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Li E, Kealy D, Aafjes-van Doorn K, McCollum J, Curtis JT, Luo X, Silberschatz G. "It Felt Like I Was Being Tailored to the Treatment Rather Than the Treatment Being Tailored to Me": Patient Experiences of Helpful and Unhelpful Psychotherapy. Psychother Res 2024:1-15. [PMID: 38833539 DOI: 10.1080/10503307.2024.2360448] [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: 01/03/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE This qualitative study explores patients' experiences of psychotherapy, focusing on elements perceived as helpful or unhelpful and suggestions for improvement in the context of public mental health care. METHODS A total of 148 adults (Mean age = 32.24, SD = 9.92) who had been or are currently receiving psychological treatment from the National Health Service (NHS) responded to an online survey. The survey included open-ended questions regarding their experiences of psychotherapy, asking them to identify helpful or unhelpful aspects, and suggestions for improvement. Using thematic analysis, key themes were identified. RESULTS The analysis highlighted the patient's preference for personalized treatment, the importance of therapeutic alliance, the demand for depth in therapy, and life skills and agency as therapeutic outcomes. Participants suggested improvements such as more tailored approaches and stronger therapist-patient relationships, supporting an adaptable, patient-centered model. CONCLUSION The study highlights challenges in public mental health services where patients might feel their specific needs are not being recognized and met and underscores the importance of personalized treatment plans that satisfy and evolve with patient needs, suggesting that therapists must be attentive and responsive to individual desires to enhance the patient experience.
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Affiliation(s)
- Elizabeth Li
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - James McCollum
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
| | - John T Curtis
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | - George Silberschatz
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Låver J, McAleavey A, Valaker I, Castonguay LG, Moltu C. Therapists' and patients' experiences of using patients' self-reported data in ongoing psychotherapy processes-A systematic review and meta-analysis of qualitative studies. Psychother Res 2024; 34:293-310. [PMID: 37322037 DOI: 10.1080/10503307.2023.2222896] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE Using patient-generated quantitative data in psychotherapy (feedback) appears to enhance treatment outcome, but there is variability in its effect. Different ways and reasons to implement routine outcome measurement might explain such variability. The goal of this review is to address the insufficient knowledge on how these data are used by therapists and patients. METHODS The present study is a systematic review and meta-analysis of qualitative reports of therapists' and patients' experiences using patient-generated quantitative data during ongoing psychotherapy. RESULTS Four main categories of use were identified: (1) uses of patients' self-reported data as nomothetic/objective markers for assessment, process monitoring, and treatment planning; (2) intrapersonal uses that enhance self-awareness, initiate reflection, and influence patients' mood or responses; (3) uses that prompt interactional processes by facilitating communication, supporting exploration, creating ownership in patients, changing treatment focus, enhancing therapeutic alliance, or disturbing the psychotherapy process; and (4) patients responding for specific purposes due to uncertainty and interpersonal motives, or strategic responding to achieve a desired result. CONCLUSION These results demonstrate that patient-reported data, when used in active psychotherapy, is very clearly not just an objective measurement of client functioning: the inclusion of patient-data has the potential to influence psychotherapy in numerous ways.
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Affiliation(s)
- J Låver
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - A McAleavey
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- District General Hospital of Førde, Førde, Norway
| | - I Valaker
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - L G Castonguay
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - C Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- District General Hospital of Førde, Førde, Norway
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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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Levitt HM, Grabowski LM, Minami T, Morrill Z. An initial validation of the Clients’ Experience of Therapy Scale (CETS): assessing the quality of psychotherapy process and outcome from clients’ perspectives. COUNSELLING PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1080/09515070.2023.2191171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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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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Berking M, Eichler E, Naumann E, Svaldi J. The efficacy of a transdiagnostic emotion regulation skills training in the treatment of binge-eating disorder-Results from a randomized controlled trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:998-1018. [PMID: 35567309 DOI: 10.1111/bjc.12371] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Deficits in emotion regulation (ER) have been shown to be associated with binge-eating disorder (BED). To further clarify the causal nature of this association, we tested whether systematically enhancing ER skills would reduce symptoms of BED. METHODS We randomly allocated N = 101 individuals meeting the criteria for BED to a transdiagnostic ER skills training or to a waitlist control condition (WLC). Primary outcome was the reduction in binges during the treatment-vs.-waiting period as assessed with the Eating Disorder Examination (EDE) interview. RESULTS Mixed-model ANOVAs indicated that the average pre-to-post decrease in binges assessed with the EDE was significantly greater in the ER skills training condition than in the WLC (d = 0.66). These effects were stable over the 6-month follow-up period (d = 0.72). Remission rates at post/follow-up were 34.4/45.0% in the skills training and 7.5/20.0% in the WLC. Additionally, we found a greater reduction in general eating disorder psychopathology, of food consumption in a bogus taste test and of depression in the ER skills training condition. Moreover, the greater reduction in binge-eating episodes in the training condition was (partially) mediated by a greater increase in ER skills. CONCLUSIONS The findings provide further support for the assumed importance of deficits in ER as a maintaining factor and, hence, as a target in the treatment of BED. As ER skills trainings have been shown to also reduce other kinds of psychopathology, they might be considered a promising transdiagnostic add-on component to disorder-specific interventions.
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Affiliation(s)
| | - Eva Eichler
- University of Erlangen-Nuremberg, Erlangen, Germany
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7
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The Use of Evidence in Clinical Reasoning. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Nedelcea C, Ciorbea ID, Vasile DL, Ionescu Ș, Papasteri C, Letzner RD, Cosmoiu A, Georgescu T. The structure of PTSD. Development of the Post Traumatic Symptom scale from a clinician-based perspective. Eur J Psychotraumatol 2022; 13:2066455. [PMID: 35957630 PMCID: PMC9359187 DOI: 10.1080/20008198.2022.2066455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nations marked by a Marxist-Leninist ideology have suffered greatly due to a culture of abuse emphasized by the absolute absence of psychology, thus contributing to a diminished ability in recognizing the consequences of traumatic experiences. OBJECTIVE To improve the assessment of the presence and severity of posttraumatic stress disorder (PTSD) in such a cultural context, our paper aimed at developing an alternative self-report measure for PTSD - the Post Traumatic Symptom Scale (PTSs), developed by clinicians with wide relevant expertise, based on the natural language people use to describe its subjective experience. This research used multiple samples consistent with the corresponding objectives. Mokken Scale Analysis and the Classical Test Theory were both employed. The proposed scale was tested against five competing PTSD models, whilst also investigating the symptoms' clusters in two different samples by using, to our knowledge, a network analysis approach for the first time. METHOD The results indicated excellent psychometric properties regarding internal consistency and temporal reliability, as well as convergent and discriminant validity. The results of MSA showed that the scale fully conforms to the assumptions of the monotone homogeneity model, interpreted as positive evidence for its use in clinical purposes. The factor analyses pointed that the newer models outperformed the standard DSM-5 model, with bifactor models displaying better fit indexes than second-order models. Finally, a distinct pattern of symptom activation in the high-risk group (i.e. first-responders) was found, bringing support for symptoms overlapping between PTSD and affective disorders, thus reinforcing the idea of bridge symptoms which has significant clinical implications. RESULTS This study presents an alternative sound instrument for measuring PTSD symptomatology focused on how people naturally describe their subjective experiences. Theoretical and practical implications are discussed alongside limitations. HIGHLIGHTS The construction of PTSs encompasses cultural trauma and one's subjective experience.PTSs was tested against the five major competing models of PTSD.Network analyses suggest different patterns in a student sample vs. a first-responders one, with the accent on the negative alterations in cognitions and mood (NACM) model.
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Swanson L, Schwannauer M, Bird T, Eliasson E, Millar A, Moritz S, Griffiths H. Metacognitive Training Modified for Negative Symptoms (MCT-N): A Feasibility study. Clin Psychol Psychother 2021; 29:1068-1079. [PMID: 34792834 DOI: 10.1002/cpp.2692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although patients often prioritise the treatment of negative symptoms, few psychological interventions targeting negative symptoms exist. This study attempts to fill this gap by piloting a modified Metacognitive training programme, specifically targeted at negative symptoms (MCT-N), with a group of patients with prominent negative symptoms. METHOD We adopted a mixed methods case series design, providing detailed quantitative data on changes over time, to focus on potential mechanisms underlying the intervention, in combination with qualitative interviews. RESULTS The intervention showed good feasibility as demonstrated by the attendance rate, the positive feedback from participants and the multidisciplinary team, and the improvements on negative symptoms observed following the intervention. Multilevel modelling showed that depression, internalised stigma, and reflective functioning explained the variance in negative symptoms. DISCUSSION The pilot study indicated that the intervention has high feasibility and that improvements in negative symptoms can be partially explained by improvements on depression, stigma, and reflective functioning.
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Affiliation(s)
- Linda Swanson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh.,NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh.,Region Sörmland, Sweden, Centre for Clinical Research Sörmland, Eskilstuna
| | - Matthias Schwannauer
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Tim Bird
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Emma Eliasson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Audrey Millar
- NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Germany, Department of Psychiatry and Psychotherapy, Hamburg
| | - Helen Griffiths
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
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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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