With the rise in efforts to evaluate the quality of mental health care and its outcomes, the measurement of change has become an important topic. This paper tracks the creation of a new instrument designed to assess psychotherapy outcome. The Outcome Questionnaire (OQ) was designed to include items relevant to three domains central to mental health: subjective discomfort, interpersonal relations, and social role performance. This study describes the theoretical development and psychometric properties of the OQ. Psychometric properties were assessed using clinical, community, and undergraduate samples. The OQ appears to have high reliability and evidence to suggest good concurrent and construct validity of the total score. The data presented show that it distinguishes patient from non‐patient samples, is sensitive to change, and correlates with other measures of patient distress.

This study examined sources of therapist effects in a sample of 25 therapists who saw 1,141 clients at a university counseling center. Clients completed the Outcome Questionnaire-45 (OQ-45) at each session. Therapists' facilitative interpersonal skills (FIS) were assessed with a performance task that measures therapists' interpersonal skills by rating therapist responses to video simulations of challenging client-therapist interactions. Therapists completed the Social Skills Inventory (SSI) and therapist demographic data (e.g., age, theoretical orientation) were available. To test for the presence of therapist effects and to examine the source(s) of these effects, data were analyzed with multilevel modeling. Of demographic predictor variables, only age accounted for therapist effects. The analysis with age, FIS, and SSI as predictors indicated that only FIS accounted for variance in outcomes suggesting that a portion of the variance in outcome between therapists is due to their ability to handle interpersonally challenging encounters with clients.

Client-focused research systems have been developed to monitor and provide feedback information about clients' progress in psychotherapy as a method of enhancing outcome for those who are predicted to be treatment failures. In the current study, the authors examined whether feedback regarding client progress and the use of clinical support tools (CSTs) affected client outcome and number of sessions attended. Results showed that clients in the feedback plus CST group stayed in therapy longer and had superior outcomes. Nearly twice as many clients in the feedback plus CST group achieved clinically significant or reliable change, and fewer were classified as deteriorated by the time treatment ended.

Empirically supported psychotherapies, treatment guidelines, best practices, and treatment manuals are methods proposed to enhance treatment outcomes in routine practice. Patient‐focused research systems provide a compatible and contrasting methodology. Such systems monitor and feed back information about a patient's progress during psychotherapy for the purpose of enhancing outcomes. A meta‐analytic review of three large‐scale studies is summarized and suggests that formally monitoring patient progress has a significant impact on clients who show a poor initial response to treatment. Implementation of this feedback system reduced deterioration by 4% to 8% and increased positive outcomes. Our interpretation of these results suggests that it may be time for clinicians routinely and formally to monitor patient treatment response.

Patient-focused research attempts to provide information that answers the question: Is this treatment benefiting this patient? Although several systems have been developed to monitor and provide feedback about a patient's response to psychotherapy, few if any have been tested empirically. The current study divided 609 patients into four groups (two experimental and two control) to determine if feedback regarding patient progress, when provided to a therapist, affected patient outcome and number of sessions attended. Results showed that feedback increased the duration of treatment and improved outcome relative to patients in the control condition who were predicted to be treatment failures. Twice as many patients in the feedback group achieved clinically significant or reliable change and one-third as many were classified as deteriorated by the time treatment ended. For those patients who were predicted to have a positive response to treatment, feedback to therapists resulted in a reduction in the number of treatment sessions without reducing positive outcomes.

Several systems have been developed to monitor and feedback information about a client's responses to psychotherapy as a method of enhancing client outcome. The current study divided 1020 clients into four groups (two experimental and two control) to determine if feedback regarding client progress, when provided to a therapist, affected client outcome and number of sessions attended. Results showed that feedback increased the duration of treatment and improved outcome for clients identified as potential treatment failures thereby replicating an earlier study using nearly identical methodology. Nearly twice as many clients in the feedback group achieved clinically significant or reliable change and fewer were classified as deteriorated by the time treatment ended. For those clients who were predicted to have a positive response to treatment, feedback to therapists resulted in an equal number of treatment sessions and equivalent outcomes compared to the no feedback controls. The results are discussed in terms of quality management in routine clinical practice and the need to base treatment decisions on clients' response to treatment rather than arbitrary session limits. Suggestions for additional research aimed at enhancing the effects of feedback on client outcome are made.

No abstract

This study examined data collected on over 5,000 clients seen by 71 therapists over a 6-year period in a University Counseling Center. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis to track their treatment response. Data were also collected on therapists' theoretical orientation, years of experience, gender, and type of training. Data were analyzed using hierarchical linear modeling (HLM) to see if general therapist traits (i.e., theoretical orientation, type of training) accounted for differences in clients' rate of improvement. Data were then analyzed, again using HLM with therapists as a fixed effect, to compare individual therapists to see if there were significant differences in the efficiency of treatment. In addition, pre- minus posttest OQ-45 scores were examined to see if there were differences in the overall outcome of clients. There was a significant amount of variation among therapists' clients' rates of improvement. Therapist feedback reports were generated to summarize client outcome for individual providers in contrast to center averages and in an attempt to improve client outcome.