The Proper Application of Statistical Models in Counseling Psychology: Using Survival Analysis to Model Client Outcomes in a Telepsychology Clinic

Abstract

There has been a “quiet methodological revolution” that has started to move psychology away from reliance on null hypothesis statistical significance testing, and the focus has shifted to the utilization of statistical/mathematical models to answer research questions. Survival data are a specific type of data that incorporate a discrete event and time. These events can vary and do not have to be literal survival, and in counseling psychology this more general conceptualization can be utilized in psychotherapy outcome research. Outcome data was collected at the TCC on the PHQ-9 and CORE-B for clients who were residents of an underserved region of Texas. There is needed research looking at “treatment-as-usual” psychotherapy outcomes because it best represents the reality of providing clinical services, especially in a rural, underserved area. The clinically significant change paradigm was used as it provided a structure of measuring responses to therapy, and there was literature available for comparison. This type of data can demonstrate the strengths of survival analysis. This study presented specific research questions pertinent to clinics, practitioners, and researchers about client response to treatment, and these research questions were answered through a survival analytic framework. Results from this study generally support other research showing that 11 to 14 sessions of psychotherapy lead to clinically significant change or reliable improvement on outcome measures, and additionally, there is much client growth in the first few sessions. The impact of client demographics remains unclear; however, insurance status appears to be a preliminary factor positively affecting clients in this region. iii

The use of survival analysis in the counseling psychology literature is minimal, with a few exceptions. However, many psychologists would not argue with a conceptualization of psychotherapy as a longitudinal process that occurs across a series of psychotherapy sessions. Moving forward, counseling psychologists are well suited to expand their clinical services through the use of telepsychology and to expand their thinking and research to involve statistical models that better represent the reality they are trying to capture and understand.