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TMatch: Client/Therapist Matching
Based on Client Neuroticism

Short Restatement of Matching Recommendations

Neuroticism (N) measures emotional instability and distress, anxiety, and insecurity. The recommendations are that the higher the N, the more therapy should emphasize longer term therapy that focuses on depth instead of symptom relief, and the less therapy should tend toward using psychopharmacology.

Client Assessments

Clients were assessed on the five domains of Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness using the NEO Five Factor Inventory, as described in the introduction page to matching using 5-factor personality theory.

Therapist Assessment: Longer Term Emphasis

The assessment for long-term emphasis of therapy was made with a combination of two questions relating to therapy complexity, one question directly related to therapy depth, and a section of direct questions asking therapist about their preference for length of therapy. The questions about complexity were added because it was assumed that complex therapy would require more time. This Long-Term Emphasis questionnaire was used for several different purposes in TMatch.

Therapist Assessment: Symptom Relief Versus Depth

The assessment of therapists' emphasis on symptom relief (emphasis on external behavior or changing symptoms) versus their emphasis on depth (emphasis on insight, self-knowledge, self-understanding, and awareness) was made through how therapists answered a questionnaire that asked them to order and rate 7 different possible ways of helping clients (the Help-Ways questionnaire), and through two additional questions:

  1. How much does your therapy focus on alleviation of symptoms, vs. on depth (underlying causes of problems)?
  2. To what degree do either of these descriptions describe your therapy? (Straightforward, practical, symptom-focused, educational, and supportive vs. Provocative, imaginative, involves novel thinking and experiences, focuses on self-exploration and discovery, and/or involves paradigm shifts).

Therapist Assessment: Emphasis on Not Using Psychopharmacology

This assessment was made with one question, with a range of answers from 1 to 7: What is your feeling about using psychopharmacology (medication) in conjunction with your therapy? (1 = Medications are usually useful, and should probably be tried for most clients with serious problems, 7 = Medications should be used very sparingly, and only tried in the most extreme cases, or after most other methods have been unsuccessful).

Future Use of Neuroticism for Matching

Results of Study: Client Assessment

For all clients in the study, including pilot testers, on a scale of 1-5, the mean for Neuroticism was 3.42, with sd = 0.79. This is rather high, with a rather small standard deviation, but not unexpected in a population interested in or seeking psychotherapy. However, if the range of clients seeking therapy on N is very small, then N doesn't have great utility for differentiating among them for matching purposes.

Results of Study: Therapist Assessment of Longer Term Emphasis

This assessment seemed to work quite well. For this first version of TMatch, this rating had a possible range of -18 (shorter term emphasis) to +18 (longer term emphasis). For all therapists, the mean was 3.32 with sd = 7.10. Thus almost all answers were between -4 and +10. This seems to accurately reflect the position of the therapists who took the questionnaire, who tended to be psychodynamic or use other systems interested in more depth therapy (e.g., existential therapists).

Results of Study: Therapist Assessment of Symptom Relief Versus Depth

Although this was only a first preliminary version of TMatch, this particular assessment did seem to be valid, with psychodynamic therapists being rated toward the insight (depth) direction, and cognitive therapists being rated toward the symptoms direction. It is unlikely that this same assessment will be used in the future, but at least this first version of TMatch has shown that therapists can be usefully differentiated on this dimensions.

Results of Study: Therapist Assessment of Use of Psychopharmacology

Almost all therapists answered slightly in the direction of a tendency to use medications, which seems to reflect the current feeling in society in general. This assessment appears to have accurately determined therapists' opinions on the use of medication, especially since the question was so direct and clear.

Results of Study: Matching Success

These matching recommendations were complete failures. As a matter of fact, it seems that the reverse of the matching suggestions would work better. There was evidence that clients with higher N wanted more emphasis on symptoms, more practical advice, and more emphasis on shorter term therapy, and the opposite for clients with low N. In addition, indications were that clients seeking psychotherapy would tend to be high on N, making this not useful for differentiating clients.

The Next Step for Matching Based on Neuroticism

In my opinion, based on my study, the treatment matching recommendations in the literature for 5-Factor Neuroticism should not be used for client-therapist matching