Towards a Person-Oriented Approach to Psychotherapy Research

The need for a change in medical research thinking. Eco-systemic research frames are better suited to explore patterned disease behaviors

Many practicing physicians struggle to properly evaluate clinical research studies - they either simply do not know them, regard the reported findings as 'truth' since they were reported in a 'reputable' journal and blindly implement these interventions, or they disregard them as having little pragmatic impact or relevance to their daily clinical work. Three aspects for the latter are highlighted: study populations rarely reflect their practice population, the absolute average benefits on specific outcomes in most controlled studies, while statistically significant, are so small that they are pragmatically irrelevant, and overall mortality between the intervention and control groups are unaffected. These observations underscore the need to rethink our research approaches in the clinical context - moving from the predominant reductionist to an eco-systemic research approach will lead to knowledge better suited to clinical decision-making for an individual patient as it takes into account the complex interplay of multi-level variables that impact health outcomes in the real-world setting.

Person, Population, Mechanism. Three Main Branches of Psychological Science

There are different ways of dividing psychology into subdisciplines. The purpose of the present paper is to explore one specific meta-perspective on psychological science, seen as having three main branches: person psychology, population psychology, and mechanism psychology, linked to three different levels of research. Person-level research focuses on psychological phenomena as experienced and enacted by individual persons in their interaction with other persons and other parts of the environment, and in their development over time. Population-level research focuses on populations of individuals, frequencies of various psychological phenomena in a population, risk factors, and population-level effects of various psychological interventions. Mechanism-level research focuses on psychological functioning as explained in terms of neurophysiological mechanisms and information processes at a sub-personal level. It is argued that the failure to differentiate clearly between research questions at these three levels lead to questionable research practices. Most notably, a failure to differentiate clearly between the population level and the person level leads to problem-method mismatches in the form of researchers trying to answer questions about persons by research on populations. Also, because of a failure to differentiate between the person level and the mechanism level, explanations in terms of sub-personal mechanisms are too often seen as providing answers about what occurs at the person level, thereby failing to study persons as intentional agents in interaction with other persons and other parts of the environment. It is argued that a clear differentiation between three levels of psychological science - population, person, and mechanism - may contribute to an increased clarity in these matters and may thereby contribute to the development and maturation of psychological science.

The Central Role of the Concept of Person in Psychological Science

The first article in the present issue of JPOR is written by two pioneers in person-oriented research, John Nesselroade and Peter Molenaar. Among other things they argue that the individual is the primary unit of analysis for studying behaviour, and that this is in line with a growing emphasis on personalized diagnoses and treatment regimens in medicine, which reflects a renewed emphasis on focusing on the individual person. As was argued by Julia Moeller in a previous article in JPOR, however, psychological science seems to “lag behind” in this respect, with a concomitant risk of a credibility loss. One problem is that psychology still lack a coherent theoretical paradigm that places the person at the center of the stage. Some promising theoretical work on the concept of person has been carried out by researchers such as Mark Bickhard and Peter Ossorio, and it is possible that the future will see an increased cross-fertilization between (1) the theoretical development of a comprehensive model of the person and (2) methodological developments that facilitate the study of developmental processes at the level of the individual person.

Averting the Next Credibility Crisis in Psychological Science: Within-Person Methods for Personalized Diagnostics and Intervention

Personalizing assessments, predictions, and treatments of individuals is currently a defining trend in psychological research and applied fields, including personalized learning, personalized medicine, and personalized advertisement. For instance, the recent pandemic has reminded parents and educators of how challenging yet crucial it is to get the right learning task to the right student at the right time. Increasingly, psychologists and social scientists are realizing that the between-person methods that we have long relied upon to describe, predict, and treat individuals may fail to live up to these tasks (e.g., Molenaar, 2004). Consequently, there is a risk of a credibility loss, possibly similar to the one seen during the replicability crisis (Ioannides, 2005), because we have only started to understand how many of the conclusions that we tend to draw based on between-person methods are based on a misunderstanding of what these methods can tell us and what they cannot. An imminent methodological revolution will likely lead to a change of even well-established psychological theories (Barbot et al., 2020). Fortunately, methodological solutions for personalized descriptions and predictions, such as many within-person analyses, are available and undergo rapid development, although they are not yet embraced in all areas of psychology, and some come with their own limitations. This article first discusses the extent of the theory-method gap, consisting of theories about within-person patterns being studied with between-person methods in psychology, and the potential loss of trust that might follow from this theory-method gap. Second, this article addresses advantages and limitations of available within-person methods. Third, this article discusses how within-person methods may help improving the individual descriptions and predictions that are needed in many applied fields that aim for tailored individual solutions, including personalized learning and personalized medicine.

The emancipation of mindfulness from its religious context

The present paper argues that if the so-called mindfulness movement is to reach its full potential it needs to emancipate from its religious context and ally itself fully with psychological science. The argument that mindfulness meditation needs a religious context for ethical reasons is untenable. Although mindfulness skills may well be used for un-ethical purposes, this applies equally to both religious (e.g., Buddhist) and secular contexts, and is best handled by an open-minded philosophical-ethical discussion. One problem with present mindfulness-based treatments and mindfulness research is that they are still partly enmeshed with Buddhist conceptualizations of the world, which are thought to represent "seeing things as they are". If the full potential of mindfulness meditation is to be understood, research methods are needed which focus on the phenomenological practices involved in terms of psychological processes such as the regulation of attention and attitudes.

Do therapist effects really impact estimates of within-patient mechanisms of change? A Monte Carlo simulation study

Objective: Existing evidence highlights the importance of modeling differential therapist effectiveness when studying psychotherapy outcome. However, no study to date examined whether this assertion applies to the study of within-patient effects in mechanisms of change. The study investigated whether therapist effects should be modeled when studying mechanisms of change on a within-patient level. Methods: We conducted a Monte Carlo simulation study, varying patient- and therapist level sample sizes, degree of therapist-level nesting (intra-class correlation), balanced vs. unbalanced assignment of patients to therapists, and fixed vs random within-patient coefficients. We estimated all models using longitudinal multilevel and structural equation models that ignored (2-level model) or modeled therapist effects (3-level model). Results: Across all conditions, 2-level models performed equally or were superior to 3-level models. Within-patient coefficients were unbiased in both 2- and 3-level models. In 3-level models, standard errors were biased when number of therapists was small, and this bias increased in unbalanced designs. Ignoring random slopes led to biased standard errors when slope variance was large; but 2-level models still outperformed 3-level models. Conclusions: In contrast to treatment outcome research, when studying mechanisms of change on a within-patient level, modeling therapist effects may even reduce model performance and increase bias.