Psychotherapy Change Project
Director, Center for Applied Psychological and Family StudiesClinical Professor, Department of Psychology
Clinical Professor, Department of Psychology
Professor and Director of Clinical Training, Department of Psychology
Tara LattaPsychotherapy Change Project Manager
Emily BettinPsychotherapy Change Project Administrator
Erin StaabResearch Administrator
The field of psychotherapy lacks empirical understanding of how people change. In order to strengthen the scientific foundation of intervention, we must develop an empirically grounded theory of how people change that can guide and improve our treatment. The Psychotherapy Change Project was created to address this need.
The Psychotherapy Change Project is a long term research program that has three aims:
- to delineate how people change in psychotherapy
- to identify the therapist behaviors associated with those changes
- to develop a procedure for regularly feeding that information back to therapists and clinical supervisors during the process of therapy
The overall goal of this project is to develop more effective, empirically informed, generic psychotherapy. As part of this project, The Family Institute has developed two linked proprietary systems for tracking client change, providing feedback of that change to the therapist, and identifying patterns of therapist intervention that are associated with particular client change profiles. The system for tracking client change and providing feedback to therapists during psychotherapy is called the Systemic Therapy Inventory of Change. The system for tracking therapist intervention is called the Integrative Therapy Session Report.
Systemic Therapy Inventory of Change (STIC(R))
In 2004 the Systemic Therapy Inventory of Change was completed after approximately six years of development work. The STIC is the first instrument in the field of family therapy for studying how people change over the course of therapy and it is the primary research tool of the Psychotherapy Change Project. The STIC employs self-report questionnaires to track client change during therapy as well an Internet-based system for analyzing the data and providing feedback to the therapist.
The STIC assesses change in individual adult, marital-couple, family/household and child functioning. It also taps adult client's recollections of their family-of-origin when they were growing up as a predictor variable at the beginning of therapy. Lastly, it includes Pinsof's modality specific (individual, couple and family therapy) measures of the client's experience of the integrative psychotherapy alliance. The website through which therapists access their clients' STIC data was activated in November 2005 and is currently being used by more than 70 Northwestern University student therapists being trained at The Family Institute, as well as a number of therapists in The Institute's staff practice. The secure website provides bar graphs with clients' absolute Initial scores and change profiles on the scales and subscales over the course of therapy. Therapists may access STIC data about their clients at any point during therapy.
The data for STIC is gathered via two client instruments: the Initial STIC, which clients fill out before the very first therapy session, and the Intersession STIC, a shorter version which clients fill out before every subsequent therapy session. The Initial STIC consists of six parts: 1) a 21 item Demographic Questionnaire; 2) a 24 item Individual Problems and Strengths Questionnaire that assesses individual functioning; 3) a 22 item Family of Origin Questionnaire that taps patients' recollections of their families of origin when they were growing up; 4) a 25 item Relationship with Partner Questionnaire that assesses couple functioning; 5) a 32 item Family/Household Questionnaire that taps current family functioning; and 6) a 29 item Child Problems and Strengths Questionnaire that assesses patients' view of one of their children. Clients complete the scales that fit their demographics, not the type of therapy they are in. For instance, a married mother in individual therapy completes all six questionnaires. A childless married man in couple therapy completes the Demographic, Individual Problem and Strengths, Family of Origin and Relationship with Partner questionnaires. On average, it takes about 45 minutes to complete all six measures. The briefer Intersession STIC does not include the Demographic or the Family of Origin questionnaires. It contains shorter versions of each of the other questionnaires as well as three brief questionnaires that respectively tap the alliance between the therapist and the clients in individual, couple and family therapy. Typically, clients take five to seven minutes to complete the Intersession STIC form. All non-demographic STIC questions use a five- or seven-point likert-type response format (Never, Rarely, Sometimes, Often, All the Time).
In addition to STIC validity and reliability studies that are currently underway, The Family Institute also plans to undertake a "norming" study to define the "normal" average and range on each STIC scale and subscale. Obtaining these norms will allow us to inform therapists about the status of their patients on the STIC variables at the beginning and throughout the course of therapy. Thus, therapists will be able to see at a glance at the beginning of therapy exactly those areas in which their patients are in the clinical range and those areas in which they are in the normal range. The areas in which they are in the clinical range would constitute the primary targets of intervention. Over the course of therapy, the norms will help us inform therapists if and when their patients make progress and move from the clinical into the normal range on these targeted variables.
Integrative Therapy Session Report (ITSR)
The Integrative Therapy Session Report is a companion instrument to the STIC. Two goals drove its development. The first was to create a therapist self-report instrument that provides a generic, clinically meaningful and statistically reliable picture of what occurred in a recently completed therapy session. The second was to develop a web-based feedback system for therapist behavior that could provide therapists and clinical supervisors with therapist behavior profiles over the course of therapy. The ultimate objective is to link the ITSR and STIC feedback systems in order to provide a comprehensive picture of client change and therapist behavior over the course of therapy.
The Family Institute has tested the ITSR with numerous clinicians on its staff and determined that therapists can be reliably trained to rate their own sessions (as measured by agreement between the therapist and "objective" observers). In 2006 The Institute began seeking additional feedback from other mental health professionals and experts prior to formally testing the measure. More than 30 leading psychotherapists in North America, representing all of the major active schools of psychotherapy, have been asked to review the ITSR. After receiving their feedback, the ITSR Manual and Rating Form will be finalized and tested methodologically (for reliability and validity) by Family Institute staff therapists and student therapists (Fall 2006). Development of the ITSR component to the Psychotherapy Change Website - providing both clients change (STIC) and therapist behavior (ITSR) feedback throughout the course of therapy - is scheduled for 2007.