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McLeod J, Stänicke E, Oddli HW, Smith S, Pearce P, Cooper M. How do we know whether treatment has failed? Paradoxical outcomes in counseling with young people. Front Psychol 2024; 15:1390579. [PMID: 38895499 PMCID: PMC11184953 DOI: 10.3389/fpsyg.2024.1390579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024] Open
Abstract
Background In both routine practice contexts and research studies, evidence from standardized self-report symptom measures, administered pre- and post-treatment, is predominantly used to determine whether psychotherapy has been successful. Understanding the nature of unsuccessful psychotherapy requires an ability to evaluate the credibility of outcome data generated by such techniques. An important body of research has identified discrepancies between outcomes assessed through symptom measures and those obtained from other sources. However, not enough is known about the extent to which such paradoxical outcomes exist. Objective This study analyzes the relationship between outcomes, as assessed by a standardized self-report measure, and as assessed by ratings of young people's descriptions of change at post-counseling interviews. Methods Participants were 50 young people (13-16 years old) who had taken part in a trial of up to 10 weeks of school-based humanistic counseling. Our primary standardized measure was the Young Person's CORE (YP-CORE). To assess young people's experiences of counseling change, three independent raters scrutinized transcripts of post-counseling interviews, and scored levels of helpfulness on a 1 (Not at all helpful) to 10 (Extremely helpful) scale. Inter-rater reliabilities were 0.94 (Cronbach's Alpha) and 0.96 (McDonald's Omega). Sensitivity analyses were conducted to explore relationships between helpfulness ratings and other outcome measures, i.e., satisfaction with counseling (ESQ) and the Goal-Based-Outcome Tool (GBO), and process measures, i.e., the Working Alliance Inventory (WAI-S) and the Barret Lennard Relationship Inventory (BLRI). Results Multilevel analysis indicated that helpfulness ratings were not significantly associated with changes in YP-CORE scores. Analyzed categorically, 38% of those showing reliable improvement on the standardized measure were below the median for self-described helpfulness, and 47% of those not showing reliable change were at or above the median for self-described helpfulness. Sensitivity analyses demonstrated closer correlations between helpfulness ratings and other outcome measures (ESQ and GBO), and between helpfulness ratings and process measures (WAI-S and BLRI). Discussion Our results raise questions about reliance on symptom change outcome measures for defining treatment success and failure, given their disparity with clients' own descriptions of the helpfulness of therapy. Implications for practice and research are discussed.
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Affiliation(s)
- John McLeod
- Institute for Integrative Counselling and Psychotherapy, Dublin, Ireland
| | - Erik Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Stephanie Smith
- Research and Policy, National Children’s Bureau, London, United Kingdom
| | - Peter Pearce
- Faculty of Applied Social and Organisational Sciences, Metanoia Institute, London, United Kingdom
| | - Mick Cooper
- School of Psychology, University of Roehampton, Roehampton, United Kingdom
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2
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Trigg A, Lenderking WR, Boehnke JR. Introduction to the special section: "Methodologies and considerations for meaningful change". Qual Life Res 2023; 32:1223-1230. [PMID: 37027088 DOI: 10.1007/s11136-023-03413-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Andrew Trigg
- Medical Affairs Statistics, Bayer plc, Reading, UK
| | | | - Jan R Boehnke
- School of Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK.
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3
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Truijens F, De Smet M, Vandevoorde M, Desmet M, Meganck R. What is it like to be the object of research? On meaning making in self-report measurement and validity of data in psychotherapy research. METHODS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.metip.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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4
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Evans C, Carlyle JA, Paz C. Rigorous idiography: Exploring subjective and idiographic data with rigorous methods-The method of derangements. Front Psychol 2023; 13:1007685. [PMID: 36710731 PMCID: PMC9879009 DOI: 10.3389/fpsyg.2022.1007685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/22/2022] [Indexed: 01/13/2023] Open
Abstract
Psychological research often seeks general rules applying across individuals, an aim that is in tension with examining that which is unique to any individual. There are general statistical regularities across individuals' subjective self-report which enable much psychology and psychotherapy research to combine data from self-report questionnaire responses with statistical and psychometric methods to create a fundamental part of Cronbach and Meehl's foundational nomological networks of validity. However, these methods only apply when most participants answer the same questions on measures creating nomothetic data and this has led to a neglect of idiographic data. This paper reviews a method of analysis of idiographic data, of "rigorous idiography": the method of derangements. This is a remarkably simple statistical test of whether purely idiographic data convey reliable information. We show how the method appeared to become stuck in a bibliometric backwater but we expand on its potential for research and practise and hope it will be taken up and used correctly and more widely.
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Affiliation(s)
- Chris Evans
- Escuela de Psicología y Educación, Universidad de Las Américas, Quito, Ecuador,School of Psychology, University of Roehampton, London, United Kingdom,*Correspondence: Chris Evans,
| | | | - Clara Paz
- Escuela de Psicología y Educación, Universidad de Las Américas, Quito, Ecuador
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5
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Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatient hospitals: A multicentred descriptive cross-sectional study. J Psychiatr Ment Health Nurs 2023; 30:568-579. [PMID: 36588478 DOI: 10.1111/jpm.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse-patient relationship. Collecting nurse-sensitive patient outcomes is a strategy to provide outcomes of a nurse-patient relationship from patients' perspectives. Because there was no validated scale, the Mental Health Nurse-Sensitive Patient Outcome-Scale (six-point Likert-scale) was recently developed and psychometrically evaluated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study using the Mental Health Nurse-Sensitive Patient Outcome-scale to measure nurse-sensitive patient outcomes of the nurse-patient relationship in psychiatric hospitals. Moderate to good average scores for the MH-NURSE-POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Our results are consistent with the patient-reported effect(s) of relation-based nursing in qualitative research. The scores generate evidence to support the outcomes of the nurse-patient relationship and implicates that further investment in (re)defining and elaborating nurse-patient relationships in mental healthcare is meaningful and justified. More comparative patient-reported data can determine how nurse-sensitive patient outcomes are affected by the patient, nurse, and context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Demonstrating patient-reported outcomes of the nurse-patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self-awareness and cultural sensitivity, can be pivotal to achieving the patient-reported outcomes for inpatients with mental health problems. ABSTRACT INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing. AIM/QUESTION To measure nurse-sensitive patient outcomes of the nurse-patient relationship. METHOD In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'. RESULTS Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). DISCUSSION The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment. IMPLICATIONS FOR PRACTICES Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.
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Affiliation(s)
- Karel Desmet
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy Clinic St-Joseph, Pittem, Belgium
| | - Peter J J Goossens
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Dimence Mental Health Center for Bipolar Disorder, Deventer, The Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic St-Joseph, Pittem, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
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Bringmann LF, Elmer T, Eronen MI. Back to Basics: The Importance of Conceptual Clarification in Psychological Science. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221096485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the lack of conceptual clarity has been observed to be a widespread and fundamental problem in psychology, conceptual clarification plays a mostly marginal role in psychological research. In this article, we argue that better conceptualization of psychological phenomena is needed to move psychology forward as a science. We first show how conceptual unclarity seeps through all aspects of psychological research, from everyday concepts to statistical measures. We then turn to recommendations on how to improve conceptual clarity in psychology, emphasizing the importance of seeing research as an iterative process in which it is necessary to revisit the phenomena that are the foundations of theories and models, as well as how they are conceptualized and measured.
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Affiliation(s)
- Laura F. Bringmann
- Department of Psychometrics and Statistics, Faculty of Social and Behavioural Sciences, University of Groningen
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen
| | - Timon Elmer
- Department of Psychometrics and Statistics, Faculty of Social and Behavioural Sciences, University of Groningen
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7
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Boehnke JR, Rutherford C. Using feedback tools to enhance the quality and experience of care. Qual Life Res 2021; 30:3007-3013. [PMID: 34635961 DOI: 10.1007/s11136-021-03008-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jan R Boehnke
- School of Health Sciences, University of Dundee, City Campus, 11 Airlie Place, Dundee, DD1 4HJ, UK.
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), The University of Sydney, Sydney, Australia
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8
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Evans C, Paz C, Mascialino G. " Infeliz" or " Triste": A Paradigm for Mixed Methods Exploration of Outcome Measures Adaptation Across Language Variants. Front Psychol 2021; 12:695893. [PMID: 34434145 PMCID: PMC8381247 DOI: 10.3389/fpsyg.2021.695893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
The literature on measure translation tends to hold, overtly or covertly, a questionable assumption about the possibility of exact translation and almost completely ignores issues of within language variation. Equally, psychometric methods used to assess cross-cultural validity after translation focus on large sample tests of cross-sectional measurement invariance. Such invariance is often not found and is of dubious pertinence to change/outcome measures usually used in psychotherapy research. We present a sequential process of three substudies using quantitative and qualitative procedures to explore whether an outcome measure needs to be changed when used across language variation. Qualitative data confirmed that an item was not ideal in the new context. However, quantitative exploration showed that, although statistically significant and affected by gender and item order, the impact of changing the item in the overall score was small, allowing retention of the existing Spanish translation. We argue that the myth of perfect translation and over-reliance on large-sample psychometric testing pursuing measurement invariance limit exploration of language effects. We recommend that these be used in the companion of user-based, sequential, mixed-method exploration to support the development of a richer field of understanding of outcomes and change self-report measures across languages and cultures and both across and within languages.
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Affiliation(s)
- Chris Evans
- Department of Psychology, The University of Sheffield, Sheffield, United Kingdom
| | - Clara Paz
- Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador
| | - Guido Mascialino
- Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador
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9
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Yassin S, Evans C. A journey to improve Arabic‐speaking young peoples’ access to psychological assessment tools: It’s not just Google translate! COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sulafa Yassin
- Research Associate (based in London, UK) PSYCTC Aime la Plagne France
| | - Chris Evans
- Department of Psychology University of Sheffield Sheffield UK
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10
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Stephen S, Bell L, Khan M, Love R, Macintosh H, Martin M, Moran R, Price E, Whitehead B, Elliott R. Comparing helpful and hindering processes in good and poor outcome cases: A qualitative metasynthesis of eight Hermeneutic Single Case Efficacy Design studies. Psychother Res 2021; 32:389-403. [PMID: 34088254 DOI: 10.1080/10503307.2021.1934746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: We tested qualitative metasynthesis of a series of Hermeneutic Single Case Efficacy Design (HSCED) studies as a method for comparing within-session processes that may explain good and poor therapeutic outcome. Method: We selected eight HSCED studies according to change in clients' scores on the Strathclyde Inventory (SI), a brief self-report instrument used to measure outcome in person-centered psychotherapy. Four of the case studies investigated the experience of clients whose pre-post change in SI scores showed improvement by the end of therapy, and the other four focused on clients whose change in SI scores indicated deterioration. We conducted a qualitative metasynthesis, adopting a generic descriptive-interpretive approach to analyze and compare the data generated by the HSCED studies. Results: In contrast to improvers, deteriorators appeared to be less ready to engage in therapeutic work at the beginning of therapy, and found the process more difficult; their therapists were less able to respond to these difficulties in a responsive, empathic manner; deteriorators were less able to cope successfully with changes of therapist and, eventually, gave up on therapy. Conclusion: We found that our qualitative metasynthesis of a series of HSCED studies produced a plausible explanation for the contrasting outcomes that occurred.
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Affiliation(s)
- Susan Stephen
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Laura Bell
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Maha Khan
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Ruth Love
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Hannah Macintosh
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Melanie Martin
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Rebecca Moran
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Emily Price
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Brigid Whitehead
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Robert Elliott
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
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Thoresen LHK, Thørnquist HH, Stänicke E, Mcleod J. Shift in representation and symbolisation of affective experience: A paradoxical outcome in therapy. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2021. [DOI: 10.1080/13642537.2021.1923048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Erik Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
| | - John Mcleod
- Professor Emeritus of Counselling, University of Abertay Dundee, Tallaght, Dublin
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12
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Stänicke E, McLeod J. Paradoxical outcomes in psychotherapy: Theoretical perspectives, research agenda and practice implications. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2021. [DOI: 10.1080/13642537.2021.1923050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - John McLeod
- Department of Psychology, University of Oslo
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13
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Truijens FL, Van Nieuwenhove K, De Smet MM, Desmet M, Meganck R. How questionnaires shape experienced symptoms. A qualitative case comparison study of questionnaire administration in psychotherapy research. QUALITATIVE RESEARCH IN PSYCHOLOGY 2021. [DOI: 10.1080/14780887.2021.1886383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Femke L. Truijens
- Erasmus University Rotterdam, Erasmus School of Social and Behavioral Sciences, Department of Psychology, Education and Child Studies, Rotterdam, The Netherlands
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Kimberly Van Nieuwenhove
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Melissa M. De Smet
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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Desmet M, Van Nieuwenhove K, De Smet M, Meganck R, Deeren B, Van Huele I, Decock E, Raemdonck E, Cornelis S, Truijens F, Zeuthen K, Schiepek G. What too strict a method obscures about the validity of outcome measures. Psychother Res 2021; 31:882-894. [PMID: 33539266 DOI: 10.1080/10503307.2020.1865584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively.Method: The outcome of 29 psychotherapeutic treatments was evaluated by means of quantitative analysis of pre- and post-treatment scores on commonly used outcome measures (such as the Symptom Checklist-90-R, the Inventory of Interpersonal Problems, and the General Health Questionnaire-12), as well as through consensual qualitative research.Results: Overall, a moderate to low convergence between qualitative and quantitative evaluations of outcome was observed. Detailed analyses of six cases are presented in which pre-to-post comparisons of outcome measures proved misleading.Conclusions: It is concluded that psychotherapy outcome research might benefit from assessment strategies that are sensitive to the singularities of individual treatments and to the complexity of the phenomenon of therapeutic outcome. Furthermore, classical psychometric evaluations of the validity of outcome measures might be supplemented with less-systematic evaluations that take any contingent source of information on outcome into account.
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15
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Clients with different problems are different and questionnaires are not blood tests: A template analysis of psychiatric and psychotherapy clients' experiences of the CORE‐OM. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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De Smet MM, Meganck R, Truijens F, De Geest R, Cornelis S, Norman UA, Desmet M. Change processes underlying "good outcome": A qualitative study on recovered and improved patients' experiences in psychotherapy for major depression. Psychother Res 2020; 30:948-964. [PMID: 32022647 DOI: 10.1080/10503307.2020.1722329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research.
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Affiliation(s)
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Femke Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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17
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Truijens FL, Cornelis S, Desmet M, De Smet MM, Meganck R. Validity Beyond Measurement: Why Psychometric Validity Is Insufficient for Valid Psychotherapy Research. Front Psychol 2019; 10:532. [PMID: 30915008 PMCID: PMC6423000 DOI: 10.3389/fpsyg.2019.00532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022] Open
Abstract
In psychotherapy research, "validity" is canonically understood as the capacity of a test to measure what is purported to measure. However, we argue that this psychometric understanding of validity prohibits working researchers from considering the validity of their research. Psychotherapy researchers often use measures with a different epistemic goal than test developers intended, for example when a depression symptom measure is used to indicate "treatment success" (cf. outcome measurement for evidence-based treatment). However, the validity of a measure does not cover the validity of its use as operationalization of another target concept within a research procedure, nor the validity of its function toward an epistemic goal. In this paper, we discuss the importance of considering validity of the epistemic process beyond the validity of measures per se, based on an empirical case example from our psychotherapy study ("SCS", Cornelis et al., 2017). We discuss why the psychometric understanding of validity is insufficient in covering epistemic validity, and we evaluate to what extent the available terminology regarding validity of research is sufficient for working researchers to accurately consider the validity of their overall epistemic process. As psychotherapy research is meant to offer a sound evidence-base for clinical practice, we argue that it is vital that psychotherapy researchers are able to discuss the validity of the epistemic choices made to serve the clinical goal.
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Affiliation(s)
- Femke L. Truijens
- Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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