FAYETTEVILLE, Ark. - In an age that demands increased accountability, University of Arkansas researchers have developed a model to evaluate psychotherapy’s effectiveness for individual patients - and demonstrated that the therapist-patient interactions and relationship more than any other factors determine therapy’s success.

What’s more, they have shown that such therapy can benefit people commonly neglected in depression studies - depressed patients with personality disorders.

University of Arkansas psychology professor Mark Hilsenroth will present data from a two-year study today (Aug. 24) at the American Psychological Association’s 107^th National Convention in Boston. They will be part of a symposium, "Programmatic Research on Psychodynamic Psychotherapy," that will also feature researchers from Harvard Medical School, The Menninger Clinic in Topeka, Kan., the Austen Riggs Center in Stockbridge, Mass., and The Institute for Psychoanalytic Training and Research (IPTAR), New York.

"Evaluating the effectiveness of therapy has become essential," Hilsenroth said, because most health maintenance organizations (HMOs) limit the number of outpatient mental health visits allowed each year.

Social misconceptions can also undermine people seeking long-term psychotherapeutic treatment: Many people see little value in long-term therapy when they can just take an antidepressant pill.

"People are always looking for the quick fix," Hilsenroth said. "But if someone’s been depressed and has behaved the same way for 30 years, it’s going to be hard for them to recover in six sessions," a typical limit placed on therapy by health insurance organizations.

Hilsenroth and a team of graduate students followed 46 patients at the University of Arkansas Outpatient Psychological Clinic, which serves the Northwest Arkansas community. From this group he looked at data on a subset of 16 people diagnosed with depression. The participants visited the clinic an average of 23 times over a six-month period.

The researchers measured the effectiveness of treatment using several different methods. The patient, therapist and an external observer who watched the interactions on video tape each evaluated the sessions. The patient also answered questions on standardized tests at set points during therapy. The tests evaluated psychiatric symptoms, as well as the patient’s ability to function at work and leisure, to interact with others and addressed other quality of life issues.

A member of Hilsenroth’s graduate student team, Matt Blagys, developed a scale where patients and therapists characterized their sessions using several criteria: Expressing emotion, identifying patterns in thoughts and feelings, exploring dreams and wishes, focusing on interpersonal experiences and past experiences, examining the patient-therapist relationship and exploring attempts to avoid important, often painful, topics.

"The higher the therapist rated on this scale, the better the outcome for the depressed patients," Hilsenroth said.

This also held true for people with complicated mental health issues - particularly people with personality disorders and depression. Researchers conducting large depression studies typically filter out people with personality problems, because their therapy typically takes longer to be effective and demonstrate significant change. However, half the people in Hilsenroth’s study had personality disorders and still improved significantly with psychotherapeutic treatment.

Hilsenroth chose to work with anyone seeking treatment at the clinic instead of excluding people with particular mental health disorders. Using a strict inclusion and exclusion model for mental health studies can actually pose a problem when trying to generalize results to clinical work, Hilsenroth said.

"It’s rare in clinical work to find someone with just depression," he said.

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