FORMING FRIENDSHIPS WITH FORMER CLIENTS

Forming Friendships with Former Clients

Forming Friendships with Former Clients

Introduction

Mental health therapists face increasing pressures to demonstrate effective practice by third-party payers, health managed organizations (HMOs), and administrators (Addis, Wade, & Hatgis, 1999; Plante, Couchman, & Hoffman, 1998; Rainer, 1996). The now infamous Hans Eysenck (1952) study purporting that people undergoing psychotherapy were no better off than those going without psychotherapy galvanized researchers to focus on the task of outcome studies (Clarkin & Levy, 2004). In the late 1970's and early 1980's, psychotherapy researchers subsequently turned in an impressive mass of empirical evidence demonstrating the general benefit of counseling (Shapiro & Shapiro, 1982; Smith & Glass, 1977; Smith, Glass, & Miller, 1980), and were able to conclude that clients who received counseling were better off than 80% of those who had not received counseling (Lambert & Ogles, 2004).

With the general effectiveness of counseling demonstrated, attempts were then undertaken to discover specifically what treatments, or schools of therapy, worked for which clients (Chambless & Ollendick, 2001), and to identify what the curative factors (e.g., advanced empathy, disputing irrational beliefs) of therapy were (Lambert & Ogles, 2004). To accurately evaluate which schools of psychotherapy (e.g., cognitive-behavioral therapy vs. person centered therapy) were most effective, treatment manuals were developed that specified procedures for applying the interventions (Beck, Rush, Shaw, & Emery, 1979).

The advent of treatment manuals-psychotherapy researchers constituted a “small revolution” (Luborsky & DuRubeis, 1984) in counseling methodology. Manuals also allowed researchers within a school to remove one intervention to an approach (i.e., dismantling study), or add one intervention (i.e., component study) to that approach, to study which interventions were the crucial elements of the particular school of psychotherapy (Wampold, 2001). Paul's overarching question (1969) “What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances, and how does it come about?” was ready to be investigated.

The advent of treatment manuals and, later, better measurement tools and statistical methods (Howard, Moras, Brill, Martinovich, Lutz, 1996; Nathan, 1998), have indeed helped identify when specific treatments for diagnoses should be considered. Client ailments such as panic disorder, phobias, and compulsions have especially emerged as treatable interventions delineated in manuals (Lambert & Ogles, 2004). Some findings even show that interventions from manuals improve therapy relationships (Brown, Dreis, & Nace, 1999). Other reports indicate that manuals not only help clients with their primary problem (e.g., agoraphobia) but also with coexisting mental health complaints (Addis et al., 1999). Even though the rigor of comparative outcome studies in counseling research is in its infancy, in general, modest advantages have accrued to behavioral, cognitive, or cognitive-behavioral approaches over humanistic approaches (Lambert & Ogles, 2004).

The focus is on the individual client while in treatment rather than groups of clients after treatment has been completed (Howard et al., 1996). The tracking system of Howard et al. was derived from research about the dose-effect of psychotherapy based on multiple research efforts collected over 30 years and including 2,400 clients (Howard, Kopta, ...