THE SHAPE OF CHANGE IN PSYCHOTHERAPY - LONGITUDINAL ASSESSMENT OF PERSONAL PROBLEMS

We propose 4 parameters that describe the course of change in the subj ective intensity of personal Problems during psychotherapy: (a) the Pr oblems initial severity; (b) its rate of change (deterioration or impr ovement); (c) its instability (day-to-day variability in intensity); a nd (d) its curve (change in the rate of change during treatment). We c onstructed indexes of these parameters for 10 individualized personal problems rated 3 times per week by each of 40 clients (most were diagn osed as depressed) over the course of their 16-session treatment and a ssociated assessment periods. Initial severity predicted problems' rep orted salience to clients. The rate of change parameter was correlated (across clients) with traditional pretreatment to posttreatment outco me measures. Instability was high, and problems dealing with tension s ymptoms and mood were more unstable than were problems dealing with re lationships or self-esteem. Cutting across problem content were large individual differences among clients in the patterns of change.