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TMatch: Matching Clients to Therapists

Based on Client Coping Style

Short Restatement of Matching Recommendations

According to Prescriptive Psychotherapy, clients' coping styes are either externalizing or internalizing. Externalizing people blame other people or external objects for their behavior or problems, while internalizing people blame themselves. For externalizing patients, treatments are recommended that focus on external behavior or on changing symptoms, independently from any introspection by the patients. For internalizing patients, treatments are recommended that emphasize insight, self-knowledge, self-understanding, awareness, and emotional arousal.

Client Assessments

For measuring coping style, Beutler and Harwood (2000) recommend using the Systematic Treatment Selection computer software, which was developed by Beutler and his associates. Beutler and Harwood also suggest that coping style can be measured by combining various scales of the Minnesota Mutiphasic Personality Inventory (MMPI). The Beutler et. al software was not available to me, and the MMPI would have been too lengthy for this one matching criterion. Therefore, it was decided to attempt to assess coping style using three direct questions, and a measurement based on the results of the clients' NEO Five-Factor Inventory assessment, which was already part of TMatch. This correspondence between coping style and the five domains of the NEO-FFI was suggested by Sanderson and Clarkin (1994). They believe that internalizing clients would be high on Openness (O), low on Extraversion (E), and perhaps high on Neuroticism (N). Externalizing would be the opposite. Since the suggestions for N seemed to have less sureness, the following formula was created: internalization = O x2 + (6-E) x2 + N. The three direct questions were:

  1. To what extent are your problems caused by your own actions, thoughts, and feelings?
  2. To what extent are your problems caused by the actions of other people?
  3. To what extent are your problems caused by external situations not under your control?

Therapist Assessments

The therapist assessment was for emphasis on treatments that focus on external behavior or changing symptoms versus emphasis on treatments that focus on insight, self-knowledge, self-understanding, awareness, and emotional arousal. This assessment was given the name symptoms vs. insight for discussion of TMatch. The higher client externalization, the higher therapists should be on symptoms vs. insight. This assessment was made through how therapists answered a questionnaire that asked them to order and rate 7 different possible ways of helping clients (the Help-Ways questionnaire), and through two additional questions:

  1. How much does your therapy focus on alleviation of symptoms, vs. on depth (underlying causes of problems)?
  2. To what degree do either of these descriptions describe your therapy? (Straightforward, practical, symptom-focused, educational, and supportive vs. Provocative, imaginative, involves novel thinking and experiences, focuses on self-exploration and discovery, and/or involves paradigm shifts).

Future Use of Resistance for Matching (in TMatch or any other system)

Results of Study: Client Assessment

The three main questions used for this assessment were not as productive as hoped. For the first question, almost all clients answered that their problems were their own fault. For the next two questions, most clients tended to be fairly neutral about whether their problems were caused by external people and situations. The final result from these three questions is that they seem to draw out answers weighted heavily toward clients being internalizers. This result could be because they were worded in a way to make this seem the correct answer. It also could be because of the order of the questions. That is, once clients had answered that their problems were caused by themselves, then it would not make sense to answer that they were caused by other people. An additional problem in this assessment is that it was not tested in any way to check its validity.

Results of Study: Therapist Assessment

Although this was only a first preliminary version of TMatch, this particular assessment did seem to be valid, with psychodynamic therapists being rated toward the insight direction, and cognitive therapists being rated toward the symptoms direction. It is unlikely that this same assessment will be used in the future, but at least this first version of TMatch has shown that therapists can be usefully differentiated on this dimension.

Results of Study: Matching Success

In spite of the client assessment problems, this was probably the most effective section in TMatch of matching based on client characteristics. All indications from the study were that this would be a very effective method of matching clients to therapists. Both clients and therapists have a wide spectrum of values on the assessment dimensions, and the matching recommendations seem to work effectively.

The next step for client-therapist matching based on the principles of Prescriptive Psychotherapy would be to integrate the assessment instruments (and quantitative information) developed by Larry Beutler and his associates into a matching system, or to develop a matching system from scratch using these instruments and information. Click the link above for a more complete discussion of this subject, or click here.


For more information, or to give feedback, email Kenneth Frankel, Ph.D.

References

Beutler, L. E., Arizmendi, T. G., Crago, M, Shanfield, S., & Hagaman, R. (1983). The effects of value similarity and clients' persuadability on value convergence and psychotherapy improvement. Journal of Social and Clinical Psychology, 1, 231-245.

Beutler, L. E., Brookman, L., Harwood, T. M., Alimohamed, S., & Malik, M. (2001). Functional impairment and coping style. Psychotherapy, 38(4), 437-442.

Beutler, L. E., & Consoli, A. J. (1992). Systematic eclectic psychotherapy. In J. C. Norcross & M. R. Goldfried, (Eds.), Handbook of psychotherapy integration (pp. 264- 299). New York: Basic Books.

Beutler, L. E., & Harwood, T. M. (2000). Prescriptive psychotherapy: A practical guide to systematic treatment selection. New York: Oxford University Press.

Beutler, L. E., Mohr, D. C., Grawe, K., Engle, D., & MacDonald, R. (1991). Looking for differential treatment effects: Cross-cultural predictors of differential psychotherapy efficacy. Journal of Psychotherapy Integration, 1, 121-141.

Beutler, L. E., Rocco, F., Moleiro, C. M., & Talebi, H. (2001). Resistance. Psychotherapy, 38 (4), 431-436.