Attribute by treatment interactions

An emerging emphasis in psychotherapy outcome research is the investigation of attribute by treatment interactions. Partly influenced by the common finding of no differences between psychotherapies, as well as the desire to make more specific clinical recommendations, investigators have hypothesized that certain matches of client characteristics and treatment modalities produce superior outcomes. One initial problem with pursuing potential matches of patient characteristics with the type of treatment is that there are a large number of potential variables (for instance, various combinations of diagnosis, therapist, treatment, patient's problem, setting). Rather than investigate all the possibilities, Beutler and Clarkin (20> have proposed a number of theoretical hypotheses about patient-treatment matching, including the notion that patients who are more introspective (internalizing coping skills) fare better in an insight-oriented psychotherapy, whereas those who are more action-oriented (externalizing coping skills) will have superior outcomes in cognitive-behavioural psychotherapy.

The investigation of patient-treatment matches has intuitive clinical appeal, as most therapists believe that some patients seem to 'fit' a form of treatment better than others. Research on patient-treatment matching, however, is inherently difficult, particularly because large sample sizes are generally needed to adequately test interaction effects. Two of the largest randomized clinical trials ever performed with psychotherapeutic treatments have failed to find much support for specified patient-treatment interactions/2 22) Thus, it remains to be seen whether aptitude by treatment-interaction designs will provide useful information about psychotherapy outcome.

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