Despite evidence for positive treatment outcomes, research on treatment processes remains quite limited so even EBT's (evidence-based treatments) 1 in 3 times don't have the desired outcomes. Therapists vary and no one has figured out exactly what matters about their style.
CLIENT CHARACTERISTICS
This section examines pretreatment characteristics that might predict the outcome of treatment for anxiety, depression, and disruptive behavior in adolescents.
Comorbidity
Most studies show that kids who come in with both anxiery and depression have poorer tx outcomes. But some studies have shown the opposite effects. And some even show better outcomes with comorbidity. However, comorbid behavioral problems (ODD, Conduct disorder, etc.) could complicate the tx of other primary problems because they aren't compliant with tx. This research is limited. So as far as tx goes for comorbidity, you have to look at the specific issues and decide what would be most helpful to deal with first. (duh...)
Developmental Characteristics
Older ages usually show better outcomes in tx. However, sometimes older kids have more severe symptoms and stronger maladaptive strategies, so they're harder to work with. We have to disentangle age and its confounding variables. But overall, younger kids aren't suited to CBT as well as older kids.
Family Characteristics
In anxiety, maternal symptoms predict poor tx outcome. In conduct disorders, higher parenting stress, depression scores among mothers, low marital satisfaction, adverse child--rearing practices, dysfunctional family environment, single-parent status, and lower SES are all associated with poor response to parent management training. But improved parenting can help the outcomes over time. In adolescent depression, their stress can predict negative outcomes a lot of the time.
Some research says adding families in treatment won't always improve outcomes. If the mom is anxious it will help a lot though. Disruptive behavior problems need family tx. Adolexcent depression doesn't always improve with parental inclusion.
THERAPIST CHARACTERISTICS
The impact of therapists haven't really been studied because we are so focused on therapies right now. But not all therapists are the same, so we need to study what makes an effective therapist--regardless of the model they are using. One of the only things to be studied so far is how much training a therapist has. In the studies, paraprofessionals produce larger tx effects than either students or professionals! This could be, though, because professionals are given more difficult cases than paraprofessionals. Professionals did better in two areas--when treating internalizing rather than externalizing problems, and when working with adolescents.
In the future, we need to look at therapist competency, and relational capacity.
TREATMENT CHARACTERISTICS
Evidence for the specific treatment processes within effective therapies is thin. But there are a few studies out there.
1) Treatment Adherence=better outcome
2) Children's participation in therapy: How engaged are the kids in CBT for working on their anxiety? The more engaged=the better the outcome. The metaphor is that even if you give a prescription for medication, if the patient doesn't take it, it doesn't matter. They talked a lot here about alliance. The only thing that helped children's alliance with the therapist they said was the therapist framing things in terms of a team--"we", "us", "let's", and setting goals together. Being playful, pushing a child to talk about anxiety, emphasizing common ground, "me too!", etc. hurt the alliance. They tried to measure positive ways of interacting with adolescents, but none of them predicted a strong alliance...haha.
SUMMARY
Overall, we really don't know anything, except that none of the factors are consistently predictive of anything really, so we need to work on researching the process of treatment!!
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