Early trajectory features and the course of psychotherapy

Objective: We investigated the relationship between psychotherapy outcome and trajectory variables measured during the first five treatment sessions. Method: In a psychotherapy training clinic, 158 patients completed a measure of symptomatic distress at each visit during treatment lasting a median 30 sessions. We investigated outcome predictions based on symptomatic distress at intake, change in distress between the first and fifth sessions, and intersession shifts. Results: Elevated symptomatic distress at intake predicted reliable change, while limited initial distress predicted clinically significant improvement; both predictions were independent of those by other trajectory variables. Large early change and large intersession shifts yielded similar predictions of reliable change and clinically significant improvement. Greater change between the first and fifth sessions predicted less change in subsequent sessions. By contrast, neither initial distress nor early intersession shifts predicted change in distress after the fifth session. Conclusion: Considered together, symptomatic distress at intake and change in distress over the first five sessions improve the prediction of psychotherapy outcome over base rate. Intersession shifts contribute little to the prediction of outcome after accounting for overall change in symptomatic distress during the first five sessions.