Involving clients in treatment methods: a neglected interaction in the therapeutic relationship
Open accessAbstract
OBJECTIVE: The authors investigate a model on how clients' differential involvement in therapeutic methods mediates the effect of therapist support in psychological treatment-in this case, a cognitive behaviorally based bibliotherapy for insomnia, administered with or without supportive telephone calls. METHOD: Eighty-nine participants, who fulfilled diagnostic criteria for insomnia, had a mean age of 49.1 years (range, 18-73 years) and were predominantly female (77%), fairly well educated, and mainly Caucasian. Participants were randomized between a bibliotherapeutic self-help treatment and the same treatment with the addition of therapist support. Primary outcome measure was the Insomnia Severity Index. Data on involvement in different methods and aspects of the treatment were estimated by clients at posttreatment and validated against therapist ratings of client involvement during treatment. Structural equation modeling was used to test if the effect of therapeutic support on outcome was mediated by involvement in treatment. RESULTS: Carrying out the treatment with therapist support significantly boosted the therapeutic effects. A mediational analysis with involvement in the three key treatment methods (sleep restriction, sleep compression, and stimulus control) as the mediator fully mediated the differential effect between the two conditions (Sobel test; r = .31; z = 2.173; p < .05) and explained 68.4% of the total effect. CONCLUSIONS: Therapeutic support improved outcome via higher patient involvement rather than having a direct effect on outcome. Thus, relationship and methods could be regarded as interactional, and patient involvement should be considered. These factors could be further studied in treatments where specific ingredients within the therapeutic contact can be experimentally manipulated.
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Others have found that the therapist support in internet-delivered therapy do increase outcome, but not as a direct, general effect, but by mediating patients' involvement and engagement in important therapeutic processes (Kaldo et al., 2015).
“Others have found that the therapist support in internet-delivered therapy do increase outcome, but not as a direct, general effect, but by mediating patients' involvement and engagement in important therapeutic processes, which underlines a complexity in understanding the role of the therapist in these types of interventions (Kaldo et al., 2015).”
From Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response (2021) · cites this paper as Kaldo et al., 2015
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- Authors
- Kaldo, V., Ramnerö, J., & Jernelöv, S.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2015-12
- Volume
- 83
- Issue
- 6
- Pages
- 1136-1141
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2390253038
- Cited by
- 27
- References
- 17
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 5 · 2015: 3
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- therapeutic relationship, therapist support, bibliotherapy, insomnia, cognitive behavioral therapy, sleep restriction, stimulus control, telephone support, self-help treatment, mediation, Insomnia Severity Index
- MeSH terms
- Adolescent, Adult, Aged, Bibliotherapy, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Participation, Professional-Patient Relations, Self Care, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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