M. R. Goldfried, (Eds.),Handbook of psychotherapy integration(pp.94-23).New York:Basic.
bvgLambert, M.J.(2001).Psychotherapy outcome and quality improvement:introduction to the special section on patient-focused research.Journal of Consulting and Clinical Psychology, 69(2),147-149.
Lambert, M.J.(2005).Early response in psychotherapy:further evidence for the importance of common factors rather than "placebo effects".Journal of Clinical Psychology,7,855-869.
Lambert, M. J.(2007). Presidential address:What we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychotherapy Research,17(1),1-14.
Lambert, M.J.& Bergin, A.E.(1994). The effectiveness of psychotherapy. In Bergin, A.E.,& Garfield, S.L. (Eds.),Handbook of psychotherapy and behavior change:an empirical analysis(pp.143-189).New York:John Wiley.
Lambert, M.J.,Burlingame, G.M.,Val Umphress, Hansen, N.B.,Vermeersch, D.A.,Clouse, G.C.,& Yanchar, S.C.(1996). The reliability and validity of the outcome questionnaire.Clinical Psychology and Psychotherapy,3,249-258.
Lambert, M. J., Hansen, N.B.& Finch, A.E.(2001).Patient-focused research:using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69(2),159-172.
Lambert, M.J.& Hawkins, E. J.(2004).Measuring outcome in professional practice:considerations in selecting and using brief outcome instruments.Professional Psychology:Research and Practice,35(5),492-499.
Lambert, M.J.,Lunnen, K., Umphress, V.,Hansen, N.& Burlingame, G.M.(1994). Administration and scoring manual for the Outcome Questionnaire (OQ-45.1).Salt Lake City: IHC Center for Behavioral Healthcare Efficacy.
Lambert, M.J.& Ogles, B.M. (2003).The efficacy and effectiveness of psychotherapy.In Lambert, M. J.(Eds.),Bergin and Garfield's Handbook of Psychotherapy and behavioral change (5th ed.) (pp.139-193).New York:John Wiley.
Lambert, M.J., Okiishi, J.C., Finch, A.E.,& Johnson, L. D.(1998). Outcome assessment:from conceptualization to implementation professional.Psychology:research and practice,29(1), 63-70.
Lambert, M. J.,Whipple, J. L.,& Bishop, M. J.(2002). Comparison of empirically-derived and rationally-derived methods for identifying patients at risk for treatment failure.Clinical Psychology and Psychotherapy,9,149-164.
Lambert, M. J., Whipple, J. L.,Smart, D. W.,Vermeersch, D.A.,Nielsen, S.L. (2001).The effects of providing therapists with feedback on patient progress during psychotherapy:Are outcomes enhanced?Psychotherapy Research,11,49-68.
Lambert, M.J.,Whipple, J.L.,Vermeersch, D. A.,Smart, D. W., Hawkins, E. J.,Lars Nielsen, S., et al.(2002). Enhancing psychotherapy outcomes via providing feedback on client progress:A replication. Clinical Psychology and Psychotherapy,9,91-103.
Larsen, D.L., Attkisson, C.C.,Hargreaves, W.A.,& Nguyen, T.D.(1979) Assessment of client/ patient satisfaction:Development of a general scale. Evaluation and Program Planning,2, 139-150.
Laurenceau, J.-P.,Hayes, A.M.,& Feldman, G. C. (2007). Some methodological and statistical issues in the study of change processes in psychotherapy. Clinical Psychology Review,27, 682-695.
Leahy, R. L. (2002).A model of emotional schemas.Cognitive and Behavioral Practice,9(3), 177-190.
Lepper, G.,& Riding, N. (2006).Researching the psychotherapy process:A practical guide to transcript-based methods(pp.1-17).Basingstoke, Hampshire, New York:Palgrave Macmillan.
Lilienfeld, S.O. (2007). Psychological treatments that cause harm. Perspective on Psychological Science,2,53-70.
Lingiiardi, V.,Filippucci, L.,& Baiocco, R. (2005).Therapeutic alliance evaluation in personality disorder psychotherapy. Psychotherapy Research,15,45-53
Lo Coco, G.,Chiappelli, M.,Bensi, L., Gullo, S.,Prestano, C.,& Lambert, M.J.(2008). The factorial structure of the outcome questionnaire-45:a study with an Itanian sample. Clinical Psychology & Psychotherapy,15(6),418-423.
Luborsky, L.(1976). Helping alliances in psychotherapy. In J.L. Cleghhorn (Ed.), Successful psychotherapy(pp.92-116). New York:Brunner/Mazel.
Luborsky, L.,Barber, J.P., Siqueland, L., Johnson, S.,Najavits, L.M., Frank, A.,& Daley, D.(1996). The Revised Helping Alliance Questionnaire (Haq-II). Journal of Psychotherapy Practice and Research,5,260-271.
Luborsky, L., Diguer, L., Seligman, D. A.,Rosenthal, R., Krause, E. D.,Johnson, S.,et al.,(1999). The researcher's own therapy allegiance:A "wild card" in comparisons of treatment efficacy. Clinical Psychology:Science and Practice,6,95-106.
Luborsky, L., Diguer, L.,Luborsky, E., McLellan, A.T.,Woody, G.,& Alexander, L.(1993). Psychological Health-sickness (PHS) as a predictor of outcomes in dynamic and other psychotherapies.Journal of Consulting and Clinical Psychology,61(4),542-548.
Luborsky, L., Rosenthal, R., Diguer, L.,Andrusyna, T. P.,Berman, J.S.,Levitt, J.T.,et al.(2002). The Dodo Bird Verdict is alive and well-mostly. Clinical Psychology:Science and Practice,9, 2-12.
Lucock, M.,Leach, C.,& Iveson, S.(2005).Using evidence to improve psychological therapies services.Mental health and learning disabilities:research and practice,2(1),51-60.
Lunnen, K. M.& Ogles, B.M.(1998). A multiperspective, multivariable evaluation of reliable change. Journal of Consulting and Clinical Psychology,66(2),400-410.
Lutz, W.,Lambert, M.J.,Harmon, S.C.,Tschitsaz, A.,Schurch, E.,& Stulz, N. (2006).The probability of treatment success, failure and duration-what can be learned from empirical data to support decision making in clinical practice? Clinical Psychology and Psychotherapy,13, 223-232.
Lutz, W.,Saunders, S.M.,Leon, S.,Martinovich, Z.,Kosfelder, J.,Schulte, D.,Grawe, K.,Tholen, S.(2006). Empirically and clinically useful decision making in psychotherapy:differential predictions with treatment response models. Psychological Assessment,18(2),133-141.
Magyar-Moe, J.L. (2003).Predictors of therapy outcome:An attempt to explain more of the variance. Unpublished Doctorial Dissertation, University of Kansas.
Mallinckrodt, B.(1993).Session impact, working alliance, and treatment outcome in brief counseling. Journal of Counselling Psychology,40(1),25-32.
March, J.S.& Curry, J. F.(1998).Predicting the outcome of treatment. Journal of Abnormal Child Psychology,26(1),39-51.
Margison, F. R., Barkham, M.,Mellor-Clark, J.,Audin, K., Connell, J.,& Evans, M. (2000). Measurement and psychotherapy:Evidence-based practice and practice-based evidence.British Journal of Psychiatry,177,123-130.
Marmar, C.R., Gaston, L.,Gallagher, D.& Thompson, L.W.(1989).Alliance and outcome in latelife depression. Journal of Nervous and Mental Disease,177,464-472.
Martens, M.P.& Haase, R. F. (2006). Advanced applications of structural equation modeling in counseling psychology research. The Counseling Psychologist,34,878-912.
Martin, D.J.,Garske, J.P.& Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables:a meta-analysis review. Journal of Consulting and Clinical Psychology, 68(3),438-450.
Meltzoff, J.,& Kornreich, M.(1970). Research in Psychotherapy(p57).New York:Atherton.
McLellan, A.T.,& Durell, J.(1996). Outcome evaluation in psychiatric and substance abuse treatments:Concepts, rationale, and methods. In:L.J.Sederer & B. Dickey (Eds.),Outcome assessment in clinical practice. Baltimore, M.D., USA:Williams and Wilkins.
Meier, S.T.,& Davis, S.R.(1990).Trends in reporting psychometric properties of scales used in counseling psychology research. Journal of Counseling Psychology,37,113-115.
Meyer, B.,Pilkonis, P. A.,Krupnick, J.L., Egan, M.K., Simmens, S.J.,& Sotsky, S.M. (2002). Treatment expectancies, patient alliance, and outcome:Further analyses from the national institute of mental health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology,70,1051-1055.
Minami,T.,Brown, J.(2009). Outcomes-informed care.Retrieved Jan 29,2009 from http://www. psychoutcomes.org/bin/view/COMMONS/OutcomesInformedCare.
Miklowitz, D. J.,Otto, M. W.,Wisniewski, S.R., Araga, M.,Frank, E.,Reilly-Harrington, N.A.,et al.(2006). Psychotherapy, symptom outcomes, and role functioning over one year among patients with bipolar disorder. Psychiatric Services,57(7),959-965.
Mohr, D.C.(1995). Negative outcome in psychotherapy:a critical review. Clinical Psychology: Science and Practice,2,1-27.
Moscovitch, D.A.,Hofmann, S.G., Suvak, M.K.,& In-Albon, T. (2005). Mediation of changes in anxiety and depression during treatment of social phobia. Journal of Consulting and Clinical Psychology,73,945-952.
Nathan, P. E.,Stuart, S.P.& Dolan, S.L. (2000).Research on psychotherapy efficacy and effectiveness:between Scylla and Charybdis? Psychological Bulletin,6,964-983.
Newnham, E. A.& Page, A.C. (2007).Client-focused research:new directions in outcome assessment. Behavior Change,24(1),1-6.
Nerison, R.M.,& Claiborn,C.D.(1990).Counselor attractiveness, similarity, and session impact:A field study. Paper presented at the Annual Convention of the American Psychological Association (98th, Boston,MA, August 10-14,1990).
Nocita, A.,& Stiles, W. B.(1986). Client introversion and counseling session impact. Journal of Counseling Psychology,33(3),235-241.
Ogles, B.M.,Lunnen, K. M.& Bonesteel, K. (2001).Clinical significance:history, application, and current practice. Clinical Psychology Review, (21)3,421-446.
Ogrodniczuk, J.S.,Piper, W. E.,Joyce, A.S.,& McMallun, M.(2001).Effect of patient gender on outcome in two forms of short-term individual psychotherapy. The Journal of Psychotherapy Practice and Research,10(2),69-78.
Okiishi, J.C.,Lambert, M. J.,Eggett, D.,Nielsen, S.L., Dayton, D.D.,& Vermeersch, D.A.(2006). An analysis of therapist treatment effects:toward providing feedback to individual therapists on their clients'psychotherapy outcome. Journal of Clinical Psychology,62,1157-1172.
Pachankis, J.E.& Goldfried, M. R. (2007). On the next generation of process research. Clinical Psychology Review,27,760-768.
Patel, V., Chisholm, D., Rabe-Hesketh, S.,Dias-Saxena, F., Andrew, G.,& Mann, A.(2003).Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India:a randomised, controlled trial.Lancet,361,33-39.
Prochaska,J.O.& Norcross, J.C.(2001).Stages of change. Psychotherapy,38(4),443-448.
Prochaska, J., DiClementi, C.,& Norcross, J.(1992).In search of how people change. American Psychologist,47,1102-1114.
Quintana, S.M.& Maxwell,S.E.(1999). Implications of recent developments in structural equation modeling for counseling psychology. The Counseling Psychologist,27(4),485-527.
Reynolds, S.,Stiles, W. B.,Barkham, M.,Shapiro, D. A.,Hardy, G. E.,& Rees, A.(1996). Acceleration of changes in session impact during contrasting time-limited psychotherapies. Journal of Consulting and Clinical Psychology,64,577-586.
Rhodes, R.,Hill, C.,Thompson, B.,& Elliot, R.(1994). Client retrospective recall of resolved and unresolved misunderstanding events. Counseling Psychology,41,473-483.
Rice, L.& Greenberg, L.(1984).Patterns of change:An intensive analysis of psychotherapeutic process. New York:Guilford Press.
Rizvi, S.L.,Reynolds, S.K.,Comtois, K. A.,& Linehan, M. M. (2000). Therapeutic alliance in the treatment of borderline personality disorder. Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, New Orleans, LA.
Rochlen, A. B.,& Rude, S. S.(2001).The relationship of client stages of change to retention, working alliance, and outcome in short-term therapy. The research consortium of counseling & psychotherapy serices in higher education,2(1),1-17.
Roemer, L.,& Orsillo, S.M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder:Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models.Clinical Psychology:Science and Practice,9,54-68.
Rosenblatt, A.,& Attkinsson, C.C.(1993).Assessing outcomes for sufferers of severe mental disorder:A conceptual framework and review. Evaluation and Program Planning,16, 3347-3363.
Rosenzweig, S.(1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry,6,412-415.
Safran, J.D., Crocker, P., McMain, S.,& Murray, P.(1990). The therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy:Theory, Research and Practice,27, 154-165.
Salzer, M. S.,Bickman, L.& Lambert, E. W.(1999).Dose-effect relationship in children's psychotherapy services. Journal of Consulting and Clinical Psychology,67(2),228-238.
Schramm, E.,Van Calker, D., Dykierek, P.,Lieb, K.,Kech, S.,Zobel, I., et al.(2007). An intensive
treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed inpatients:acute and long-term results.American Journal Psychiatry,164(5),768-777.
Schneider, W.,& Klauer, T. (2001).Symptom level, treatment motivation, and the effects of inpatient psychotherapy. Psychotherapy Research,11,153-167.
Smith, J.C.(1976). Psychotherapeutic effects of transcendental meditation with controls for expectation of relief and daily sitting. Journal of Consulting and Clinical Psychology,44, 630-637.
Smith, M. L.& Glass, G. V.(1977). Meta-analysis of psychotherapy outcome studies.American Psychologists,32(9),752-760.
Smith, M.L.(1982).What research says about the effectiveness of psychotherapy. Hospital Community Psychiatry,33,457-461.
Smits, J.A.J.,Powers, M.B.,Cho, Y.,& Telch, M.J. (2004). Mechanism of change in cognitive-behavioral treatment of panic disorder:Evidence for the fear of fear mediational hyposis.Journal of Consulting and Clinical Psychology,72,646-652.
Snell, M.N., Mallinckrodt, B.,Hill, R. D.,& Lambert, M. J.(2001).Predicting counseling center clients'response to counseling:a 1-year follow-up.Journal of Counseling Psychology,48(4), 463-473.
Snow, R. E.(1991).Aptitude-treatment interaction as a framework for research on individual differences in psychotherapy. Journal of Consulting and Clinical Psychology,59(2),205-216.
Spiegel, D.A.,& Bruce, T. J.(1997). Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder:conclusions from combined treatment trials.American Journal of Psychiatry,154,773-781.
Stiles, W.B.(1980). Measurement of the impact of psychotherapy sessions.Journal of Consulting and Clinical Psychology,48(2),176-185.
Stiles, W. B.,Agnew-Davies, R., Hardy, G. E., Barkham, M.,& Shapiro, D.A.(1998). Relations of the alliance with psychotherapy outcome:findings in the second Sheffield psychotherapy project. Journal of Consulting and Clinical Psychology,66(5),791-802.
Stiles, W. B.,Leach, C., Barkham, B.,Lucock, M.,Iveson, S.,Shapiro, D.A.,et al. (2003).Early sudden gains in psychotherapy under routine clinic conditions:practice-based evidence. Journal of Consulting and Clinical Psychology,71(1),14-21.
Stiles, W.B.,Gordon, L. E.,& Lani, J. A.(2002). Session evaluation and the Session Evaluation Questionnaire.In G. S.Tryon (Ed.),Counseling based on process research:Applying what we know (pp.325-343).Boston, MA:Allyn & Bacon.
Strupp, H.H.& Hadley, S.W.(1977). A tripartite model of mental health and therapeutic outcomes: With special reference to negative effects in psychotherapy. American Psychologist,3,187-196.
Stulz, N.,Lutz, W.G.,Leach, C.,Lucock, M.,& Barkham, M.(2007). Shapes of early change in psychotherapy under routine outpatient conditions. Journal of Consulting and Clinical Psychology,75(6),864-874.
Sue, S.,& Zane, N.(1987).The role of culture and cultural techniques in psychotherapy:A critique and reformulation. American Psychologist,42,37-45.
Summers, R. F.& Barber, J. P. (2003). Therapeutic alliance as a measurable psychotherapy skill. Academic Psychiatry,27,160-165.
Tang, T. Z,& DeRubeis, R. J.(1999). Sudden gains in recovering from depression:Are they also found in psychotherapies other than cognitive-behavioral therapy? Journal of Consulting and Clinical Psychology,70,444-447.
Tracey, T.J.,& Kokotovic, A.M.(1989). Factor structure of the working alliance inventory. Psychological Assessment,1,207-210.
Vermeersch, D.A.,Whipple, J.L.& Lambert, M. J.(2004).Outcome Questionnaire:Is It Sensitive to Changes in Counseling Center Clients? Journal of Counseling Psychology,51(1),38-49.
Vogela, P. A.,Hansenb, B.,Stiles, T. C.,& Gotestam, K. G. (2006).Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. Journal of Behavior Therapy and Experimental Psychiatry,37(3),247-255.
Wampold, B.E.(1997). Methodological problems in identifying efficacious psychotherapies. Psychotherapy Research,7,21-43.
Wampold, B.(2001).The great psychotherapy debate:Models, methods and findings(pp.17-31). Hillsdale, NJ:Erlbaum.
Wei, M.F.& Heppner, P. P. (2005).Counselor and client predictors of the initial working alliance:a replication and extension to Taiwanese client-counselor dyads. The Counseling Psychologist, 33,51-72.
Westen, D.,Novotny, C.A.& Thompson-Brenner, H.(2004).The next generation of psychotherapy research:reply to Ablon and Marci (2004), Goldfried and Eubanks-Carter (2004), and Haaga (2004). Psychological Bulletin,130(4),677-683.
Whipple, J. L.,Lambert, M. J.,Vermeersch, D. A.,Smart, D. W.,Nielsen, S.L.,& Hawkins, E. J. (2003).Improving the effects of psychotherapy:the use of early identification of treatment failure and problem-solving strategies in routine practice.Journal of Counseling Psychology, 50(1),59-68.
Wolf, J.N.,& Hopko, D. R. (2008).Psychosocial and pharmacological interventions for depressed adults in primary care:A critical review. Clinical Psychology Review,28,131-161.
Zane, N.,Sue, S.,Chang, J.,Huang, L., Huang, J., Lowe, S.,Srinivasan, S.,Chun, K.,Kurasaki, K., & Lee, E. (2005).Beyond ethnic match:Effects of client-therapist cognitive match in problem perception, coping orientation, and therapy goals on treatment outcomes.Journal of Community Psychology,33(5),569-585.