The importance of adoption of formal client feedback in therapy: a narrative review

Lappan, Sara; Shamoon, Zain; Blow, Adrian J.

doi:10.1111/1467-6427.12183

Cited by 15 publications

(16 citation statements)

References 80 publications

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“…We agree with Lappan et al. () that the combination of verbal and written feedbacks from clients minimises the risk of clients’ premature termination with therapy and helps therapists to gather feedback that evaluates outcomes.…”

Section: Resultssupporting

confidence: 81%

“…Future papers could examine the use of SCORE‐15 in clinical supervision to facilitate treatment outcome and assure treatment quality as argued by McComb, Diamond, Breunlin, Chambers, and Murray () and Lappan et al. ().…”

Section: Resultsmentioning

confidence: 99%

“…A narrative review conducted by Lappan, Shamoon, and Blow () found up to 50% of clients prematurely drop out from psychotherapy. In one study 12% of clients terminated prematurely citing therapy as contributing to the worsening of their presenting issues, yet therapists were generally oblivious to the dissatisfaction or clinical deterioration regardless of clinical experiences.…”

mentioning

confidence: 99%

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Measuring Therapeutic Changes for a British Chinese Family UsingSCORE‐15

Teh¹,

Lek²

2018

ANZ J of Family Therapy

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This paper details the findings and reflections of family therapy treatment outcomes for a British-Chinese family using SCORE-15, a reliable and valid systemic outcome measure developed in the UK. It aims to examine the clinical usefulness of SCORE-15 through its application to a single case study. The two culture-specific treatments were conducted at the Marlborough Cultural Therapy Centre (MCTC), which was part of the Marlborough Family Service in London. MCTC was a mental health specialist service for ethnic minorities in their preferred languages that operated for 18 years within the mainstream mental health setting of the National Health Service (NHS). The overall family functioning was found to have improved and problem severity decreased, apart from some aspects rated by the mother. Reflections and discussions with the family with regard to the SCORE-15 findings facilitated understanding and feedback about clinical changes in the systemic intervention. Key Points1 SCORE-15 is a self-report measure designed to indicate crucial aspects of family life that are relevant to the need for therapy and for therapeutic change. 2 Therapeutic outcome of two family therapy treatments attended by the same British-Chinese family were analysed using a systemic outcome measure, SCORE-15. 1 3 SCORE-15 was administered at the first and penultimate sessions of treatment two, and discussed with the family twice, first at the end of treatment and another time during the process of involving them in this writing process. 4 Overall ratings on SCORE-15 fell between adequate and significant problem family functioning ranges and some changes were found between the start and end of treatment. 5 The findings from SCORE-15 were also compared and contrasted with the family's narrative account of the treatment outcomes.A narrative review conducted by Lappan, Shamoon, and Blow (2017) found up to 50% of clients prematurely drop out from psychotherapy. In one study 12% of clients terminated prematurely citing therapy as contributing to the worsening of their presenting issues, yet therapists were generally oblivious to the dissatisfaction or clinical deterioration regardless of clinical experiences. Clients generally censor their feedback when asked informally during sessions and therapists were only able to accurately identify unspoken negative clients' feelings towards therapy 50% or less of the time. Maintaining multiple therapeutic alliances is a challenge for family therapists given the complex and multiple interactions required with various family members in

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Section: Resultssupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Measuring Therapeutic Changes for a British Chinese Family UsingSCORE‐15

Teh¹,

Lek²

2018

ANZ J of Family Therapy

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“…For example, with regard to participant characteristics, greater ambivalence toward treatment may be associated with higher rates of dropout . With regard to facilitator characteristics, stronger therapeutic alliance may predict a reduced likelihood of dropout , and with regard to treatment characteristics, psychosocial interventions that elicit feedback from participants/clients may produce lower dropout rates , as may those that engage in directed interventions designed to minimize this outcome (e.g. ).…”

Section: Discussionmentioning

confidence: 99%

Dropout rates of in‐person psychosocial substance use disorder treatments: a systematic review and meta‐analysis

2019

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Background and Aims Relapse rates for psychosocial substance use disorder (SUD) treatments are high, and dropout is a robust predictor of relapse. This study aimed to estimate average dropout rates of in-person psychosocial SUD treatments and to assess predictors of dropout. Design A comprehensive meta-analysis of dropout rates of studies of in-person psychosocial SUD treatment. Studies included randomized controlled trials (RCTs) and cohort studies. Setting Studies conducted anywhere in the world that examined SUD treatment and were published from 1965 to 2016, inclusive. Participants/casesOne hundred and fifty-one studies, 338 study arms and 299 dropout rates including 26 243 participants. Measurements Databases were searched for studies of SUD treatment that included an in-person psychosocial component. Meta-analyses and meta-regressions were conducted to estimate dropout rates and identify predictors of dropout, including participant characteristics, facilitator characteristics and treatment characteristics. Pooled estimates were calculated with random-effects analyses accounting for the hierarchical structure of study arms nested within studies. Findings The average dropout rate across all studies and study arms was 30.4% [95% confidence interval (CI) = 27.2-33.8 and 95% prediction interval (PI) = 6.25-74.15], with substantial heterogeneity (I 2 = 93.7%, P < 0.0001). Studies including a higher percentage of African Americans and lower-income individuals were associated with higher dropout rates. At intake, more cigarettes/day and a greater percentage of heroin use days were associated with lower dropout rates, whereas heavier cocaine use was associated with higher dropout rates. Dropout rates were highest for studies targeting cocaine, methamphetamines and major stimulants (broadly defined) and lowest for studies targeting alcohol, tobacco and heroin, although there were few studies on methamphetamines, major stimulants and heroin. Programs characterized by more treatment sessions and greater average session length were associated with higher dropout rates. Facilitator characteristics were not significantly associated with dropout. Conclusions On average, approximately 30% of participants drop out of in-person psychosocial SUD treatment studies, but there is wide variability. Dropout rates vary with the treated population, the substance being targeted, and the characteristics of the treatment.

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“…The development of short and precise scales in CFT is especially important given the recent emphasis on clinicians and researchers systematically monitoring the progress of couples' and families' functioning during the course of therapy. With evidence indicating that clinical effectiveness significantly improves when client progress is systemically monitored (Lappan, Shamoon, & Blow, 2017), the use of shorter, yet reliable, scales will reduce client burden when they complete the assessments. In addition, the greater precision of the measures will allow for the detection of larger increments of change over the course of therapy.…”

mentioning

confidence: 99%

An Introduction to a New Generation of Clinical Statistical Approaches

Miller

2020

J Marital Family Therapy

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One of the most exciting, yet frustrating, aspects of being a clinical researcher is that as we therapists clinically morph and grow, so do the statistical analyses that we use. They have to change in order to account for the complexity of the work we are doing. Simple bi-variate correlations, once sufficient, paved the way for multiple regression where confounding phenomena could be controlled for. In clinical research, this allowed researchers to account for factors such as diagnosis or duration of pre-treatment impairment when examining clinical outcomes. Then, structural equation modeling (SEM) gained popularity as a tool beyond multiple regression, an improved approach for a number of reasons. SEM allowed researchers to account for measurement error, to incorporate multiple dependent variables into their research questions, to test how well a model fits the data, and to work with complex and difficult data (Wang & Wang, 2012). This allowed clinicians to account for complex change processes happening over the course of treatment. Nothing that we do clinically is simple, so why should the analyses we use to validate our approach be? Standards of practice for running and reporting statistical analyses continued to evolve. Testing and reporting of statistical power, effect sizes, and confidence intervals have increasingly become critical components of the research process to manage typical errors that arise from an overreliance on the p < .05 criterion (Cohen, 1994; Cumming, 2012). Other complex approaches emerged as means to manage the complexity of the researcher and the data. Meta-analysis became the new standard for reviewing clinical studies because of its ability to reduce researcher bias when synthesizing the results of studies. Dyadic analysis approaches such as the Actor-Partner Interdependence Model (APIM, Cook & Snyder, 2005) opened the door to more appropriate and valid analyses of data that included paired participants, such as romantic partners and parent-child dyads. These changes are exciting because they enable us to improve the precision and accuracy of our statistical analyses, thereby improving the validity of our findings (Johnson & Miller, 2014). Moreover, it is exciting to have new statistical approaches that can better model the multiple relationships and complex interactions that are inherent in couple and family therapy. However, they are also frustrating because the standard for doing state-of-the-art statistics seems to always be increasing. Learning a new statistical approach does not bring much satisfaction because, as soon as we learn it, we realize that there is something new that we need to learn. The frustration comes from feeling as if our statistical knowledge is perpetually outdated. And, make no mistake about it; newer statistical techniques seem to gravitate, like some law of physics, toward greater complexity and sophistication. Well, the evolution has continued, and there is a new generation of statistical approaches that are available to CFT researchers to enhance their ...

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The importance of adoption of formal client feedback in therapy: a narrative review

Cited by 15 publications

References 80 publications

Measuring Therapeutic Changes for a British Chinese Family UsingSCORE‐15

Measuring Therapeutic Changes for a British Chinese Family UsingSCORE‐15

Dropout rates of in‐person psychosocial substance use disorder treatments: a systematic review and meta‐analysis

An Introduction to a New Generation of Clinical Statistical Approaches

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