Researches On Effectiveness Evaluation Of Psychotherapy Of Outpatients

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.