Differential Outcomes at Follow-Up for Psychotherapy Clients Whose Therapists Received Feedback and Clinical Support Tools

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Mark D. Oshida and Professor John Okiishi, Education

Introduction

Based on intake and follow-up scores on patients’ perceptions of their well-being, approximately 10% of patients who see trained psychotherapists have a negative treatment outcome. Additionally, 30%-40% see no positive differential change at all. Because of these negative statistics, researchers have studied various methods that might improve therapy outcome. A team of BYU researchers has identified that providing feedback and Clinical Support Tools (CSTs) to therapists about patient progress has been effective in promoting patient progress as well as efficient service delivery. This feedback is given in the form of graphs that chart the rate of client change based on the OQ-45, a psychometric test found to have extensive reliability and validity across clinical and normative populations. The CSTs are based on questionnaires that measure whether the client is experiencing an average or below-average therapeutic relationship, motivation to change, or social support network. These findings are relayed to the therapist in the form of suggestions on how the therapist should proceed in his or her interaction with the client (Whipple, Lambert, Smart, Nielsen, Hawkins, & Vermeersch, 2003).

While studies have been performed to show that feedback and CSTs improve the effects of psychotherapy during the treatment period, no study has been performed to follow up on the long-term effectiveness of these resources on the client’s well-being. The aim of this study was to determine if psychotherapy clients whose therapists receive feedback and CSTs show improved outcome at follow-up when compared to a control group of patients whose therapists are not provided feedback and CSTs.

Experiment

We began by contacting former clients at the BYU Counseling and Career Center. Of 2500 clients during the 2001-02 school year, 10% were determined to have a high probability of a negative treatment outcome based on OQ-45 responses. This 10% was then divided into three groups: NOT (not on track), NOT-Fb (not on track but with therapists who received weekly feedback), and NOT-Fb+CST (not on track but with therapists who received both feedback and CSTs). NOT, NOT-Fb, and NOT-Fb+CST groups had equal OQ-45 scores at pretreatment.

Through phone calls and emails, we were able to contact 24 former clients from the NOT group, 14 former clients from the NOT-Fb group, and 14 former clients from the NOT-Fb+CST group. We had each subject complete the same OQ-45 questionnaire he or she completed before, during, and upon leaving treatment.

We expected to see a greater long-term improvement in the clients whose therapists received both feedback and CSTs than the improvement from clients in the other groups. Following is a summary of our findings:
a

Analysis

The results of our experiment show that more clients improved over the long run from the NOT-Fb and NOT-Fb+CST groups than clients from the NOT group. Although we expected to see a greater percentage of clients who improved from the NOT-Fb+CST group over the NOT-Fb group, no differentiation was seen in our experiment.

Because of the small sample size in this experiment, the long-term effects of OQ-45 feedback and CSTs remain unclear. While we found some interesting and promising trends in our current data, we need follow-up data from a larger number of samples in order to examine this in a more comprehensive manner.

However, from the data that we did obtain, we made a poster presentation at the Society for Psychotherapy Research 2004 Conference in Rome, Italy. We are finishing gathering up data from more former clients and are preparing to publish our results in the Journal of Counseling Psychology, the top journal in the area of counseling psychology.

References

  • Whipple, J.L, Lambert, M.J., Smart, D.W., Nielsen, S.L., Hawkins, E.J., & Vermeersch, D.A. (2003). Improving the Effects of Psychotherapy: The Use of Early Identification of
  • Treatment Failure and Problem-Solving Strategies in Routine Practice. Journal of Counseling Psychology, Vol. 50, No. 1, 59-68.