The importance of preventing and treating incomplete data in effectiveness studies is nowadays emphasized. However, most of the publications focus on randomized clinical trials (RCT). One flexible technique for statistical inference with missing data is multiple imputation (MI). Since methods such as MI rely on the assumption of missing data being at random (MAR), a sensitivity analysis for testing the robustness against departures from this assumption is required. In this paper we present a sensitivity analysis technique based on posterior predictive checking, which takes into consideration the concept of clinical significance used in the evaluation of intra-individual changes. We demonstrate the possibilities this technique can offer with the example of irregular longitudinal data collected with the Outcome Questionnaire-45 (OQ-45) and the Helping Alliance Questionnaire (HAQ) in a sample of 260 outpatients. The sensitivity analysis can be used to (1) quantify the degree of bias introduced by missing not at random data (MNAR) in a worst reasonable case scenario, (2) compare the performance of different analysis methods for dealing with missing data, or (3) detect the influence of possible violations to the model assumptions (e.g., lack of normality). Moreover, our analysis showed that ratings from the patient's and therapist's version of the HAQ could significantly improve the predictive value of the routine outcome monitoring based on the OQ-45. Since analysis dropouts always occur, repeated measurements with the OQ-45 and the HAQ analyzed with MI are useful to improve the accuracy of outcome estimates in quality assurance assessments and non-randomized effectiveness studies in the field of outpatient psychotherapy.

Self-report questionnaires are economical instruments for routine outcome assessment. In this study, the performance of the German version of the Outcome Questionnaire-45 (OQ-45) and the Brief Symptom Inventory (BSI) was evaluated when applied in analysis of the outcome quality of psychiatric and psychotherapeutic interventions. Pre-post data from two inpatient samples (N = 5711) and one outpatient sample (N = 239) were analyzed. Critical differences (reliable change index) and cut-off points between functional and dysfunctional populations were calculated using the Jacobson and Truax method of calculating clinical significance. Overall, the results indicated that the BSI was more accurate than the OQ-45 in correctly classifying patients as clinical subjects. Nonetheless, even with the BSI, about 25% of inpatients with schizophrenia attained a score at admission below the clinical cut-off. Both questionnaires exhibited the highest sensitivity to psychopathology with patients with personality disorders. When considering the differences in the prescores, both questionnaires showed the same sensitivity to change. The advantage of using these self-report measures is observed primarily in assessing outpatient psychotherapy outcome. In an inpatient setting two main problems—namely, the low response rate and the scarce sensitivity to psychopathology with severely ill patients—limit the usability of self-report questionnaires.

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Verschiedene Forschungsergebnisse unterstützen die These, dass die Mehrheit der Therapeutinnen und Therapeuten eine integrative Praxis ausüben. Ausgehend von dieser Annahme wurden im vorliegenden Artikel, auf der Basis der Audioaufnahmen von Therapiesitzungen, Gemeinsamkeiten in der therapeutischen Haltung bzw. in der Anwendung von therapeutischen Techniken zwischen Therapeutinnen und Therapeuten aus verschiedenen Schulen analysiert. Als Grundlage für die Analyse wurden zwei Stichproben von 108 bzw. 162 Sitzungen aus Therapien aus der »Praxisstudie Ambulante Psychotherapie Schweiz« verwendet. Die Audioaufnahmen der Sitzungen wurden entweder mit dem Psychotherapie-Prozess Q-Set oder mit dem PAP-S-Rating-Manual analysiert. Beide Instrumente zeigten deutliche Ähnlichkeiten bezüglich Handlungen und Haltungen von Therapeutinnen und Therapeuten mit unterschiedlichen therapeutischen Orientierungen. Bezüglich der Art der verwendeten Interventionen, die in jeder Therapeut/innengruppe beobachtet wurden, zeigte sich, dass mit Abstand am häufigsten die emotionsbezogenen Interventionen verwendet wurden. An zweiter bzw. an dritter Stelle standen die verhaltensbezogenen bzw. die auf das Unbewusste gerichtete Interventionen. Auch besondere Techniken, wie die körperbezogenen oder kunstund ausdrucksorientierten Interventionen, liessen sich in jeder Gruppe beobachten.