The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy. A review of empirical studies.
Empirical studies are reviewed, the aim being to investigate characteristics of the therapeutic relationship in cognitive-behavior therapy (CBT) and to identify therapist or patient interpersonal behavior that affects treatment outcome. CBT is characterized by a more active and directive stance on the part of the therapists and higher levels of emotional support than are found in insight-oriented psychotherapies. Therapists express high levels of empathy and unconditional positive regard, similar to those expressed by insight-oriented psychotherapists. Two clusters of interpersonal behavior have been identified that are clearly associated with CBT outcome: (a) the Rogerian therapist variables--empathy, nonpossessive warmth, positive regard, and genuineness; and (b) therapeutic alliance. There is some evidence for the impact on outcome of three additional clusters of patient behavior: (a) the patients' perception of the therapist as being self-confident, skillful, and active; (b) the patients' openness to discuss their problems; and (c) the patients' pretreatment predisposition to change and to accept psychological treatment as a means of achieving this. It is further concluded that relationship factors in general have a consistent but moderate impact on CBT outcome.
Keijsers
G P
GP
Department of Clinical Psychology and Personality, University of Nijmegen, The Netherlands.
Schaap
C P
CP
Hoogduin
C A
CA
D001521:Behavior Therapy; D015928:Cognitive Behavioral Therapy; D005163:Factor Analysis, Statistical; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D009629:Person-Centered Psychotherapy; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D014481:United States