Stevan Lars Nielsen

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.

The Consumer Reports effectiveness score: What did consumers report?

From readers’ ratings of satisfaction, problem resolution, and perceived emotional change during treatment, Consumer Reports magazine (CR, 1995) concluded both that psychotherapy is effective and that longer, more intensive therapy is more effective. The authors compared prospectively gathered 45-Item Outcome Questionnaire scores (OQ-45; M. J. Lambert, N. B. Hansen, et al., 1996) with CR scores gathered 6 or more weeks after treatment among 302 former counseling center clients. CR perceived emotional change scores were strongly correlated with but sharply overestimated prospectively measured OQ-45 change scores. Treatment length was correlated with CR satisfaction ratings but not with CR perceived change scores, CR problem resolution scores, or change measured with the OQ-45. CR’s conclusions appear to have been too optimistic and too general. In their annual subscriber survey of 1994, the publishers and editors of Consumer Reports magazine (CR) asked for descriptions of experiences with seeking help for mental health problems. A paragraph early in an article describing results from the survey in CR’s November 1995 issue summarized their conclusions concisely: The results of a candid, in-depth survey of Consumer Reports subscribers—the largest survey ever to query people on mental-health care—provide convincing evidence that therapy can make an important difference. Four thousand of our readers who responded had sought help from a mental-health provider or a family doctor for psychological problems, or had joined a self-help group. The majority were highly satisfied with the care they received. Most had made strides toward resolving the problems that led to treatment, and almost all said life had become more manageable. (CR, 1995, p. 734)

Religiously sensitive rational emotive behavior therapy: Elegant solutions and ethical risks.

Rational emotive behavior therapy (REBT) can be an elegant treatment modality for explicitly religious clients. This is true in spite of the traditional antireligious stance of Albert Ellis. In this article, the authors summarize the evolution of Elliss views on religion and mental health, consider potential ethical dilemmas caused by utilizing REBT with religious clients, and recommend strategies for reducing violation of ethical and specialty guidelines in work with religious clients. The authors conclude by proposing a general model for religiously sensitive psychotherapy, which may serve to undergird theorizing and research on the application of REBT and other treatment approaches to religious clients.

Religiously Sensitive Rational Emotive Behavior Therapy: Theory, Techniques, and Brief Excerpts From a Case

Rational emotive behavior therapys (REBTs) methods for fostering change, such as disputation of irrational beliefs, are similar to the kinds of activities one may expect to encounter in many organized religions. REBT also bears a strong theoretical affinity with some religions because of its preferred therapeutic goal of helping clients examine and change their beliefs. Furthermore, the formal religious tenets and traditions to which many clients adhere will usually include doctrinal material that is highly congruent with REBTs theory of change. Such belief-oriented material maybe enlisted during REBT to help religious clients evaluate and change their self-defeating, irrational beliefs. A case that integrates religious belief with REBT is presented. Finally, the authors conclude with a brief summary of preliminary outcome research regarding the efficacy of this approach. Rational emotive behavior therapy (REBT) is surprisingly similar to organized religion in its approach to fostering change. Similarities with the practice of religion are apparent in both REBTs theoretical assumptions about change and its essential techniques for producing change. In this article, we propose that these similarities and affinities offer clinicians who practice REBT

Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies

This paper aims to provide researchers with practical information on sample sizes for accurate estimations of therapist effects (TEs). The investigations are based on an integrated sample of 48,648 patients treated by 1800 therapists. Multilevel modeling and resampling were used to realize varying sample size conditions to generate empirical estimates of TEs. Sample size tables, including varying sample size conditions, were constructed and study examples given. This study gives an insight into the potential size of the TE and provides researchers with a practical guide to aid the planning of future studies in this field.

Are therapists uniformly effective across patient outcome domains? A study on therapist effectiveness in two different treatment contexts.

As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patients change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record

Rational-Emotive Assessment with Religious Clients

Rational Emotive Behavior Therapy (REBT), when practiced effectively and flexibly, can be an excellent treatment modality for religious clients. Most of the American population acknowledges some religious belief and/or practice and religious clients sometimes present with unique disturbances and concerns about psychotherapy. In this article we discuss the rapidly changing literature relative to religiousness and mental health and highlight the ethical-professional risks of failing to carefully assess and responsibly manage client religiousness when it is personally and clinically salient. We conclude by outlining a model for focused assessment of religiousness early in REBT and recommend that REBT practitioners consider different components of religiousness and the manner in which they may impact response to treatment.

Self-Acceptance and Christian Theology

In this chapter we explore self-acceptance in Christianity and rational emotive behavior therapy (REBT). Our thesis is that the self and self-acceptance as evident in fundamental tenets of Christianity and as conceptualized in REBT overlap or parallel one another sufficiently that they resonate. We will show that this resonance allows use of Christian scripture in therapy to help people attain greater self-acceptance. We chose REBT’s approach to self-acceptance because REBT theory is specific about the nature of the self and self-acceptance, because REBT theory is clear about the function of self-acceptance in emotion and behavior, and because REBT offers a well-defined method for helping clients deal with emotional problems that arise because of conditional self-acceptance (CSA). Helping clients attain unconditional self-acceptance (USA) is one of REBT’s fundamental goals.