Jason L. Whipple

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.

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.

The Relationship Between Clients' Depression Etiological Beliefs and Psychotherapy Orientation Preferences, Expectations, and Credibility Beliefs.

The purpose of this study was to examine the relationship between clients’ etiological beliefs for depression and treatment preferences, credibility beliefs, and outcome expectations for five different depression treatments—behavioral activation, cognitive therapy, interpersonal psychotherapy, pharmacotherapy, and psychodynamic psychotherapy. Adult psychotherapy clients (N = 98) were asked to complete an online survey that included the Reasons for Depression Questionnaire, a brief description of each of the five treatment options, and credibility, expectancy, and preference questions for each option. On average, the participating clients rated pharmacotherapy as significantly less credible, having a lower likelihood of success, and being less preferred than the four types of psychotherapy. In general, interpersonal psychotherapy was also rated more negatively than the other types of psychotherapy. However, these findings depended somewhat on whether the participating client was personally experiencing depression. Credibility beliefs, outcome expectations, and preferences for pharmacotherapy were positively associated with biological beliefs for depression; however, the other hypothesized relationships between etiological beliefs and treatment attitudes were not supported. Although the study is limited based on the specific sample and treatment descriptions that were used, the results may still have implications for psychotherapy research, training, and practice.

Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring.

This systematic review and meta-analysis examines the impact of measuring, monitoring, and feeding back information on client progress to clinicians while they deliver psychotherapy. It considers the effects of the 2 most frequently studied routine outcome monitoring (ROM) practices: The Partners for Change Outcome Management System and the Outcome Questionnaire System. Like other ROM practices, they typify attempts to enhance routine care by assisting psychotherapists in recognizing problematic treatment response and increasing collaboration between therapist and client to overcome poor treatment response. A total of 24 studies were identified and considered suitable for analysis. Two-thirds of the studies found that ROM-assisted psychotherapy was superior to treatment-as-usual offered by the same practitioners. Mean standardized effect sizes indicated that the effects ranged from small to moderate. Feedback practices reduced deterioration rates and nearly doubled clinically significant/reliable change rates in clients who were predicted to have a poor outcome. Clinical examples, diversity considerations, and therapeutic advances are provided.

Perceived Impact on Client Outcomes: The Perspectives of Practicing Supervisors and Supervisees

Clinical supervision is considered to be an essential component of psychotherapy training. However, research on supervisors’ ability to affect client outcome has been mixed. This investigation aims to answer two questions: (a) What is the perceived impact of supervision on client outcome, and (b) how important is it to supervisors and supervisees that supervision affects client outcome? A mixed-methods approach was used to examine the perspectives of both supervisors and supervisees. The survey consisted of survey questions and one open-ended qualitative question. Findings suggest that both supervisors and supervisees perceive supervision as beneficial and important for impacting client outcome. Supervisees perceive supervision as more important in impacting outcome than supervisors. Existing literature suggests that supervision may not have as significant an impact on client outcome as previously believed; however, supervisors and supervisees perceive the supervision process as essential for psychotherapy training. Implications and future directions are discussed.