Dan J. Epstein Family Foundation Center for Psychotherapy Change
In 1998 a team of researchers at The Family Institute, under the direction of Dr. William Pinsof, created the Psychotherapy Change Project, a research initiative with the goal of studying the process of client change in therapy. To that end, the Psychotherapy Change project has conducted a series of studies examining different aspects of the client change, always with an eye toward couple and family systems and always with a focus on improving the quality of therapy. Over time, our focus has increasingly shifted to include the development of new and better tools to facilitate this work. The culmination of this effort is the development of the STIC feedback system described below. Since its inception, the work of Psychotherapy Change Project has been made possible by generous donations. In November 2013 the Institute recognized a major gift by creating the Dan J. Epstein Family Foundation Center for Psychotherapy Change in honor of former Chairman of the Board, Dan J. Epstein.
The overarching goals of the Epstein Center are:
- to have a deeper understanding of how people change
- to understand how therapists contribute to client change
- to improve the quality and efficiency of therapy
- to develop tools and techniques for integrating research and clinical practice
The mission of the Epstein Center for Psychotherapy Change is to transform psychotherapy throughout the world by integrating science, technology and family systems.
The Epstein Center for Psychotherapy Change is an international leader in feedback research and empirically-informed psychotherapy. Our measurement systems set a worldwide benchmark for assessing individuals, couples, and families, for tracking change over the course of therapy, and for studying therapists’ behavior. Our feedback tools provide therapists and institutions with timely, accurate information about clients and therapists that facilitates data-informed, multi-systemic psychotherapy services, and empowers clients as collaborators in their treatment. By coordinating large-scale data collection in treatment centers across the globe we illuminate how clients and therapists collaborate in the change process and improve the efficacy and efficiency of therapy.
One primary goal of the Epstein Center is to create tools that bridge research and clinical practice. To that end, we developed the STIC® (Systemic Therapy Inventory of Change), a cutting-edge measurement and feedback system. The STIC is the first instrument that simultaneously looks at client’s individual symptoms and also problems that occur in romantic partnerships, families, and between parents and children. The STIC is designed to monitor weekly changes in the client’s personal and relationship functioning. We use the STIC as both a research tool and a way of fostering better clinical practice.
- The STIC® Initial is an online self-report questionnaire which assesses a wide range of problems that clients experience in their daily lives and in their important relationships. It is completed by clients before the first session of therapy.
- The STIC® Intersession is an abridged version of the STIC Initial designed to be completed in just a few minutes before each session. It targets all of the same areas as the STIC Initial and also assesses the relationship between clients and therapist.
- The STIC® Feedback System analyzes the Initial and Intersession data and provides detailed, real-time assessments to therapists. The STIC System provides objective empirically-grounded feedback which can be used by clients and therapists together to set goals, plan, and evaluate treatment.
Both the multi-systemic focus and electronic feedback set the STIC apart. The STIC website allows the therapist to quickly review their client’s results before each therapy session. Using the STIC website together during a session, therapists and clients can set clearer goals, assess progress in real-time, and make informed treatment choices.
Testing the Effectiveness of the STIC System in Psychotherapy
The Epstein Center is currently involved in a large-scale multi-site international program of research with the aim of testing and improving the STIC system. We are conducting randomized clinical trials in the United States and Norway to gather empirical data on the use of the STIC and therapeutic outcomes while broadening the reach of the project as a pre-eminent research tool. To date, 169 therapists at The Family Institute have utilized the STIC with 1,647 clients. Through participating Chicago agencies (Catholic Charities of the Archdiocese of Chicago, Jewish Child & Family Services, Community Counseling Centers of Chicago), 73 therapists have used the STIC with a total of 585 clients.
Therapeutic Alliance and the Process of Change in Psychotherapy
While extensive research has documented that the quality of the relationship between therapist and patient is associated with successful psychotherapy, investigations conducted at The Family Institute at Northwestern University demonstrate the importance of expanding this definition to include the influence of significant other people in the patient’s life. For example, in individual therapy, support of the treatment by the patient’s significant others (e.g., family members, spouse, close friends) is associated with successful outcome. In couple therapy, the extent to which the couple agrees with each other on treatment tasks, goals, and bonds predicts whether therapy will be successful.
Studies are currently being conducted at the Epstein Center to evaluate the links between the therapeutic alliance and the process and outcome of individual, couple, and family therapy.
“Using the STIC with clients allows a therapist to see - in a visual form - the problems that clients are describing in session and adds more depth and understanding to the processes of hypothesizing, treatment planning, and monitoring progress. I have found that my clients enjoy looking at their data and are able to use it to discuss in greater detail the things they want the therapist to understand.”
“I have found the STIC incredibly useful for hypothesizing about my clients and their presenting problems using STIC Initial data. I could not possibly ask all these questions before the first session or even in the first session or two, so having clients fill out the STIC before they even come in gives me a huge leg up on getting to know them.”
“The STIC has been helpful to co-plan treatment with clients by showing them their scores and asking what they think of them. This can help us decide which issues are most pressing by identifying the scales that are most in the clinical range. Showing the clients their scores has also been helpful in re-hypothesizing once some problems have been resolved in the therapy…”
“The alliance scales also offer an interesting and helpful way to track changes in the therapeutic alliance that, without STIC data, would go undetected. As a student therapist, the STIC offers me a unique opportunity to be a part of cutting edge research regarding therapeutic change in our clients. It is both rewarding and inspiring to be a part of that process.”
“Sometimes I get discouraged when I feel like I'm not changing, but then I see the line graphs and I realize how far I've come already -- it gives me motivation to work on continuing to change.”
“When my counselor shows me the different areas that my questions have answered, it is so interesting, and I get an idea of where my problems are -- I find myself thinking about those areas of my life more often and how to make them better.”
Pinsof, W. M., Goldsmith, J. Z., & Latta, T. A. (2012). Information technology and feedback research can bridge the scientist–practitioner gap: A couple therapy example. Couple and Family Psychology: Research and Practice, 1:4, 253-273.
Pinsof, W. M., Zinbarg, R. E., Lebow, J. L. , Knobloch-Fedders, L. M., Durbin, E., Chambers, A., Latta, T., Karam, E., Goldsmith, J., & Friedman, G. (2009). Laying the foundation for progress research in family, couple, and individual therapy: The development and psychometric features of the initial systemic therapy inventory of change. Psychotherapy Research, 19(2), 143-156.
Pinsof, W. M., Zinbarg, R. E., Knobloch-Fedders, L. M. (2008). Factorial and construct validity of the revised short form integrative psychotherapy alliance scales for family, couple, and individual therapy. Family Process 47, 281-301.
Pinsof, W., Knobloch-Fedders, L. M., & Mann, B. J. (2007) Therapeutic alliance and treatment progress in couple therapy. Journal of Marital & Family Therapy 33, 2, 245-257.
Knobloch-Fedders, L. M., Pinsof, W. M., & Mann, B. J. (2004). The formation of the therapeutic alliance in couple therapy. Family Process 43, 425-442.