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Wallerstein, R.S. (1963). The Problem of the Assessment of Change in Psychotherapy. Int. J. Psycho-Anal., 44:31-41.

(1963). International Journal of Psycho-Analysis, 44:31-41

The Problem of the Assessment of Change in Psychotherapy

Robert S. Wallerstein

The assessment of change in psychological variables is a core problem in clinical research in any aspect of the behavioural sciences—whether it be in personality growth and development, in psychosomatics, in education and learning, in psychodiagnostics or in psychotherapy. The change brought about in personality functioning under the impact of psychotherapeutic intervention is often taken as the prototypical expression of this issue.

Most simply (and naïvely) this is expressed as an inquiry into the effectiveness of psychotherapy. The questions are: Does psychotherapy work? If so, how well does it work, to what extent and with what kinds of patients? And, in deference to the scientist's expected quest for controls, the question is often added: How well does it work, as compared with the natural history of the same morbid state left untreated? Asking, and expecting answers to questions set in these terms, is clearly based on a series of (at least tacitly) agreed-upon assumptions. These are that there exist currently accepted criteria of three kinds: (1) criteria of illness—specifications of the degree and kind of deviations that merit the designation, pathological; (2) criteria of a state of ideal mental health (called 'positive mental health' in the current literature (Jahoda, 1958)); and (3) measures of improvement as the degree to which the patient has diminished the gap between his state of mental illness prior to treatment and these desiderata of mental health.

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