Using patient‐focused research in evaluating treatment outcome in private practice

Abstract

The increasing emphasis on therapist accountability and empirical demonstration of psychotherapeutic treatment effectiveness points to the need for practicing therapists to integrate treatment evaluation methods into routine clinical practice. Unfortunately, most private practitioners have little involvement in carrying out evaluation procedures. In this study we demonstrate how patient-focused research was used to track the progress and outcome of patients seen by a clinical psychologist in private practice. Twenty-nine adults and 40 children/adolescents were evaluated on a weekly basis to assess the number of sessions required to reach improvement (reliable change) and recovery (clinically significant change). Dose-response survival analysis results indicated that 50% of adults reached clinically significant change in 54 sessions, and 50% of youth met the same standard in 14 sessions. These results were compared with outcome in large-scale studies. Implications of this study for integrating treatment evaluation methods into clinical practice are discussed.

Outcome assessment for children and adolescents: psychometric validation of the Youth Outcome Questionnaire 30.1 (Y-OQ®-30.1)

“…For instance, Asay, Lambert, Gregersen, and Goates (2002) found evidence of clinically significant improvement in 73% of youth receiving outpatient treatment in a private setting after an average of nine sessions. In this same sample, 22% of youth demonstrated no reliable change, while 5% showed signs of clinically significant deterioration.…”

What is a scientist‐practitioner anyway?

“…Patient-focused research not only focuses on the patient, as the name implies, but on the individual patient, asking whether treatment is progressing for the specific individual that is being seen (Asay, Lambert, Gregerson, & Goates, 2002;Lambert, Hansen, & Finch, 2001). It is a direct application of science to idiographic practice, and may be the best example of the aspirations of the S-P model, as well as of the LCS in action.…”

“…In the study presented in this series (Asay et al, 2002), the therapist is presented as psychodynamic, and the patients typically were personality disordered. As a result, there was a higher number of sessions required to reach clinically significant change.…”

Impact of Clinician Expectations on Termination Status and Therapeutic Outcome

“…This hypothesis was non-directional as the relationship between clinician expectations and client outcomes has not yet been considered in the existing literature. The researchers held a supplementary hypothesis based on the notion that clinicians tend to be reluctant to utilize outcome questionnaires as a tool for therapy (Kazdin, 2006;Talley & Clack, 2006) despite the suggested benefits such as helping to guide decisions about the course of treatment and adding to their clinical judgment (Asay, Lambert, Gregersen, & Goates, 2002). Specifically, we hypothesized that clients of clinicians who report accessing and utilizing OQ45.2 scores on a regular basis would show better outcomes and lower rates of premature termination than clients of clinicians who report rarely or never accessing their clients' responses.…”