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To make use of psychotherapy research in practice, therapists need real-time access to valid clinically relevant information about patients. The dose-effect and phase models of psychotherapy provide a theoretical background for empirically based psychotherapy management by describing the systematic nature of progress in therapy and guiding the selection of outcome criteria. Given this theoretical background, it is possible to derive appropriate models for monitoring cases in ongoing therapies (patient profiling) and identifying therapists' relative strengths and weaknesses (severity-adjusted provider profiling). These applied methods may be used to inform decision making in ongoing psychotherapies and to support supervision and clinical training., (Copyright 2002 Wiley Periodicals, Inc. J Clin Psychol 58: 1291-1304, 2002.)

Objective: The implications of the use of national norms of the Eating Disorders Inventory (EDI) are investigated., Method: A German version of the EDI was administered to a representative national sample (n = 650), a repeatedly measured community sample (n = 207), and a national inpatient sample with primary diagnoses of anorexia or bulimia nervosa (n = 959). Resulting scale distributions were compared with those of North American samples of the handbook., Results: Normal ranges on several scales markedly differed when German community norms were used. When estimates of rates of clinical significant changes were based on German norms instead of on North American norms, rates were markedly lower for scales measuring core diagnostic features (e.g., binging/purging, Drive for Thinness) and higher for those measuring correlates (e.g., Maturity Fears, Interpersonal Distrust)., Discussion: Neglecting differences in national norms can lead to substantial misinterpretation of empirical findings in the diagnosis of eating disorders and the evaluation of treatment outcome., (Copyright 2001 by John Wiley & Sons, Inc.)

The dosage model provides a normative estimate of the overall pattern of patient improvement in psychotherapy. The phase model further specifies patterns of change in the domains of subjective well-being, symptom remediation, and functioning. The expected treatment response (ETR) approach uses patient characteristics to predict an expected path of progress for each patient. With repeated measures of mental health status, the treatment progress of an individual patient can be assessed against the patient's ETR to support decisions that would enhance the quality of a clinical service while it is being delivered.

Despite recent attempts to define acute injury characteristics of mild traumatic brain injury (MTBI), neuropsychological outcome is often unpredictable. One hundred MTBI cases were prospectively collected, which were consecutive referrals to a concussion clinic, and the roles of various acute neurologic variables were examined in relation to neuropsychological status and vocational outcome. Significant differences were found between subgroups of patients classified by (1) mechanism of injury (i.e. acceleration/deceleration trauma in which the head strikes an object (HSO) versus acceleration/deceleration trauma in which the head does not strike an object (HNSO) versus trauma in which an object strikes the head (OSH), and (2) type of injury (i.e. motor vehicle collision, fall, assault, motor vehicle-pedestrian collision, falling object, sports/recreation). There was no difference, with respect to neuropsychological status or vocational outcome, between patients who had positive findings on computerized tomography (CT) versus those who were CT negative. Additionally, there was no difference between patients who had suffered brief loss of consciousness (LOC) and those without LOC. These findings suggest that selective acute injury characteristics may be used to classify subtypes of MTBI patients.

Adaptive treatment planning is a dynamic process that is dependent on valid, systematic assessments. The dosage and phase models provide theoretical bases for the development of such "patient-focused" information. Given an underlying mathematical regularity to the recovery process, growth modeling techniques can be used to determine an expected treatment response for every patient. By mapping the patient's actual status against such an expected change trajectory, it is possible to address the most clinically relevant question, "Is this treatment working?"

Treatment-focused research is concerned with the establishment of the comparative efficacy and effectiveness of clinical interventions, aggregated over groups of patients. The authors introduce and illustrate a new paradigm-patient-focused research-that is concerned with the monitoring of an individual's progress over the course of treatment and the feedback of this information to the practitioner, supervisor, or case manager.

The strategies for extending clinical significance (CS) methodology, suggested by Tingey et al., have considerable merit. They also serve to highlight the difficulties encountered with CS methodology in general. Problems encountered with the original methodology may be compounded, not solved, by such extensions. For example, problems around lack of agreement about the appropriateness of certain measures, and the questionable psychometric properties of measures, are likely to be exacerbated, not lessened, when attempting to measure social impact. Similarly, the proposal that multiple normative groups be identified to provide the impact factor does not resolve the original difficulty of identifying and discriminating more obviously diverse groups, such as functional and dysfunctional. Other problems with the proposed extensions, such as using criterion "c" (Jacobson and Truax, 1991) with non-normal distributions, are discussed. Some recommendations regarding these problems are made.

A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 x 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.