Routine outcome monitoring (ROM) systems that identify clients at-risk for treatment failure using outcome and therapeutic process measures are a recognized evidence-based practice. However, only 3 empirical studies have tested ROMs in group therapy, producing mixed results. This randomized clinical trial tested the Outcome Questionnaire System, the ROM system with the most empirical support for individual therapy patients, with 430 group therapy patients who were randomly assigned to 2 experimental arms (Group Questionnaire [GQ] + Outcome Questionnaire-45 [OQ-45] vs. OQ-45). Given the strong evidence for progress feedback, the primary purpose of this study was to ascertain if therapeutic relationship feedback using the GQ reduced rates of relationship deterioration and failure when progress feedback was held constant. Group leaders simultaneously ran pairs of groups that were randomly assigned to the 2 conditions. Of the 430 patients enrolled in 58 groups, 374 attended more than 4 sessions. Results showed that therapeutic relationship predicted improvement in outcome and that feedback reversed the course of relationship deterioration and reduced rates of relationship failure. Although there were no effects on attendance and dropout for feedback, the 2 experimental arms produced mixed results for the OQ-45 not-on-track cases. The combined relationship and progress feedback (GQ/OQ-45) was associated with fewer outcome deterioration cases, while the progress feedback condition (OQ-45) showed higher outcome improvement cases. Findings are discussed with respect to previous group ROM studies, clinical implications, and future research. (PsycINFO Database Record

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The use of feedback based on outcome and process measures to inform treatment is gaining ground as one form of evidence-based treatment. However, little is known regarding how therapists actually use feedback, particularly from process measures, to affect treatment. This two-part qualitative study used session-by-session and treatment-episode narratives from group therapists to define how they acted on process feedback from a member-completed measure of the therapeutic relationship: the Group Questionnaire (GQ). Therapists' responses in the first wave of data were also used to develop a therapist-completed measure to quantify how feedback affected treatment. Sixteen group leaders received weekly session feedback reports on group members' responses to the GQ from the preceding group session. Leaders explained how they used that feedback in two ways: (a) with session-by-session written descriptions of feedback use and (b) with end-of-semester debrief interviews in which leaders described their experience with the feedback over the course of an entire group treatment episode. A content analysis of leader descriptions was undertaken by two independent pairs of raters to determine whether common patterns of use could be uncovered. Thirteen common use categories emerged across the two rater pairs. A 7-item questionnaire reflecting the most frequently used categories of use completed at the end of group treatment was shown to be highly correlated with session-by-session leader narrative. Implications of the common use patterns across therapists, variability between therapists, and the potential of the 7-item questionnaire are discussed. (PsycINFO Database Record

Chronic pain management services are often provided in group formats, as they are cost effective, increase access to care, and provide unique and needed social support to patients, but mixed outcomes for these groups indicate room for improvement. A small but growing body of research suggests routine assessment of and feedback on group cohesion may improve individual patient outcomes, though this has not been studied among chronic pain groups. Provided in this article is a rationale for assessing group cohesion in pain management programs, along with considerations for how and when to use routine outcome monitoring of cohesion in clinical practice. Clinical Impact StatementQuestion: This article hopes to address using routine process feedback monitoring to improve outcomes in group therapy for chronic pain. Findings: Group clinicians in chronic pain programs can use the ideas in this article to inspire using cohesion measures in pain management programs, with the hope that it could improve their patient outcomes. Meaning: The conclusions in this article indicate that group clinicians in chronic pain programs can look at cohesion as a possible contributor to outcomes and that there are ways to improve cohesion in these groups through progress monitoring. Next Steps: Group clinicians could begin to assess cohesion and alter their interventions based on the continuous progress monitoring described.