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Assessing the Statistical and Personal Significance of the Method of Levels

Published online by Cambridge University Press:  17 April 2009

Timothy A. Carey*
University of Canberra, ACT, Australia
Margaret Carey
Garran, ACT, Australia
Richard J. Mullan
Northern Health and Social Care Trust, Northern Ireland
Christopher G. Spratt
Psychiatric Services, NHS Fife, Scotland
Margaret B. Spratt
Anstruther, Scotland
Reprint requests to Timothy A. Carey, Centre for Applied Psychology, University of Canberra, ACT 2601, Australia. E-mail:


Background: Perceptual Control Theory (PCT) suggests that psychological distress can be conceptualized as the by-product of conflicted control systems. Method: Using a program of psychotherapy based on the principles of PCT called the Method of Levels (MOL), a 12-month study was conducted with 120 patient participants and 4 clinicians. In this study, analyses of statistical significance were conducted. Qualitative data were also analysed to understand psychotherapy from patients' perspectives. Data were collected on the attendance patterns of patients, their ages, referral problem, and socio-economic background. A standardized questionnaire measured pre and post treatment effects. The null hypothesis of no difference between pre and post treatment scores was examined by the derivation of p values and the construction of 95% confidence intervals. Results: In all cases the null hypothesis was rejected. Conclusions: Results suggest that MOL is a useful form of psychotherapy that warrants further investigation.

Research Article
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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Beitman, B. D. and Soth, A. M. (2006). Activation of self-observation: a core process among the psychotherapies. Journal of Psychotherapy Integration, 16, 383397.CrossRefGoogle Scholar
Bell, A. and Rollnick, S. (1996). Motivational interviewing in practice: a structured approach. In Rotgers, F., Keller, D. S. and Morgenstern, J. (Eds.), Treating Substance Abuse: theory and technique (pp. 266285). New York: Guilford Press.Google Scholar
Bourbon, W. T. (1995). Perceptual control theory. In Roitblat, H. L. and Meyer, J. A. (Eds.), Comparative Approaches to Cognitive Science (pp. 151172). Cambridge, MA: MIT Press.Google Scholar
Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy, 12, 326335.CrossRefGoogle Scholar
Carey, T. A. (2006a). Estimating treatment duration for psychotherapy in primary care. Journal of Public Mental Health, 5, 2328.CrossRefGoogle Scholar
Carey, T. A. (2006b). The Method of Levels: how to do psychotherapy without getting in the way. Hayward, CA: Living Control Systems Publishing.Google Scholar
Carey, T. A. (2008). Conflict, as the Achilles heel of perceptual control, offers a unifying approach to the formulation of psychological problems. Counselling Psychology Review, 23, 516.Google Scholar
Carey, T. A. and Mullan, R. J. (2007). Patients taking the lead: a naturalistic investigation of a patient led approach to treatment in primary care. Counselling Psychology Quarterly, 20, 114.CrossRefGoogle Scholar
Carey, T. A. and Mullan, R. J. (2008). Evaluating the Method of Levels. Counselling Psychology Quarterly, 21, 110.CrossRefGoogle Scholar
Carver, C. S. and Scheier, M. F. (1982). Control theory: a useful conceptual framework for personality-social, clinical, and health psychology. Psychological Bulletin, 92, 111135.CrossRefGoogle ScholarPubMed
Charman, D. P. (2004). Effective psychotherapy and effective psychotherapists. In Charman, D. P. (Ed.), Core Processes in Brief Psychodynamic Psychotherapy: advancing effective practice (pp. 322). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
De'ath, G. and Fabricius, K. E. (2000). Classification and regression trees: a powerful yet simple technique for ecological data analysis. Ecology, 81, 31783192.CrossRefGoogle Scholar
Efron, B. and Tibshirani, R. J. (1993). An Introduction to the Bootstrap. New York: Chapman and Hall.CrossRefGoogle Scholar
Elliott, R. (2001). Contemporary brief experiential psychotherapy. Clinical Psychology: Science and Practice, 8, 3850.Google Scholar
Foster, S. L. and Mash, E. J. (1999). Assessing social validity in clinical treatment research: issues and procedures. Journal of Consulting and Clinical Psychology, 67, 308319.CrossRefGoogle ScholarPubMed
Good, P. I. (2006). Resampling Methods: a practical guide to data analysis (3rd ed.). Boston: Birkhäuser.Google Scholar
Henry, J. D. and Crawford, J. R. (2005). The short-form of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227239.CrossRefGoogle Scholar
Howard, K. I., Kopta, S. M., Krause, M. S. and Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159164.CrossRefGoogle ScholarPubMed
Kazdin, A. E. (1999). The meanings and measurement of clinical significance. Journal of Consulting and Clinical Psychology, 67, 332339.CrossRefGoogle ScholarPubMed
Kopta, S. M., Lueger, R. J., Saunders, S. M. and Howard, K. I. (1999). Individual psychotherapy outcome and process research: challenges leading to greater turmoil or a positive transition? In Spence, J. T., Darley, J. M. and Foss, D. J. (Eds.), Annual Review of Psychology, 50 (pp. 441470). Palo Alto, CA: Annual Reviews.Google Scholar
Lambert, D. (1985). Robust two-sample permutation tests. The Annals of Statistics, 13, 606625.CrossRefGoogle Scholar
Lambert, M. (2007). Presidential address: what we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychotherapy Research, 17, 114.CrossRefGoogle Scholar
Lambert, M. J. and Asay, T. P. (2004). Measuring clinically significant change. In Charman, D. P. (Ed.), Core Processes in Brief Psychodynamic Psychotherapy: advancing effective practice (pp. 309322). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Lambert, M. J., Hansen, N. B. and Finch, A. E. (2001). Patient-focused research: using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159172.CrossRefGoogle ScholarPubMed
Lovibond, P. F. and Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety inventories. Behaviour Research and Therapy, 33, 335343.CrossRefGoogle ScholarPubMed
MacKenzie, K. R. (1996). The time-limited psychotherapies: an overview. In Dickstein, L. J., Riba, M. B. and Oldham, J. M. (Eds.), Review of Psychiatry (vol. 15) (pp. 1121). Washington, DC: American Psychiatric Press.Google Scholar
Mansell, W. (2005). Control theory and psychopathology: an integrative approach. Psychology and Psychotherapy: Theory, Research and Practice, 78, 140.CrossRefGoogle Scholar
Marken, R. S. (1988). The nature of behavior: control as fact and theory. Behavioral Science, 33, 196206.CrossRefGoogle Scholar
Moore, E. L. and Abramowitz, J. S. (2007). The cognitive mediation of thought-control strategies. Behavior Research and Therapy, 45, 19491955.CrossRefGoogle ScholarPubMed
Nathan, P. E., Stuart, S. P. and Dolan, S. L. (2000). Research on psychotherapy efficacy and effectiveness: between Scyllan and Charybdis? Psychological Bulletin, 126, 964981.CrossRefGoogle ScholarPubMed
Orlinsky, D. E. and Howard, K. I. (1986). Process and outcome in psychotherapy. In Garfield, S. L. and Bergin, A. E. (Eds.), Handbook of Psychotherapy and Behavior Change (3rd ed.) (pp. 311381). New York: Wiley and Sons.Google Scholar
Pekarik, G. (1983). Improvement in clients who have given different reasons for dropping out of treatment. Journal of Clinical Psychology, 39, 909913.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Pekarik, G. (1985). Coping with dropouts. Professional Psychology: Research and Practice, 16, 114123.CrossRefGoogle Scholar
Pekarik, G. and Wierzbicki, M. (1986). The relationship between clients' expected and actual treatment duration. Psychotherapy, 23, 532534.CrossRefGoogle Scholar
Powers, W. T. (2005). Behavior: the control of perception. New Canaan, CT: Benchmark Publications.Google Scholar
R Development Core Team. (2005). R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL: http// ScholarPubMed
Ritchie, J. and Lewis, J. (Eds.) (2003). Qualitative Research Practice: a guide for social science students and researchers. London: Sage.Google Scholar
Runkel, P. J. (2005). People as Living Things: the psychology of perceptual control. Hayward, CA: Living Control Systems Publishing.Google Scholar
Segal, Z. V. and Shaw, B. F. (1996). Cognitive therapy. In Dickstein, L. J., Riba, M. B. and Oldham, J. M. (Eds.), Review of Psychiatry (vol. 15) (pp. 6990). Washington, DC: American Psychiatric Press.Google Scholar
Seligman, M. E. P. (1995). The effectiveness of psychotherapy: the Consumer Reports study. American Psychologist, 50, 965974.CrossRefGoogle ScholarPubMed
Shapiro, D. A. (1995). Finding out how psychotherapies help people change. Psychotherapy Research, 5, 121.CrossRefGoogle Scholar
Shapiro, D. A., Barkham, M., Stiles, W. B., Hardy, G. E., Rees, A., Reynolds, S. and Startup, M. (2003). Time is of the essence: a selective review of the fall and rise of brief therapy research. Psychology and Psychotherapy: Theory, Research and Practice, 76, 211235.CrossRefGoogle ScholarPubMed
Stiles, W. B., Elliott, R., Llewellyn, S. P., Firth-Cozens, J. A., Margison, F. R., Shapiro, D. A. and Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy, 27, 411420.CrossRefGoogle Scholar
Strosahl, K. D., Hayes, S. C., Wilson, K. G. and Gifford, E. V. (2004). An ACT primer: core therapy processes, intervention strategies, and therapist competencies. In Hayes, S. C. and Strosahl, K. D. (Eds.), A Practical Guide to Acceptance and Commitment Therapy (pp. 3158). New York: Springer.CrossRefGoogle Scholar
Talmon, M. (1990). Single-Session Therapy: maximizing the effect of the first (and often only) therapeutic encounter. San Francisco: Jossey-Bass.Google Scholar
Teasdale, J. D., Segal, Z. and Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33, 2539.CrossRefGoogle ScholarPubMed
Wells, A. (2005). The metacognitive model of GAD: assessment of meta-worry and relationship with DSM-IV generalized anxiety disorder. Cognitive Therapy and Research, 29, 107121.CrossRefGoogle Scholar
Winston, A. and Muran, J. C. (1996). Common factors in the time-limited psychotherapies. In Dickstein, L. J., Riba, M. B. and Oldham, J. M. (Eds.), Review of Psychiatry (vol. 15) (pp. 4368). Washington, DC: American Psychiatric Press.Google Scholar
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