Progress monitoring with couple clients

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.

Therapists' confidence in their theory of change and outcomes

Previous research has sought to understand what therapist characteristics contribute to positive outcomes for clients. It is widely accepted knowledge that the alliance between the therapist and client is a significant contributing factor to client outcomes. With that said, few studies have examined specific characteristics within the therapist themselves that may contribute to client success, regardless of the therapeutic model being used. Using data from a sample of therapist-trainees at a large, midwestern institution, this study sought to explore therapist confidence in their theory of choice and its potential impact on client outcomes. Findings suggest that those clients who have therapists with greater confidence in their theory are less likely to terminate treatment prematurely or without agreement. These findings have the potential to inform the curriculum for training programs to focus more on developing confidence in the chosen theory.

Understanding routine outcome monitoring and clinical feedback in context: Introduction to the special section

The practice of routine outcome monitoring and providing clinical feedback has been widely studied within psychotherapy. Nevertheless, there are many outstanding questions regarding this practice. Is it an evidence-based adjunct to ongoing psychotherapies, or an ineffective complication of treatment? If it is effective, through what mechanism(s) does it act? Is it effective with all patient populations, treatment types, and service delivery mechanisms, or does its impact vary across context? What choices in the implementation process affect the utility of patient-reported data feedback on psychotherapy outcomes? The studies in this special section explore these questions using a wide variety of methods and significantly expand the reach of studies on feedback. Together, these studies represent a snapshot of a maturing field of study: Initial discoveries are developed into more robust theories and applied in a wider range of contexts, while the limits of that theory are tested. They also signal directions for future clinical and research work that may improve patient care in psychosocial interventions into the future.