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The Relationship of Process to Outcome

Mardi J. Horowitz, MD; Charles Marmar, MD; Daniel S. Weiss, PhD; Kathryn N. DeWitt, PhD; Robert Rosenbaum, PhD

Arch Gen Psychiatry. 1984;41(5):438-448.

Abstract
• We studied the relationship of dispositional and process variables with outcome in 52 bereaved patients given timelimited dynamic psychotherapy. Outcomes were generally favorable in symptom relief and improvement in relationship and occupational functioning. Patients' symptoms improved more than did their social and work functioning. Pretreatment levels of impairment or distress were significantly related to outcome, but most demographic and dispositional variables did not predict outcome. Process variables examined in relation to outcome—therapeutic alliance and actions by the therapist—were not significantly related to either type of outcome. When we considered the same process variables in interaction with two dispositional variables, motivation for dynamic therapy and developmental level of the self-concept, we found significant predictions of outcome. The major findings suggest that more exploratory actions were more suitable for highly motivated and/or better-organized patients and less suitable for patients with lower levels of motivation or organization of self-concept. More supportive actions were more suitable for patients at lower dispositional levels and less therapeutic for patients at higher levels.

Author Affiliations
From the Center for the Study of Neuroses, Department of Psychiatry, Langley Porter Institute, University of California, San Francisco.

Footnotes
Accepted for publication Aug 16, 1983.

Reprint requests to Box 38-B, Department of Psychiatry, 401 Parnassus Ave, University of California, San Francisco, CA 94143 (Dr Horowitz).

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