TMatch: Matching Clients and Therapists Based on Client Preference for Therapy Characteristics

General Description

Therapists know that there are many different types of therapy, and many different therapy characteristics that may coincide with named types of therapy, or may cut across named types. Although most clients aren't familiar with the named types of therapy, or the ways therapies can differ from each other, there is strong evidence that allowing clients to select therapists based on the their preferences for therapy characteristics improves outcome. After reviewing studies of the effect on outcome of accommodating client preferences, Glass, Arnkoff, and Shapiro (2001, p. 460) concluded "clients who receive a treatment they believe in and prefer may be more likely to engage early in therapy, work hard, and comply with and continue in treatment, leading to better outcome." In a study using a system called "the negotiation approach," Van Audenhove and Vertommen (2000) found that clients who were educated and informed about their therapeutic options, and then allowed to choose their types of therapy and their particular therapists, had lower dropout rates from therapy than other clients. In TMatch, clients were given the opportunity to express preferences for several areas of characteristics of their therapies. In each of these areas, therapists were assessed with similar questions about their usual emphases in therapy. Clients were then matched to therapists based on the similarity of the clients' preferences to the therapists' answers. To see more information on any of these areas, click on the links below.

Clients put a list of 7 possible ways of being helped in therapy in order of their preferences, and then rated each "help-way" as to how often they would like this type of help. Therapists ordered and rated the same list. This was one of several attempts to distinguish among different styles of therapy based on something other than names of specific schools or belief systems.

Clients put a list of seven possible types of insight or ways of understanding problems in order of their preferences. Therapists put the same list into order of their usual amount of emphasis.

Time limitation in therapy is related to, but not identical with, therapy depth, in that the more depth desired, the more time required. However, some systems of therapy allow clients to go as deep as they desire, and other systems by their nature remain at the depth at which they start. For example, a client who is referred to behavior therapy has no opportunity to decide to remain in therapy for a long term depth therapy. Therefore, clients were asked for their preferences for both therapy length and depth.

Studies comparing psychotherapy and pharmacotherapy within diagnoses have in general not found any preferential effects for either (Beitman, Hall, & Woodward, 1992; Elkin, 1994). Studies comparing differential effects between psychotherapy and pharmacotherapy according to client aptitudes are so preliminary, and the findings so complex (Dance and Neufeld, 1988), that the results are almost impossible to use for matching. It would be wonderful if a matching system could help clients decide the relative amounts of psychotherapy and pharmacotherapy to use. Unfortunately, there isn't enough information available to do this. The best that could be done in TMatch was to match clients according to their preferences for therapists' attitudes regarding medication for psychological problems.

Other Therapy Characteristics

This is a catch-all category, to hold a few therapist or therapy characteristics that could be used for matching, most of which had already been answered by therapists for matching on other criteria. There were eight items in this criterion. For each of the eight, clients were asked to express preferences, and therapists were asked to rate themselves. Most of these questions were selected because they had already been answered by therapists for assessing other qualities used for matching. The client preference questions were:

1. How often would you like your therapist to use humor during therapy sessions?
2. What level of intimacy with your therapist would you prefer?
3. What amount of structure would you prefer in your therapy?
4. To what extent would you like your therapist to think of therapy as a collaboration with you?
5. Would you prefer your therapist to use standard methods, or to create novel methods?
6. Would you like your therapy to focus on acceptance of problems, or on overcoming problems?
7. Would you prefer your therapist to plan your sessions ahead, or to be flexible?
8. How directive would you like your therapist to be?

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References

Beitman, B. D., Hall, M. J., & Woodward, B. (1992). Integrating pharmacotherapy and psychotherapy. In J. C. Norcross & M. R. Goldfried, (Eds.), Handbook of psychotherapy integration (pp. 533-560). New York: Basic Books.

Dance, K. A. & Neufeld, R. W. J. (1988). Aptitude-treatment interaction research in the clinical setting: A review of attempts to dispel the "patient uniformity myth." Psychological Bulletin, 104, 192-213.

Elkin, I. (1994). The NIMH treatment of depression collaborative research program: Where we began and where we are. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed.) (pp. 114-139). New York: John Wiley & Sons.

Glass, C. R., Arnkoff, D. B., & Shapiro, S. J. (2001). Expectations and preferences. Psychotherapy, 38(4), 455-461.

Greenberg, L. S., Elliott, R., Watson, J. C., & Bohart, A. C. (2001). Empathy. Psychotherapy, 38(4), 380-384.

Van Audenhove, C., & Vertommen, H. (2000). A negotiation approach to intake and treatment choice. Journal of Psychotherapy Integration, 10(3), 287-299.