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TMatch: Matching Clients to Therapists
Based on Clients' Stage of Change

Short Restatement of Matching Recommendations

The more action oriented the therapists, the more they should be matched with clients in later stages of change. The more therapists tend to use experiential or exploratory techniques, the more they should be matched with clients in earlier stages of change. The more the therapists concentrate on alleviating premature termination, the more they should be matched with clients in the precontemplation stage of change.

Client Assessments

The obvious method for assessing stage of change is the 32-item Stages of Change Scale questionnaire developed by Prochaska and associates. As an alternative, they suggest a few direct questions, which were slightly modified for TMatch to produce the following questions:

  1. How aware are you of your serious problems? (Range = 1-5, the higher the number, the more aware the client is).
  2. Do you think you need to change to solve your problems? (1 = No, 2 = Yes). (Questions 3 and 4 below only appear if answer to Question 2 is Yes).
  3. Do you know what changes you need to make to solve your problem or problems? (Range = 0-5, 0 = this question didn't appear, 1 = I have no idea what changes I need to make, 5 = I know exactly what changes I need to make).
  4. What is the status of your making changes to solve your problem or problems? (Range = 0-5, 0 = this question didn't appear, 1 = I don't want to make any changes within the next 2 years, 5 = I have started making changes already).

The first raw score was obtained by adding the answers to all these questions. The higher the score, the later the stage of change.

Therapist Assessment: Action Orientation

Therapist action orientation, or amount of emphasis on action, was assessed through one question, and how therapists answered two items from the Help-Ways questionnaire, which asked them to order and rate 7 different possible ways of helping clients:

  1. How much does your therapy focus on alleviation of symptoms, vs. on depth (underlying causes of problems)?
  2. The help-way develop new skills or learn new ways to behave in the outside world.
  3. The help-way get immediate help to take specific actions as soon as possible to make symptoms better.

Therapist Assessment: Experiential or Exploratory Techniques

Therapist emphasis on experiential or exploratory techniques was assessed with the same question about symptoms vs. depth listed above, plus three items from the Help-Ways questionnaire:

  1. The help-way gain insight into, or understanding of, the causes of problems.
  2. The help-way an opportunity for deep experiencing and increased awareness of feelings and sensations.
  3. The help-way an opportunity to examine clients' lives in a growth producing climate.

Therapist Assessment: Concentration on Alleviating Premature Termination

There is no obvious way to assess therapists' concentration on alleviating premature termination. This may be a suggestion for treatment emphasis that cannot be translated into a difference among therapists. The closest method I could find was a question about how much direct support and reassurance therapists gave clients, and the rating of the help-way [clients] develop more hope that they can solve their problems.


Future Use of Stage of Change for Matching

Results of Study: Client Assessment

Every client in the study answered the question "Do you think you need to change to solve your problems?" with "Yes." The ratings of clients tended to be high in the direction of slightly later stages of change, which would be expected in people trying to find therapists.

Results of Study: Therapist Assessment

The assessments of action orientation and emphasis on experiential or exploratory techniques seemed to work quite well. Therapists were usefully differentiated by these assessments, and the assessments matched their self-described styles of therapies (e.g., existential therapists rated very high on using experiential or exploratory techniques). In contrast, the assessment of concentrating on alleviating premature termination did not work. In addition to the marginal correspondence between the assessment question and the concept being assessed, the question itself about emphasis on developing hope didn't work. The problem with this question was that trying to get clients to have more hope is probably not a quality that differentiates therapists, since all therapists would probably like to help their clients as mucy as possible to have hope.

Results of Study: Matching Success

Matching based on therapist emphasis on action or on experiential or exploratory techniques worked well enough to be tried again. The therapist assessments were fairly successful, but the client assessments were marginally successful at best. Matching based on these suggestions is worth trying again. Matching based on emphasis on alleviating premature termination did not work. There was indication from this study that this is not a quality that differentiates therapists in an easily assessible manner.

The Next Step for Matching Based on Stage of Change

It would be worth trying the first two matching suggestions again with a better client assessement instrument. Since I made up this client assessment in order to save room on the questionnaire, and it thus has almost no validity, it would be worth trying an accepted and validated instrument such as the 32 item Stages of Change Scale (Brogan, Prochaska, & Prochaska, 1999).


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

References

Brogan, M.M., Prochaska, J. O., & Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy using the transtheoretical model. Psychotherapy, 36(2), 105-113.

Prochaska, J. O. (2000). How do people change, and how can we change to help many more people. In M. A. Hubble, B. L. Duncan, & S. D. Miller, (Eds.), The heart and soul of change (pp.227-255). Washington, D.C.: American Psychological Association.

Prochaska, J. O., & DiClemente, C. C. (1992). The transtheoretical approach. In J. C. Norcross & M. R. Goldfried, (Eds.), Handbook of psychotherapy integration (pp. 300-334). New York: Basic Books.

Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy, 38(4), 443-448.