Thin slice ratings of personality have been shown to predict a number of outcomes, but have yet to be examined in the context of psychotherapy. In a sample of 66 clients participating in cognitive therapy for depression, we examined the predictive utility of thin slice rated pre-treatment client traits. On the basis of short video clip excerpts (i.e., thin slices) of intake assessments, trained observers rated clients on personality characteristics and specific personality disorder (PD) traits. Clients' therapy interest and neuroticism predicted lower odds of dropout. Ratings of extraversion predicted greater symptom change across treatment; ratings of clients' Avoidant and Schizoid PD traits predicted less marked symptom improvement. Ratings of agreeableness and likeability also predicted greater symptom change, but these relations were only significant in one of two analytic approaches used. Evidence for the predictive validity of thin slice ratings was generally stronger than that observed for self-reported PD traits and PD status. Moreover, these self-report and diagnostic assessments failed to account for the thin slice-outcome relations identified. Findings support the clinical utility of quick, thin slice impressions of clients, as these ratings could be used to identify clients with a high risk of dropout or poor treatment outcome.
Cognitive Therapy (CT) has been established as an efficacious treatment for depression (Strunk & DeRubeis, 2001). However, clients show considerable variability in their response to treatment, and not all clients achieve optimal outcomes (Hollon, Thase, & Markowitz, 2002). This variability in outcomes can be decomposed into three sets of causal factors: those associated with therapists, with clients, and any interactions of therapist and client factors (DeRubeis, Brotman, & Gibbons, 2005).
In this paper, we examine the relation of pre-treatment client characteristics to subsequent therapeutic outcomes (i.e., both treatment dropout and symptom improvement) in CT for depression. We assessed these characteristics using observer ratings of short (<1 min) video excerpts, taken from clients' intake evaluations. Such ‘thin slice ratings’ of personal characteristics have demonstrated predictive validity in a number of different domains (i.e., marital outcomes, sales effectiveness, and intelligence test scores; Ambady, Krabbenhoft, & Hogan, 2006; Borkenau, Mauer, Riemann, Spinath, & Angleitner, 2004; Ebling & Levenson, 2003). However, thin slice ratings have yet to be examined in the context of psychotherapy. We hypothesized thin slice ratings of client characteristics would have predictive validity in this context. Further, we suspected these thin slice ratings would serve as predictors of outcome above and beyond commonly used diagnostic and self-report measures. To place our work in context, we first review evidence for the relation of personality disorder (PD) status and other client characteristics with treatment outcome. Then, we consider the potential utility of a thin slice method for assessing client traits.
Our findings support the notion that individuals quickly become aware of certain personality traits on the basis first impressions, and that some of these impressions can predict subsequent symptom change and dropout in CT for depression. Thin slice ratings have the potential to serve as tools that might ultimately be used to help formulate treatment plans that will enhance responsiveness to the clients' needs. Future research could pursue this possibility by both replicating our results and examining how different intervention strategies might be used to maximize outcome across clients with different characteristics.
