Abstract

Two hundred twenty-three alumni of doctoral programs emphasizing either cognitive-behavioral or psychodynamic therapies judged the prognosis of fictional patients. Each patient presented with an interpersonal problem and expressed one of two epistemological styles: rational-empirical or metaphorical. Therapists of the two orientations differed in epistemological preference and level of optimism. Cognitive-behavior therapists espoused epistemologies that are more rational, more empirical, and less metaphorical than did psychodynamic therapists. Cognitive-behavior therapists were also more optimistic than psychodynamic therapists. ;Prognosis was assessed by four therapist characteristics: experience, orientation, optimism, and match between patient and therapist epistemology. Neither experience, orientation, nor consistency between patient's epistemology and dominant epistemology of an orientation by themselves predicted prognosis. For both orientations, higher therapist optimism predicted better prognosis for rational-empirical patients. For psychodynamic therapists, congruence between patient epistemological style and therapists' valuation of patients using each epistemological style tended to predict good prognosis. One instance of the opposite pattern was seen for cognitive-behavior therapists, for whom a mismatch tended to predict better prognosis. ;Interactions between therapists' personal epistemology and level of experience were predictive of psychodynamic therapists' prognosis for patients of both epistemological styles. For less experienced psychodynamic therapists, therapists' prognosis was better when the patient's epistemology was congruent with the therapist's personal epistemology. In contrast, more experienced psychodynamic therapists gave a better prognosis to patients whose epistemology was incongruent with the therapist's personal epistemology. These results are discussed in terms of compatibility between therapists and patients, compatibility between therapists and their orientations' dominant epistemology, and different visions of reality characteristic of the two orientations