| Psychotherapists interpret the explanatory models patients use to understand their presenting problems as reflections of these patients' personalities, use of defense, psychological mindedness, experience of agency, attributional styles, or cultural backgrounds. Patients' explanatory models have therefore been viewed as both diagnostic of their pathology and prognostic of their openness to or aptitude for therapy. The present study explores the reliability and validity of the Explanatory Model Profile (EMP), a new trans-theoretical coding system for patients' beliefs about the causes for their problems. This coding system was applied to free-response descriptions of presenting problems that 107 patients provided as part of their application for psychotherapy. Results show the EMP has adequate inter-rater reliability and a coherent internal summary and subscale organization. Validity of the EMP was supported by evidence that profiles contained a high proportion of psychological explanation, symptom endorsement was associated with corresponding forms of problem explanation, prior treatment experience predicted explanatory model profiles, and that trauma victims tended to view other people as implicated in their problems. While EMP measures of internalization were not significantly related to depression, psychoanalytic insight and non-specific explanation in terms of childhood family issues were associated with less depression and less overall distress. Results are discussed as support for the idea that common explanatory models within Western folk psychology facilitate patient engagement in therapy by preserving patients' self esteem while opening them to new insights and ultimately personality and behavior change. The unique utility of the EMP for future process, outcome, and cross-cultural therapy research is also discussed. |
