Can the content of a client's construing of personality development be used to predict outcome in Cognitive Behavioural Therapy (CBT)?

Background: A variety of factors impact on the outcome of therapy including the therapeutic relationship, the therapist, the family background and co-morbid problems of clients. The Personal Constructs of clients, particularly their concept of ideal self and presenting problem, have been found to affect outcome in therapy. However the impact of a client’s wider pattern of construing is an area that has been neglected. In particular, this study investigated whether clients’ constructs of factors influencing personality development were associated with outcome in cognitive behaviour therapy (CBT) groups. Method: Clients were recruited from CBT groups for a range of different clinical presentations. The study was in three stages. In stage one participant’s constructs around factors influencing personality development were found using dyadic elicitation. In stage two, a participant group categorised the constructs, and all participants then ranked the constructs using a modified resistance to change methodology. In the third stage, the ranking of constructs was compared between participants with good or poor therapeutic outcomes using a Mann-Whitney analysis. Results: A total of 26 participants were recruited, of whom 22 were involved in the comparison of good and poor outcome. Participants identified sixteen constructs of influences on personality development. A particularly sophisticated hierarchical model was developed spontaneously by participants, providing methodological validation. In comparing groups, it was found that constructs about education being ranked low were associated with poor outcome, and dropping out of therapy. Conclusions: CBT groups have many parallels to educational settings. Therefore it was hypothesised that if individuals ranked education constructs low they would find it more difficult to gain benefit from a CBT group. It was suggested that rather than assigning clients to treatment based on diagnosis, more attention should be given to what they construe as ‘helpful’.