Why some psychotherapists benefit from feedback on treatment progress more than others: A belief updating perspective.

Abstract

Monitoring of patient-reported outcomes and providing therapists with progress feedback has been shown to be beneficial for treatment outcomes (e.g., by preventing therapy failures). Despite recent advances in monitoring and feedback research, little is known about why some therapists benefit from feedback more than others. Addressing this issue, the present article uses the basic science literature on belief updating to propose a theoretical model for these between-therapist differences. In doing so, we provide a novel framework that allows testable hypotheses about when and how feedback on therapy progress is likely to improve treatment outcomes. In particular, we argue that the integration of feedback and its effect on therapists’ behavior depends on the weight therapists assign to their prior beliefs regarding treatment progress relative to the weight of the feedback received. We conclude by outlining some directions for future research on the underpinnings of this model, and point to some implications for the training of therapists and provision of feedback.

Psychotherapists’ outcome expectations: How are they established?

“…Therapists’ assessment of patient problems may be based on the systematic use of tools such as routine outcome monitoring of standardized data (Låver et al, 2024), structured diagnostic interviews, or both. When this is the case, therapists’ OEs should be most accurate, and there is evidence that therapists are able to adjust their expectations when given relevant and reliable information from these sources about likely patient outcomes (Brooks Holliday et al, 2020; Delgadillo et al, 2017; Herzog et al, 2023).…”

“…Tracking outcomes allows therapists’ OEs to be updated during treatment, and when the data show that patients are not improving at an appropriate rate, many therapists seem able to adjust treatment to reduce negative outcomes (Lambert et al, 2018). However, this effect is variable across therapists, suggesting that some therapists have more flexible OEs than others and/or are better able to adjust their treatment to patients after their initial OEs are violated (Bar-Kalifa et al, 2016; Herzog et al, 2023). The cyclical and iteratively updating nature of therapist OEs can be seen in, for example, Bartholomew et al’s (2019) study.…”

Belief updating is an important contribution, but not the whole story.

“…It is a privilege to be invited to comment on the article "Why some psychotherapists benefit from feedback on treatment progress more than others-A belief updating perspective" by Herzog et al (2023). We feel compelled to start with a clear statement of appreciation for their work: Belief updating is a useful model to begin to explain how therapists integrate feedback into treatment, and why feedback seems to have different effects for different therapists and patients.…”

Mind the gap.

“…This conceptual gap must be filled if we are going to be able to make progress in improving outcomes through feedback. The contribution by Herzog, Kube, and Rubel (2023) is a good step in the right direction.…”

“…I am pleased to be invited to comment on the Herzog, Kube, and Rubel (2023) article. The article makes a fine contribution to our thinking about how feedback works to improve outcomes.…”