Year

2003

Degree Name

Doctor of Psycology(Clinical)

Department

University of Wollongong, Dept. of Psychology

Abstract

How people with depression are able to master their symptoms through psychotherapy has been a subject of considerable debate. Previous research indicates that an increased sense of mastery is indicative of lower depression, with gains in interpersonal mastery throughout therapy predicting better outcomes. The current study further investigates the concept of interpersonal mastery in relation to several common factors identified in the literature as instrumental to the effective treatment of depression: the therapeutic alliance, global functioning, perceived severity of personal problems, and the patient's perception of improvement in mood. Thematic analyses were also undertaken. The aim of the study was to determine if mastery could assist in understanding the prediction of outcome. Specifically, it was anticipated that mastery would help to explain why some less theoryrelevant methods (e.g. G A F ) are useful in the prediction of therapeutic gains.

The sample consisted of 87 adults who took part in the Northfields Clinic depression program, comprising 16 sessions of psychotherapy. Depression and global functioning were assessed at intake and termination, self-reported problems were measured at intake, therapeutic alliance was assessed at week three of treatment, and the patient's perception of improvement in mood was measured at termination. Mastery levels were ascertained by applying the Mastery Scale to transcripts taken from intake interviews, and were scored by two judges, with high inter-rater agreement.

Depression was found to be related to mastery levels at intake, such that higher levels of mastery were indicative of lower depression scores. This relationship, however, was not sustained at termination, or through residualised gain scores. The hypothesis that the therapeutic alliance would be related to mastery was not supported, suggesting that the concept of mastery is different from the ability to form an alliance. A more pervasive relationship, however, was found between mastery and global functioning measures, which was further supported by findings that patients with higher mastery levels reported greater improvements in mood. The perceived severity of personal problems was also unrelated to mastery, suggesting that as a construct, mastery reflects more than an absence of patient-reported problems.

Thematic analyses found that those who reported large improvements in mood at termination were more likely to express a strong sense of social support, identify clear incidents (rather than a global sense) of interpersonal difficulties, show signs of active help-seeking behaviour, and be able to identify positive as well as negative aspects of their life, with a more acute experience of depression. These themes are indicative of higher mastery scores (level 4). In contrast, those who regarded improvements to be very small were more likely to present themes that reflected lower levels of mastery (levels 1 - 2): isolation, hopelessness, a global dissatisfaction with life, and a more chronic experience of depression.

These findings indicate that certain qualities indicative of higher mastery should predict faster gains in therapy. For example, patients w h o are well engaged within a social unit and discuss their difficulties within the context of that unit (level 4) should respond quicker to therapy than those w h o express their difficulties without reference to others (e.g., level 1). As such, these results help ascertain how long a person may need treatment, explain the kinds of things clinicians should look out for, and enhance understanding regarding the relationship between severity of symptoms (GAF) and outcome.

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