Objective measures of subjective experience: the use of therapist notes in process-outcome research

Computerized linguistic measures of emotional engagement, and reflective and affective language, previously applied to session transcripts, were applied to notes of 14 treatments by candidates under supervision at the New York Psychoanalytic Society and Institute, covering the five decades from the 1950s to the 1990s. The findings indicate a strong relationship between candidates' subjective experience as represented unintentionally in the linguistic style of their case notes and the effectiveness of their clinical work. The treatments were evaluated for effectiveness by experienced clinicians using the Global Assessment of Functioning (GAF) and the Psychodynamic Functioning Scales of Høglend and colleagues; a Composite Clinical Effectiveness (CCE) measure was constructed based on level and change in these measures. The Mean High Weighted Referential Activity Dictionary (MHW), a computerized measure of emotional engagement developed in the framework of Bucci's theory of multiple coding and the referential process, showed a positive correlation of .73 with CCE. The Hostility subcategory of the Negative Affect Dictionary (ANH) showed a negative correlation, -.48, with CCE. In a multiple regression analysis, these two variables accounted for over three-quarters of the variance in the CCE. Implications of the findings for process/outcome research and supervision and evaluation of trainees are discussed.