Understanding “patient deterioration” in psychotherapy from depressed patients’ perspectives: A mixed methods multiple case study

How do we know whether treatment has failed? Paradoxical outcomes in counseling with young people

“…Based on these results, treatment failure or success is not a straightforward matter. These results are consistent with findings of other studies that have similarly reported differences between outcomes recorded through self-report measures and those based on qualitative interviews ( McElvaney and Timulak, 2013 ; Bloch-Elkouby et al, 2019 ; De Smet et al, 2019 , 2020a , b , 2021a , b , 2024 ; Desmet et al, 2021a ). Taken together, the evidence from these studies as a whole suggest that the phenomenon that we have characterized as paradoxical outcome is a robust pattern that has been identified in different samples using different data collection and analysis strategies.…”

“…However, despite the extensive research and development work that underpins such measures, there has been a growing appreciation of their limitations in the specific context of evaluating change in psychotherapy. Specifically, research has shown discrepancies between outcome profiles generated by the use of pre- and post-therapy symptom measures, and those derived from qualitative interviews conducted with the same clients [see, for example, McElvaney and Timulak (2013) , Bloch-Elkouby et al (2019) , and De Smet et al (2019 , 2020a , b , 2021a , b , 2024) ]. The lack of convergence between narrative accounts of outcomes, and outcome analyses based on responses to standardized measures, was described by Stänicke and McLeod (2021) as paradoxical outcomes , in the sense of confronting researchers with an apparent contradiction: how can it be, that different but equally credible methods of assessing outcome, can produce (in some instances) radically different conclusions?…”