Development History

Systematic Treatment is based on over 30 years of scientific research that includes a level of detail that exceeds that usually possible within the most used research designs that are drawn from other fields. The results of extensive research on the Systematic Treatment concepts have converged around a number of demonstrably important principles that describe the conditions under which patient, treatment, therapist, and process dimensions could promote change.

There has always been an implicit belief among mental health practitioners, and especially among psychotherapy researchers, that there is some optimal or “best fit” between a given collection of interventions and the characteristics of a particular patient. The most usual tactic for exploring this illusive “fit” has been based on a model derived from pharmacology and medicine, the randomized clinical trial (RCT). While RCT research designs are good for assessing the effects of pure treatment packages, isolated techniques, and specified groups of interventions, these designs are not adequate for identifying and blending the many extra-therapy and non-diagnostic contributors to outcome that comprise the more part of treatment. A “treatment”, in the area of mental health, must be considered to extend beyond the particular methods applied. It includes these, and also important qualities of the person who applies these techniques, the receptivity and preferences of the person who is subjected to these procedures, and the quality of the interactions that comprise the medium through which the procedures are applied.

The Innerlife STS System comes from a different perspective than that from which efficacy studies derive. Instead of simply constructing and testing another rationally-based treatment to add to the 400+ already in existence, Beutler and colleagues, over the years, have inspected patients, clinicians, and treatments at more micro levels than that subsumed either by the theoretical model used or by the diagnosis of the patient on which it is applied. Instead, the team was drawn to inspect research through a lens than identifies dimensions of patient, therapist, treatment, and relationships, that optimally fit together and that induce positive effects, regardless of the model of treatment from which these qualities were conceived.

Thus, a growing number of scholars have joined the effort to match specific therapeutic technologies with equally specific non-diagnostic patient dimensions (Shoham-Salomon, 1991; Karno & Longabaugh, 2005; Norcross, 2002; Beutler, 1983; Beutler & Clarkin, 1990: Beutler, Clarkin & Bongar, 2000; Prochaska, 1984; Harwood & Williams, 2003).

The STS–Clinician Rating form (STS-CRF) was first described in 1995 (Beutler & Williams, 1995) and first was published in 1999 (Fisher, Beutler, & Williams, 1999). It represented an extrapolation of findings from a research program that was initiated in 1979 with a re-analysis of the dodo bird verdict proclaimed by Luborsky, Singer, and Luborsky in 1975. That analysis (Beutler, 1979) extracted all research comparisons of two or more psychotherapies from the original Luborsky et al review, and undertook a systematic inspection of the patient characteristics that were present when one of the treatments disaffirmed the dodo bird verdict by proving to be more effective than another treatment. This analysis, contrary to Luborsky et al’s original conclusions, suggested that patients who presented with certain kinds of characteristics were more and less responsive to different classes of therapeutic procedures. That is, procedures that share a particular form or structure, may be equally well received by a given patient, even when their objectives and founding model are different.

Two additional studies, one a post-hoc, naturalistic analysis of patients and therapists in outpatient settings (Beutler & Mitchell, 1981), and the other a quasi-experimental comparison of three types of therapy with various Abest fit@ matches with procedures used in outpatient psychotherapy (Beutler & Thornby, 1982) provided early confirmatory evidence to support the 1979 findings. These studies each constituted comparisons of three different psychotherapy approaches, as represented in therapist behaviors (Behavoral/Cognitive, Insight, Experiential). The results demonstrated the value of fitting therapist directiveness with patient resistance and of fitting the insight or symptom focus of therapy to select patient coping styles.
Complemented by a comprehensive review of accumulated research from numerous research programs, up to that time, the first book based on this research presented a multi-dimensional approach to matching patients with treatments, Systematic Eclectic Psychotherapy (Beutler), and was published in 1983. The identified patient and therapist matching variables had been found, with modest consistency, to be predictive of positive outcomes among various kinds of patients. These dimensions for tailoring the therapy to the patient established the framework for a decision model for planning an integrated approach to treatment. Research on this model then began in earnest with a randomized, prospective study of group therapy among psychiatric inpatients (Beutler, Frank, Scheiber, Calvert, & Gaines, 1984) and a companion study of treatment among psychiatric outpatients (Calvert, Beutler, & Crago, 1988).

As research accumulated, dimensions for optimizing the effects of psychotherapy were extended to include therapist, as well as therapy characteristics and prognostic as well as matching factors. A wide range of research methods were used to identify and refine the matching and prognostic dimensions, including interviews of psychotherapists (e.g., Glueck & Beutler, 1987), prospective studies using randomized clinical trials (RCT) methodologies applied to both the processes of psychotherapy (e.g.; Beutler, Daldrup, Engle, Oro’-Beutler, Meredith, & Boyer, 1987; Beutler, Daldrup, Engle, Guest, Corbishley, & Meridith, 1988; Corbishley, Hendrickson, Beutler, & Engle, 1990; Hill, Beutler, & Daldrup, 1989) and the outcome (e.g., Beutler, Engle, Mohr, Daldrup, Bergan, Meredith, & Merry, 1991; Beutler, Machado, & Engle, 1993; Scogin, Bowman, Jamison, Beutler, & Machado, 1994 ), and post-hoc or quasi-experimental designs (e.g; Beutler, 1991a; Beutler, Mohr, Grawe, Engle, & MacDonald, 1991; Calvert, Beutler, & Crago, 1988; Lafferty, Beutler, & Crago, 1989; Mohr, Beutler, Engle, Shoham-Salomon, Bergan, Kaszniak, & Yost, 1990).

The results of these studies began to converge around a number of demonstrably important principles that described the conditions under which patient, treatment, therapist, and process dimensions could promote change and expanded on the sketchy model that had been described in 1983 (e.g., Beutler, 1991a, 1991b; Beutler & Consoli, 1992; Beutler, Patterson, Jacob, Shoham, Yost, & Rohrbaugh, 1994; Beutler, Sandowicz, Fisher, & Albanese, 1996;Daldrup, Engle, Holiman, & Beutler, 1994; Lazarus & Beutler, 1992).

From early on, however, it became clear that the process of planning a broad ranging treatment for a particular patient, and carrying out that treatment plan through psychotherapy involved somewhat different processes. The new approach to identifying and using the patient and treatment matching dimensions to construct a multi-faceted treatment plan was officially christened, “Systematic Eclectic Psychotherapy” (Beutler & Consoli, 1992) but later was changed to “Systematic Treatment Selection” (Beutler & Clarkin, 1990; Beutler, & Rosner, 1997; Beutler, Zetzer, & Williams, 1996; Norcross, Beutler, & Clarkin, 1998). The particular psychotherapeutic intervention based on these plans was dubbed, “Prescriptive Psychotherapy” (Beutler & Hodgson, 1993; Beutler & Harwood, 2000). Eventually, the term Systematic Treatment Selection, or STS was used to describe the assessment process and Prescriptive Psychotherapy was used to describe the collection of interventions that comprised the particular shape of the psychotherapy that derived from this planning process (Beutler, Zetzer, & Williams, 1996; Beutler & Rosner, 1997; Norcross & Beutler, in press; Norcross, Beutler, & Clarkin, 1998; Beutler, Clarkin, & Bongar, 2000; Beutler, Alomohamed, Moleiro, & Romanelli, 2002).