Abstract
Despite evidence that psychotherapy has a positive impact on psychological disorders, 30% of patients fail to respond during clinical trials, and as many as 65% of patients in routine care leave treatment without a measured benefit. In addition, therapists appear to overestimate positive outcomes in their patients relative to measured outcomes and are particularly poor at identifying patients at risk for a negative outcome. These problems suggest the need for measuring and monitoring patient treatment response over the course of treatment while applying standardized methods of identifying at-risk cases. Computer-assisted methods for measuring, monitoring, identifying potential deteriorators, and providing feedback to clinicians are described along with a model that explains why feedback is likely to be beneficial to patients. The results of 12 clinical trials are summarized and suggest that deterioration rates can be substantially reduced in at-risk cases (from baseline rates of 21% down to 13%) and that recovery rates are substantially increased in this subgroup of cases (from a baseline of 20% up to 35%) when therapists are provided this information. When problem-solving methods are added to feedback, deterioration in at-risk cases is further reduced to 6% while recovery/improvement rates rise to about 50%. It is suggested that the feedback methods become a standard of practice. Such a change in patterns of care can be achieved through minimal modification to routine practice but may require discussions with patients about their clinical progress.
References
1.
Fava GA, Guidi J, Rafanelli C, Sonino N: The clinical inadequacy of evidence-based medicine and the need for a conceptual framework based on clinical judgment. Psychother Psychosom 2015;84:1-3.
[PubMed]
2.
Fava GA, Cosci F, Offidani E, Guidi J: Behavioral toxicity revisited: iatrogenic comorbidity in psychiatric evaluation and treatment. J Clin Psychopharmacol 2016;36:550-553.
[PubMed]
3.
Lambert MJ: Prevention of Treatment Failure: The Use of Measuring, Monitoring, and Feedback in Clinical Practice. New York, Wiley & Sons, 2010.
4.
Hansen NB, Lambert MJ, Forman EV: The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol Sci Pract 2002;9:329-343.
5.
Weiss B, Catron T, Harris V, Phung TM: The effectiveness of traditional child psychotherapy. J Consult Clin Psychol 1999;67:82-94.
[PubMed]
6.
Warren JS, Nelson PL, Mondragon SA, Baldwin SA, Burlingame GM: Youth psychotherapy change trajectories and outcome in usual care: community mental health versus managed care. J Consult Clin Psychol 2010;78:144-155.
[PubMed]
7.
Kazdin AE: Dropping out of child therapy: issues for research and implications for practice. Clin Child Psychol Psychiatry 1996;1:133-156.
8.
Wierzbicki M, Pekarik G: A meta-analysis of psychotherapy dropout. Profess Psychol Res Pract 1993;24:190-195.
9.
Kazdin AE: Evidence-based assessment for children and adolescents: issues in measurement development and clinical application. J Clin Child Adolesc Psychol 2005;34:548-558.
[PubMed]
10.
Walfish S, McAlister B, O'Donnell P, Lambert MJ: An investigation of self-assessment in mental-health providers. Psychol Rep 2012;110:639-644.
[PubMed]
11.
Hannan C, Lambert MJ, Harmon C, Nielsen SL, Smart DW, Shimokawa K, Sutton SW: A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychol 2005;61:155-63.
[PubMed]
12.
Hatfield D, McCullough L, Plucinski A, Krieger K: Do we know when our clients get worse? An investigation of therapists' ability to detect negative client change. Clin Psychol Psychother 2010;17:25-32.
[PubMed]
13.
Finch AE, Lambert MJ, Schaalje BG: Psychotherapy quality control: the statistical generation of expected recovery curves for integration into an early warning system. Clin Psychol Psychother 2001;8:231-242.
14.
Ellsworth JR, Lambert MJ, Johnson J: A comparison of the Outcome Questionnaire-45 and Outcome Questionnaire-30 in classification and prediction of treatment outcome. Clin Psychol Psychother 2006;13:380-391.
15.
Lambert MJ, Whipple JL, Bishop MJ, Vermeersch DA, Gray GV, Finch AE: Comparison of empirically derived and rationally derived methods for identifying clients at risk for treatment failure. Clin Psychol Psychother 2002;9:149-164.
16.
Lutz W, Lambert MJ, Harmon SC, Stulz N, Tschitsaz A, Schürch E: The probability of treatment success, failure and duration - what can be learned from empirical data to support decision making in clinical practice? Clin Psychol Psychother 2006;13:223-232.
17.
Spielmans GI, Masters KS, Lambert MJ: A comparison of rational versus empirical methods in the prediction of psychotherapy outcome. Clin Psychol Psychother 2006;13:202-214.
18.
Sapyta J, Riemer M, Bickman L: Feedback to clinicians: theory, research, and practice. J Clin Psychol 2005;62:145-153.
[PubMed]
19.
Riemer M, Rosof-Williams J, Bickman L: Theories related to changing clinician practice. Child Adolesc Psychiatr Clin North Am 2005;14:241-254.
[PubMed]
20.
Lambert MJ, Kahler M, Harmon C, Burlingame GM, Shimokawa K, White MM: Administration and Scoring Manual: Outcome Questionnaire OQ®-45.2. Salt Lake City, OQMeasures, 2013.
21.
Vermeersch DA, Whipple JL, Lambert MJ, Hawkins EJ, Burchfield CM, Okiishi JC: Outcome Questionnaire: is it sensitive to changes in counseling center clients? J Couns Psychol 2004;51:38-49.
22.
De Jong K, Nugter MA, Polak MG, Wagenborg JEA, Spinhoven P, Heiser WJ: The Outcome Questionnaire (OQ-45) in a Dutch population: a cross-cultural validation. Clin Psychol Psychother 2007;14:288-301.
23.
Burlingame GM, Wells MG, Lambert MJ, Cox JC: Youth Outcome Questionnaire (Y-OQ); in Maruish ME (ed): The Use of Psychological Testing for Treatment Planning and Outcome Assessment, ed 3. Mahwah, Erlbaum Associates, 2004, vol 2, pp 235-274.
24.
Lambert MJ, Bailey RJ, White M, Tingey M, Stevens E: Clinical Support Tool Manual - Brief Version-40. Salt Lake City, OQMeasures, 2015.
25.
Shimokawa K, Lambert MJ, Smart DW: Enhancing treatment outcome of patients at risk of treatment failure: meta-analytic and mega-analytic review of a psychotherapy quality assurance system. J Consult Clin Psychol 2010;78:298-311.
[PubMed]
26.
Harmon SC, Lambert MJ, Smart DW, Hawkins EJ, Nielsen SL, Slade K, Lutz W: Enhancing outcome for potential treatment failures: therapist/client feedback and clinical support tools. Psychother Res 2007;17:379-392.
27.
Hawkins EJ, Lambert MJ, Vermeersch DA, Slade K, Tuttle K: The effects of providing patient progress information to therapists and patients. Psychother Res 2004;14:308-327.
28.
Lambert MJ, Whipple JL, Smart DW, Vermeersch DA, Nielsen SL: Hawkins EJ: The effects of providing therapists with feedback on client progress during psychotherapy: are outcomes enhanced? Psychother Res 2001;11:49-68.
[PubMed]
29.
Lambert MJ, Whipple JL, Vermeersch DA, Smart DW, Hawkins EJ, Nielsen SL, Goates MK: Enhancing psychotherapy outcomes via providing feedback on client progress: a replication. Clin Psychol Psychother 2002;9:91-103.
30.
Slade K, Lambert MJ, Harmon SC, Smart DW, Bailey R: Improving psychotherapy outcome: the use of immediate electronic feedback and revised clinical support tools. Clin Psychol Psychother 2008;15:287-303.
[PubMed]
31.
Whipple JL, Lambert MJ, Vermeersch DA, Smart DW, Nielsen SL, Hawkins EJ: Improving the effects of psychotherapy: the use of early identification of treatment failure and problem solving strategies in routine practice. J Couns Psychol 2003;58:59-68.
32.
Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991;59:12-19.
[PubMed]
33.
Crits-Christoph P, Ring-Kurtz S, Hamilton J, Lambert MJ, Gallop R, McClure B, Kulaga A, Rotrosen JA: Preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. J Substance Abuse Treat 2012;42:301-309.
[PubMed]
34.
Simon W, Lambert MJ, Busath G, Vazquez A, Berkeljon A, Hyer K, Granley M, Berrett M: Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: a randomized controlled study. Psychother Res 2013;23:287-300.
[PubMed]
35.
De Jong K, van Sluis P, Nugter MA, Heiser WJ, Spinhoven P: Understanding the differential impact of outcome monitoring: therapist variables that moderate feedback effects in a randomized clinical trial. Psychother Res 2013;22:464-474.
[PubMed]
36.
Simon W, Lambert MJ, Harris MW, Busath G, Vazquez A: Providing patient progress information and clinical support tools to therapists: effects on patients at risk for treatment failure. Psychother Res 2012;22:638-647.
[PubMed]
37.
Amble I, Gude T, Stubdal S, Andersen BJ, Wampold BE: The effect of implementing the Outcome Questionnaire-45.2 feedback system in Norway: a multisite randomized clinical trial in a naturalistic setting. Psychother Res 2015;25:669-677.
[PubMed]
38.
Probst T, Lambert MJ, Loew T, Dahlbender RW, Gollner R, Tritt K: Feedback on patient progress and clinical support tools for therapists: improved outcome for patients at risk of treatment failure in in-patient therapy under the conditions of routine practice. J Psychosom Res 2013;75:255-261.
[PubMed]
39.
Drapeau M: 10 tools for progress monitoring in psychotherapy. Integrating Sci Pract 2012;2:5-43.
© 2017 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2017
You do not currently have access to this content.
