The ecology of psychotherapy research

The ecology of psychotherapy research was examined with patient reports of demand characteristics and awareness of research instrumentation. Patients were part of the Vanderbilt II project that explored the effectiveness of manualized training. A total of 59 patients from the pretraining and posttraining phases of the project were interviewed after termination assessments were made. Patients who were highly aware of their role as a "subject" in an experiment had outcomes that were consistent with the primary hypotheses of the study, although training did not significantly improve outcomes. In the pretraining cohort, patients who were highly aware of their "subject" role had poorer outcomes and engaged less in exploratory process. In the posttraining cohort, patients who were highly aware had good outcomes and engaged in more exploratory processes. Interestingly, therapists of these patients offered a positive relationship but failed to adhere to the principles taught during training. Demands of the research, especially how the patient defines his or her role, may affect results in significant ways.