In Evidence-Based Treatment, Larry E. Beutler demonstrates his research-directed approach to therapy. Dr. Beutler uses data gathered in a presession assessment to tailor his approach to working with the client. The principles on which this method is based have been proven to make therapy more targeted and therefore more effective.
In this session, Dr. Beutler works with a young man suffering with depression who wants to be able to enjoy life again. Dr. Beutler looks for relationship themes and at the client's family systems for insight into the sources of the client's depression and passivity, and helps to increase the client's self-esteem and sense of control over his own life.
Systematic Treatment Selection (STS) is not simply a psychotherapy system. Most directly it is a method of planning and delivering optimal treatments in a way that is consistent with established scientific literature and that cuts across different theoretical approaches. STS is a tracking and treatment system that involves applying contemporary research findings to clinical problems in an integrated and cross-cutting way. It provides the clinician with principles and strategies for addressing a wide range of patient problems, more than with specific techniques or theoretical constructs about the nature of the psychopathology or treatment process. The STS approach seeks to establish an optimal and maximally beneficial fit between patient and problem characteristics, on one hand, and therapist and treatment characteristics, on the other.
Six patient and problem characteristics (e.g., functional impairment, social support, complexity, coping style, resistance traits, and distress), along with a similar number of treatment, therapist, and relationship characteristics, provide the basic data from which optimal treatment is planned in STS. The treatment planning dimensions were extracted from comprehensive literature reviews.
These reviews identified variables that have been reliably associated with change, either because (1) they predict treatment outcomes directly, or (2) their presence has been systematically observed to moderate the impact of treatments. To aid the translation of research into practice, "Research-Informed Relationships" among patient, alliance, clinician, and treatment qualities are articulated as guiding principles.
Each of the patient, therapist, treatment, and relationship dimensions have been identified through systematic research as being valid contributors to improving efficacy or effectiveness, and each is a differential indicator of some aspect of treatment. The value of the dimensions that are central to the STS system is determined by the degree to which each dimension is predictive, within scientific research literature, of treatment benefit. Thus, the dimensions are not dependent on the validity of a theory of psychopathology or change, but on the leverage that is gained when a body of research is expressed and used as a principle of change that is available to guide the application of treatment.
Because it is not bound to a finite set of principles or to a particular theory of psychopathology and change, STS has the flexibility to blend the best of scientific research with clinical theory and practice. The dimensions forming the current basis of STS were designed as a starting place from which other principles and dimensions could be added as research identifies them.
Eighteen research-based principles were originally derived from research on therapeutic outcomes (Beutler, Clarkin, & Bongar, 2000), but this list has subsequently been expanded by the work of the American Psychological Association's Division 12 (Society of Clinical Psychology) joint Task Force (Castonguay & Beutler, 2006) and now includes specific principles that are applied for different kinds of problems. Both common (those that cut across disorders) and specific (those that are unique to particular problems) principles have been applied to the treatment of mass trauma victims (Housley & Beutler, in press). Moreover, a subset of the original set of 18 principles have also been applied to the specific case of using individual psychotherapy for the treatment of those with depression and chemical abuse disorders (Beutler & Harwood, 2000).
Thus, the principles that have been developed to date can assist the clinician in selecting and using the methods that are most likely to succeed, regardless of the theoretical framework from which these methods originated or the modality and format through which treatment is applied.
A strength of the STS system is that it does not specify a "typical" patient. It is designed to allow each client to receive a treatment that is tailored to their particular needs and characteristics. The system is specifically designed to vary as a function of the many qualities that characterize patients who seek mental health intervention.
It is easier to specify the limits of the STS applications as reflected in the paucity of research among certain groups. For example, the current literature from which patient, treatment, and matching variables were defined does not translate readily to children or to severely disorganized populations. It is anticipated that different dimensions and algorithms of treatment matching will be called for in applying STS to these populations. The various rules or algorithms of application do include all or most of those identified by different gender, ethnic, and age demographics.
Larry E. Beutler, PhD, is the director of the National Center on Disaster Psychology and Terrorism, a research and training program for preparing mental health practitioners to respond to mass trauma. He holds the William McInnes chair and is distinguished professor of psychology at Pacific Graduate School of Psychology in Palo Alto, California; consulting professor of Psychiatry and Behavioral Sciences at Stanford University; and professor emeritus at the University of California at Santa Barbara. He obtained his PhD from the University of Nebraska in 1970, and subsequently served on the faculties of Duke University Medical School, Stephen F. Austin State University, Baylor College of Medicine, the University of Arizona, and the University of California.
Dr. Beutler is a diplomate of the American Board of Professional Psychology (ABPP-clinical), a two-term past international president of the Society for Psychotherapy Research (SPR), past president of the American Psychological Association's (APA's) Division 12 (Society for Clinical Psychology), and past president of the APA's Division 29 (Psychotherapy). He is a recipient of the Gold Medal Award from the American Psychological Foundation, the Distinguished Scientific Achievement Award from the California Psychological Association, the Distinguished Research Career Award from the SPR, International, and of a Presidential Citation from the president of the APA.
- Beutler, L. E., Clarkin, J. F., & Bongar, B. (2000). Systematic guidelines for the treatment of the depressed patient. New York: Oxford University Press.
- Beutler, L. E., & Groth-Marnat, G. (Eds). (2003). Integrated assessment of adult personality (2nd ed.). New York: Guilford Press.
- Beutler, L. E., Malik, M., Talebi, H., Fleming, J., & Moleiro, C. (2004). Use of psychological tests/instruments for treatment planning. In M. E. Maruish (Ed), The use of psychological tests for treatment planning and outcome assessment, Vol. 1 (3rd ed., pp. 111–145). Hillsdale, NJ: Lawrence Erlbaum Associates.
- Beutler, L. E., & Harwood, T. M. (1995). Prescriptive psychotherapies. Applied and Preventive Psychology, 4, 89–100.
- Beutler, L. E., & Williams, O. B. (1995, July/August). Computer applications for the selection of optimal psychosocial therapeutic interventions. Behavioral Healthcare Tomorrow, 66–68.
- Beutler, L. E., Kim, E. J., Davison, E., Karno, M., & Fisher, D. (1996). Research contributions to improving managed health care outcomes. Psychotherapy, 33, 197–206.
- Beutler, L. E., & Rosner, R. (1995). Introduction. In L. E. Beutler & M. Berren (Eds.), Integrative assessment of adult personality (pp. 1–24). New York: Guilford.
- Beutler, L. E. (1995). Integrating and communicating findings. In L. E. Beutler & M. Berren (Eds.), Integrative assessment of adult personality (pp. 25–64). New York: Guilford Press.
- Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 353–369). New York: Oxford University Press.
- Harwood, T. M., & Williams, O. B. (2003). Identifying treatment-relevant assessment: Systematic treatment selection. In L. E. Beutler & G. Groth-Marnat (Eds.), Integrated assessment of adult personality (2nd ed., pp. 65–81). New York: Guilford Press.
- Malik, M. L., Beutler, L. E., Gallagher-Thompson, D., Thompson, L., & Alimohamed, S. (2003). Are all cognitive therapies alike? A comparison of cognitive and non-cognitive therapy process and implications for the application of empirically supported treatments (ESTs). Journal of Consulting and Clinical Psychology, 71, 150–158.
- Beutler, L. E., Moleiro, C., Malik, M., Harwood, T. M., Romanelli, R., Gallagher-Thompson, D., et al. (2003). A comparison of the Dodo, EST, and ATI indicators among co-morbid stimulant dependent, depressed patients. Clinical Psychology & Psychotherapy, 10, 69–85.
- Karno, M. P., & Longabaugh, R. (2005). Less directiveness by therapists improves drinking outcomes of reactant clients in alcoholism treatment. Journal of Consulting and Clinical Psychology, 73, 262–267.
- Karno, M. P., & Longabaugh, R. (2003). Patient depressive symptoms and therapist focus on emotional material: A new look at project MATCH. Journal of Studies in Alcohol, 64, 607–615.
- Karno, M. P., & Longabaugh, R. (2004). What do we know? Process analysis and the search for a better understanding of project MATCH's anger-by-treatment matching effect. Journal of Studies in Alcohol, 65, 501–512.
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