OUTCOME EVALUATION AND PATIENT/TREATMENT INTERACTION

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This is a revision of an application for a Research Scientist Award (RSA). Questions raised by the Review Committee have been addressed in the Introduction and in the body of the application. The major goals of the proposed research are to address issues in two areas of psychotherapy research: the evaluation of outcome and the role of patient-treatment interaction. In the area of outcome, I will focus on certain domains of functioning, rater perspectives, and levels of evaluation that have not received sufficient attention in studies of the treatment of depression. The domains include positive aspects of functioning (sense of well-being and coping ability) and behavioral measures of emotion (facial expression); the additional perspective is that of a person significant in the patient's life. l will also address substantive and methodological issues in the use of individualized measures of change. In the area of patient-treatment interaction, methods will be developed and hypotheses will be tested regarding the role of patient-treatment "fit" and therapist behaviors which may enhance that fit. This concept has relevance for the early engagement of patients in a variety of therapeutic approaches. The proposed research will draw both on my experience in coordinating the NIMH Treatment of Depression Collaborative Research Program (TDCRP) and on data and videotapes collected in that study. It has general relevance for understanding processes and outcomes in the treatment of depression and for addressing important methodological issues in psychotherapy research. It will also provide an excellent context for my mentoring of social work doctoral students in intervention research methods.