Eric J. Hawkins

The Effects of Providing Therapists With Feedback on Patient Progress During Psychotherapy: Are Outcomes Enhanced?

Patient-focused research attempts to provide information that answers the question: Is this treatment benefiting this patient? Although several systems have been developed to monitor and provide feedback about a patients response to psychotherapy, few if any have been tested empirically. The current study divided 609 patients into four groups (two experimental and two control) to determine if feedback regarding patient progress, when provided to a therapist, affected patient outcome and number of sessions attended. Results showed that feedback increased the duration of treatment and improved outcome relative to patients in the control condition who were predicted to be treatment failures. Twice as many patients in the feedback group achieved clinically significant or reliable change and one-third as many were classified as deteriorated by the time treatment ended. For those patients who were predicted to have a positive response to treatment, feedback to therapists resulted in a reduction in the number of treatment sessions without reducing positive outcomes.

Improving the Effects of Psychotherapy: The Use of Early Identification of Treatment Failure and Problem-Solving Strategies in Routine Practice

Client-focused research systems have been developed to monitor and provide feedback information about clients’ progress in psychotherapy as a method of enhancing outcome for those who are predicted to be treatment failures. In the current study, the authors examined whether feedback regarding client progress and the use of clinical support tools (CSTs) affected client outcome and number of sessions attended. Results showed that clients in the feedback plus CST group stayed in therapy longer and had superior outcomes. Nearly twice as many clients in the feedback plus CST group achieved clinically significant or reliable change, and fewer were classified as deteriorated by the time treatment ended.

Enhancing outcome for potential treatment failures: Therapist–client feedback and clinical support tools

Abstract Enhancing treatment outcomes for clients who are predicted to deteriorate before leaving treatment has important implications for quality of client care. The effects of three interventions aimed at reducing client deterioration were examined in a sample of 1,374 clients whose outcome was contrasted across experimental groups and with a no-feedback/archival control group consisting of data from 1,445 clients. Results indicated that feedback to therapists reduced deterioration rates and improved outcome across clients, especially those predicted to be treatment failures. Therapist feedback effects were enhanced by the use of prompts to action based on a clinical support tools manual but not by the provision of direct feedback to clients.

Outcome Questionnaire: Is It Sensitive to Changes in Counseling Center Clients?

Sensitivity to change of the Outcome Questionnaire (OQ; M. J. Lambert et al., 1996) items, subscales, and total score was evaluated for clients receiving personal counseling in university counseling center settings. OQ data collected for 248 university students who did not receive treatment and 5,553 students who received treatment from 527 therapists employed in 40 university counseling centers nationwide were included in the analyses. Comparisons between the treated and untreated groups indicated that the OQ total score, all of the subscales, and 34 of the 45 items met 2 preset criteria for change sensitivity, providing support for the OQ as an appropriate index of outcome in counseling center clients. The 11 OQ items that failed to demonstrate change sensitivity were aimed at assessing aspects of interpersonal functioning, related to specific physical symptoms, or were susceptible to floor effects. The possibility of using change sensitivity results in revising the OQ for optimal use in counseling center settings is addressed, and general implications for outcome test development are discussed.

Measuring outcome in professional practice: Considerations in selecting and using brief outcome instruments

Despite external pressures (e.g., quality assurance, therapist accountability) to measure outcome in psychotherapy, less than a third of clinicians choose to monitor outcome. A growing body of evidence suggests that monitoring patient progress can enhance patient outcome, particularly for patients who are at risk of not responding to treatment. To facilitate the adoption of routine assessment of patient outcome, recommendations for selecting an appropriate outcome instrument are suggested. In addition, procedures for implementing routine assessment of outcome and the use of outcome results are discussed.

Using information about patient progress in supervision: Are outcomes enhanced?

It is surprising and even ironic that clinical supervision is frequently conducted in the absence of systematic monitoring of patient progress. The use of a monitoring system that provides feedback to trainees and focuses attention on potential treatment failures is described. Potential advantages of such a practice include continued session attendance, enhanced outcome, and its ability to complement the goals considered essential to clinical supervision. Recommendations include routine use of patient tracking with supervision that focuses on the “failing” patient. Supervision may thus become a routine and integral part of treatment to prevent failure and enhance the quality of clinical services.

Psychotherapy Outcome, as Measured by the OQ-45, in African American, Asian/Pacific Islander, Latino/a, and Native American Clients Compared with Matched Caucasian Clients

Abstract Concern about the effects of counseling on ethnic minority clients has been repeatedly raised. Before embarking on a formal course of multicultural counseling sensitivity for counseling center staff, baseline client outcome data were sought as a method for evaluating the effects of this intervention. Archival data from a university counseling center were analyzed to assess the treatment outcome for four ethnic minority groups. Clients who identified themselves as Native American, Latino/a, African American, or Asian/Pacific Islander and who had both pre- and post-test scores on the Outcome Questionnaire-45 were selected for study. Each ethnic group member was matched with a Caucasian client based on initial level of disturbance, gender, marital status, and age. Every group of clients improved from intake to the termination of therapy. However, no differences in outcome were found between any ethnic group and its matched control group of Caucasians. Surprisingly, Native American clients (N = 50) had the most positive outcomes.