The role of values in psychotherapy: A critical review of process and outcome effects

This paper clarifies the definition and measurement of values by selecting the work of Rokeach as a referent and concludes that in order for research to progress, investigators must address several issues, including: construct clarity, increased specificity of both values and outcome measures, and a tripartite perspective on outcome.

Abstract

A recent surge of research and interest in the role of patient/therapist personal values in psychotherapy has followed the observation that therapists do not remain value free even when they intend to do so. The literature to date suggests that: (a) the increasing similarity of patients' values with therapists' values during therapy, known as convergence, often occurs and may be an important mechanism of patient improvement, and (b) an initial dissimilarity of patient/therapist values may be related to both convergence and improvement. Values research, however, has been plagued with discrepant construct definitions, unreliable measures, weak study designs, and contradictory results. Addressing these issues, this paper clarifies the definition and measurement of values by selecting the work of Rokeach as a referent. A referent-based critical review of empirical studies investigating the role of values in psychotherapy yielded three findings: (a) Patient/therapist values convergence does occur in therapy and is associated with initial values dissimilarity; (b) patient/therapist values convergence is associated with the therapist's rating of improvement, but not with the patient's rating and not with a standardized measure of symptom amelioration; and (c) patient/therapist initial values similarity evidences a complex association with improvement. It is concluded that in order for research to progress, investigators must address several issues, including: construct clarity, increased specificity of both values and outcome measures, and a tripartite perspective on outcome.