Making the case for using personalised outcome measures to track progress in psychotherapy

The practice-based evidence movement has become increasingly influential in the practice of counselling. One element of this approach is the recommendation that therapists regularly administer standardised or nomothetic measures to track the progress made by their clients. When this feedback indicates that therapy is off course (i.e. out of kilter with the projected course of effective treatment) therapists are alerted to the risks of potential dropout and encouraged to take some form of corrective action. Despite an expanding evidence base supporting this strategy for improving psychotherapeutic outcomes, there are also concerns that the generic measures adopted do not always possess the specificity and sensitivity required to capture the unique experiences of individual clients. The paper argues that personalised or idiographic assessments can be designed to match the language and priorities of individual clients and so provide a more nuanced measure with which to track the course of therapy and promote informed reflective conversations between client and clinician on when and whether a change in direction is needed. However the idiographic alternative is not an easy option and practical as well as theoretical challenges in adopting this approach to monitoring treatment outcomes are acknowledged and discussed. Finally the virtue of using a strategy that combines nomothetic and idiographic measures is considered.     

Goal attainment and satisfaction scores for CMHC clients

The purpose of this study was to explore the psychometric properties of goal attainment scales and client satisfaction measures. The findings revealed that goal attainment results, like other types of self-report psychotherapy outcome measures, are directly related to (a) indicators of a client's social class, and (b) the manner of treatment termination (unilateral dropout vs. mutual consent). The extent of client--therapist agreement on goal scores was relatively low thereby supporting the necessity of obtaining both perspectives in evaluating treatment outcome. Furthermore, because measures of client satisfaction were found to be sufficiently independent from goal outcome scores, it was concluded that they provide a unique source of program evaluation data. Finally, it was concluded that Goal Attainment Scaling is best considered to be a quality assurance tool for individual client/therapist dyads rather than a mechanism for the determination of the effectiveness of specific mental health programs and services.     

Hidden in Plain Sight: The Active Ingredients of Executive Coaching

We propose that I/O psychologists who coach executives have overlooked psychotherapy outcome research as a source of information and ideas that can be used to improve our executive coaching practices. This research, based on thousands of studies and many meta-analyses, has converged on the conclusion that four "active ingredients" account for most of the variance in psychotherapy outcomes. We describe how this literature has identified four primary "active ingredients" that account for most of the variance in psychotherapy outcomes: 1) Client/extratherapeutic factors (40%), 2) The relationship or alliance (30%), 3) Placebo or hope (15%), and 4) Theory and technique (15%). Working on the assumption that psychotherapy and executive coaching are sufficiently similar to justify generalization from one domain to the other, we describe these four active ingredients at length and explore how they may be at work in the executive coaching process. We also suggest that I/O psychologists have training and experience that allows us to leverage some of these active ingredients in our executive coaching (e.g., understanding of client individual differences related to coaching outcomes). But we also have areas of weakness (e.g., building a strong working relationship with an individual client) that may need to be bolstered with additional training and development experiences.     

Stepwise Latent Class Models for Explaining Group-Level Outcomes Using Discrete Individual-Level Predictors

Explaining group-level outcomes from individual-level predictors requires aggregating the individual-level scores to the group level and correcting the group-level estimates for measurement errors in the aggregated scores. However, for discrete variables it is not clear how to perform the aggregation and correction. It is shown how stepwise latent class analysis can be used to do this. First, a latent class model is estimated in which the scores on a discrete individual-level predictor are used to construct group-level latent classes. Second, this latent class model is used to aggregate the individual-level predictor by assigning the groups to the latent classes. Third, a group-level analysis is performed in which the aggregated measures are related to the remaining group-level variables while correcting for the measurement error in the class assignments. This stepwise approach is introduced in a multilevel mediation model with a single individual-level mediator, and compared to existing methods in a simulation study. We also show how a mediation model with multiple group-level latent variables can be used with multiple individual-level mediators and this model is applied to explain team productivity (group level) as a function of job control (individual level), job satisfaction (individual level), and enriched job design (group level).     

Psychoanalytic Psychotherapy with People in Abusive Relationships

Summary

Psychoanalytic perspectives on violence between partners is describedand forms a foundation for an approach to group and individual psychotherapy of men and women in relationships in which there is physical violence between partners. The empirical results of a study of the outcome of psychoanalytically oriented psychotherapy are described. Nineteen men and 16 women completed research measures before beginning psychotherapy and after completing 16 sessions of group psychotherapy. Twelve people who completed group psychotherapy continued in individual psychotherapy and completed measures again after 16 sessions of individual psychotherapy, and nine people completed measures again after the 16 sessions of group and 32 sessions of individual psychotherapy. Statistical analyses addressed outcomes in terms of verbal and physical aggression and dysphoric affects and anger. Both research and clinical outcomes are discussed.     

Therapeutic alliance and cohesion variables as predictors of outcome in short-term group psychotherapy

The current study explored the relative ability of aggregate therapeutic alliance and cohesion variables to predict short-term group therapy outcome. Data were collected from a comparative trial of two forms of time-limited group psychotherapy for complicated grief (Piper, McCallum, Joyce, Rosie, & Ogrodniczuk, 2001). The therapeutic alliance and elements of the cohesion construct were measured from the perspectives of each patient and the group therapist at intervals during the groups; scores were aggregated across assessments. Hierarchical multiple regression analyses, adjusting for the effects of treatment approach (interpretive vs. supportive) and specific group membership, demonstrated that the patient-rated alliance was a consistent predictor of outcome. Two cohesion measures, reflecting other participants' (therapist, other members) views of the patient's "fit" with the group, also accounted for variation in outcome. Implications of the findings for research and clinical practice, and the limitations of the measurement approach taken in this study, are considered.     

Team effectiveness: beyond skills and cognitive ability.

On the basis of job analysis results, the validity of using measures of general cognitive ability, job-specific skills, and personality traits jointly at both the individual level and the group level to predict the performance of 79 four-person, human resource work teams was evaluated. Team member trait and job skill scores were aggregated with a conjunctive model of task performance. At the individual level of analysis, measures of personality (i.e., Agreeableness and Conscientiousness) predicted peer ratings of team member performance beyond measures of job-specific skills and general cognitive ability. Similarly, at the group level of analysis, both Agreeableness and Conscientiousness predicted supervisor ratings of work team performance, objective measures of work team accuracy, and work completed. At both the individual and group levels, the trait of Agreeableness predicted Interpersonal Skills.     

当事人的投入与会谈效果、咨询效果的关系研究

本研究探索了当事人会谈时的投入与即时会谈效果的关系;当事人咨询初期的投入与整体咨询效果的关系。结果发现当事人会谈时的投入与即时会谈效果、在咨询初期的投入与整体咨询效果都呈现显著的正相关。进一步回归分析发现,当事人在咨询初期的投入与整体咨询效果呈现正U型的偏态分布,少数投入水平最低的当事人获得中等水平的咨询效果,中等投入水平的当事人咨询效果最差,投入水平最高的当事人的咨询效果最好。     

Feedback in Couple and Family Therapy: A Randomized Clinical Trial

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC (“treatment as usual” or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire–45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed.     

Assessment of Subjective Client Agency in Psychotherapy: A Review

Theoretical accounts of psychotherapy, especially of a constructivist or humanistic sort, often assert the importance of the client's active efforts in “making therapy work.” Psychotherapy research also supports the importance of the client's contribution to therapy outcomes. Research on subjective client agency, defined as a client's expectations for taking an active role in psychotherapy, is limited, however. This review describes and evaluates the psychometric qualities of six measures of this construct and provides recommendations for future research. Three of these measures are particularly suitable for further work by constructivist investigators of therapy process and outcome, a topic too rarely studied in the literature to date. Those studies that exist suggest that agency is positively related to the therapeutic alliance but does not directly affect therapy outcome. Additional process-outcomes studies in this area are warranted and could benefit from placing client agency in a broader framework that views therapy, and even therapy supervision, as an active process of mutual inquiry.     

A descriptive analysis of client outcomes associated with staff interventions in developmental disabilities

Although a large body of research supports the use of behavioral staff management interventions in developmental disabilities, the nature of client outcomes associated with such interventions has not been systematically assessed. We reviewed 59 staff management studies published over 20 years (1971–1990) in order to determine the generality or scope of the research (i. e., range of settings, types and levels of clients' disabilities, clients' ages), the frequency of inclusion of client outcome measures, the types of measures and levels of analysis selected (i. e., individual groups, combination), and the effects of the interventions on client behavior. Results indicated that: (a) over two-third of the studies were conducted in institutional settings; (b) more than one-half involved clients with profound to severe mental retardation; (c) clients of various ages were served; (d) assessment of client outcomes increased progressively over the period; (e) engagement and skill acquisition were the most frequently used measures; (f) group data were presented twice as frequently as either individual or a combination of group and individual data; and (g) staff interventions were associated with either positive or mixed client outcomes in 80% or more of the cases, although maladaptive behavior went unchanged in one-fifth of the studies in which they were reported. Based on these findings, suggestions are made for how researchers might extend the generality of staff management research, improve client outcome assessment practices, and produce even more consistently positive results.     

Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief,manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.     

The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: a successful and unsuccessful case using functional analytic psychotherapy

The current study investigated a behavior-analytic treatment, functional analytic psychotherapy (FAP), for outpatient depression utilizing two single-subject A/A+B designs. The baseline condition was cognitive behavioral therapy. Results demonstrated treatment success in 1 client after the addition of FAP and treatment failure in the 2nd. This study highlights the challenges in measuring treatment progress and outcome idiographically in this population.     

A critical review of psychotherapy outcome studies with adolescents: 1978-1988

Although interest in identifying effective psychotherapies for adolescent mental health problems has increased dramatically in the last decade, there have been few attempts to summarize and integrate the recent empirical literature on psychotherapy outcomes with adolescents. The present paper reviews the methods and findings of adolescent psychotherapy outcome studies published from 1978 to 1988. Evaluations of individual psychotherapy with adolescents generally reveal positive short-term outcomes, but long-term outcomes are still to be determined. Evaluations of systemic therapies (especially family therapy) with adolescents often reveal positive outcomes that are maintained over extended follow-up periods. Recommendations are presented for improving the methodology of future psychotherapy outcome studies with adolescents.     

Assessing Achievement Goals in Sport: Caveats for Consultants and a Case for Contextualization

This paper advises practitioners of the limitations of employing nomothetic research tools for the idiographic assessment of athletes' achievement goal orientations. Consultants are encouraged to appreciate the scoring trends of the Task and Ego Orientation in Sport Questionnaire (TEOSQ; Duda & Nicholls, 1992) and the Perceptions of Success Questionnaire (POSQ; Roberts, Treasure, & Balague, 1998) and to recognize that the measures may not bestow them with accurate and meaningful information on an athlete's motivational responses in the contexts of competition and practice. The contextual sensitivity of the TEOSQ and the POSQ is explored empirically among a sample of 179 high-level team and individual athletes. Repeated measures ANOVAs with follow-up paired t -tests illustrated how performers' goal orientations for competition differed significantly from their overall sport goal orientation. The findings are discussed with reference to the implications for practitioners and the development of appropriate contextual assessments of achievement goals at nomothetic and idiographic levels.     

Response times in attitudinal items as indicators of the continuous accessibility of knowledge related to attitudes

In the paradigm of social cognition, the measurement of response latencies is important not only for priming procedures directed at the cognitive representation, but also for the assessment of strength-related properties of attitudes. The present paper explored the possibility of using response times as indicators of the continuous accessibility of attitude-relevant knowledge. For two different sets of attitudinal items concerning social welfare (idiographic and nomothetic selection) response times were obtained from a sample of 20 university students. In addition to different reliability coefficients for aggregated response times, information about individual subjects' consistencies and stabilities was obtained. Further, evidence for the validity of response times as indicators of the continuous accessibility of attitude-related knowledge is reported. The aggregated response times had significant correlations with self-report data and interview-related variables (such as number of propositions mentioned) which were obtained by a content analysis of semistructured interviews.     

Confirming,Validating, and Norming the Factor Structure of Systemic Therapy Inventory of Change Initial and Intersession

Progress or feedback research tracks and feeds back client progress data throughout the course of psychotherapy. In the effort to empirically ground psychotherapeutic practice, feedback research is both a complement and alternative to empirically supported manualized treatments. Evidence suggests that tracking and feeding back progress data with individual or nonsystemic feedback systems improves outcomes in individual and couple therapy. The research reported in this article pertains to the STIC^® (Systemic Therapy Inventory of Change)—the first client‐report feedback system designed to empirically assess and track change within client systems from multisystemic and multidimensional perspectives in individual, couple, and family therapy. Clients complete the STIC Initial before the first session and the shorter STIC Intersession before every subsequent session. This study tested and its results supported the hypothesized factor structure of the six scales that comprise both STIC forms in a clinical outpatient sample and in a normal, random representative sample of the U.S. population. This study also tested the STIC's concurrent validity and found that its 6 scales and 40 of its 41 subscales differentiated the clinical and normal samples. Lastly, the study derived clinical cut‐offs for each scale and subscale to determine whether and how much a client's score falls in the normal or clinical range. Beyond supporting the factorial and concurrent validity of both STIC forms, this research supported the reliabilities of the six scales (Omega_hierarchical) as well as the reliabilities of most subscales (alpha and rate–rerate). This article delineates clinical implications and directions for future research.     

Interdependence and Social Identity in Youth Sport Teams

The degree to which team members believe that they rely on one another to perform successfully and achieve collective outcomes may relate to perceptions about the extent that they integrate the group within their own identity. This study examined the relationship between interdependence and social identity among 422 high school team sport athletes. Youth completed measures of task and outcome interdependence, as well as social identity. Multilevel analyses revealed that higher perceptions of outcome interdependence at an individual and team level predicted greater social identity. Results highlight the role of outcome interdependence on athletes’ perceptions of social identity in sport teams.     

Individual differences in client reactions to counseling and psychotherapy: A challenge for research

Recent research is reviewed that suggests extensive individual differences in how clients respond to therapeutic interventions and therapist response modes. Three research strategies are proposed as parts of a therapeutic science that aims at both nomothetic generalizations and explications of idiographic meanings, while simultaneously confronting conceptual and methodological complexities arising from client individual differences in response to counseling.