Clients' experience of therapy and its outcomes in ‘good’ and ‘poor’ outcome psychological therapy in a primary care setting: An exploratory study

Abstract

Aim: The qualitative experience of clients judged by quantitative measures as having 'good' or 'poor' outcome is not often the focus of outcome research. This exploratory study investigates client experience of psychological therapy in an inner-city primary care centre across two client groups, differentiated on the basis of their outcome scores on quantitative measures. Method: Clients (N011) were allocated to one of two research groups, (a) good outcome (n 05), or (b) poor outcome (n 06) on the basis of their pre-and post-therapy outcome scores on the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). They participated in a face-to-face semi-structured interview. Data were recorded and analysed using a descriptive and interpretive qualitative method. Results: Both groups had broadly similar experiences of their current therapy although some differences in emphasis emerged. Good outcome clients described a greater sense of empowerment in therapy, commenting on a feeling of equality with their therapist and exhibiting greater autonomy overall. Poor outcome clients valued therapist support and while reporting increased awareness of problematic functioning described a reluctance to engage fully in the therapeutic process. Conclusion: There was very little difference in the qualitative accounts of therapy and its impact by the clients deemed by quantitative pre-post therapy measurement as either 'good outcome' or 'poor outcome'. There is further research warranted, examining whether clients that seem to benefit from therapy according to standard pre-post measurement, experience therapy and its impact differently to clients whose pre-post results suggest that therapy did not work.

The client's perspective on (experiences of) psychotherapy: A practice friendly review

“…For instance, Elliott's () client change interview not only focuses on aspects of therapeutic change that clients report posttherapy but also investigates what clients variously found helpful, difficult but helpful at the same time, or unhelpful in therapy. McElvaney and Timulak () qualitatively studied clients’ perceptions of helpful and unhelpful aspects of therapy (alongside their perspectives on therapists and on the changes they achieved as clients) and compared and contrasted clients that achieved positive versus negative pre‐post outcomes, as measured on conventionally used psychometric symptom/outcome measures.…”

“…With regard to in‐session effects, clients particularly valued increased awareness or insight (e.g., McElvaney & Timulak, ). Clients also valued therapists who were caring, but also expert and capable of offering appropriate guidance (Levitt et al., ).…”

“…Although unhelpful or hindering aspects of therapy have been studied to a lesser extent, clients have identified a number of such characteristics including feeling stigmatized, exposed and unprotected, and emotionally overwhelmed (e.g., McElvaney & Timulak, ). Such findings serve to emphasize the importance of therapists being aware of those aspects of therapy that have the potential to negatively impact a client's experience of treatment.…”

The Case of "Cora": Clinical and Methodological Perspectives

“…was involved in a study that looked at this phenomenon (quantitative vs. qualitative results) from the opposite side. McElvaney and Timulak (2013) studied the qualitative experiences of therapy and its outcomes of clients who were deemed as having successful versus unsuccessful outcomes on the basis of a widely used pre to post measure (the Clinical Outcome in Routine Evaluation--Outcome Measure, or CORE-)M [Evans, Connell, Barkham, Margison, McGrath, Mellor-Clark, & Audin, 2002]). In that study there were minimal differences in the qualitative accounts of quantitatively successful vs. quantitatively unsuccessful cases.…”

Cechy pacjenta, jego doświadczenia z przebiegu psychoterapii i skuteczność psychoterapii

“…Przymierze terapeutyczne jest związane ze skutecznością podejmowanych interwencji psychoterapeutycznych (Bachelor, 2013;Bottella i in., 2008;Czabała, 2006;Rakowska, 2005), ale także -jak ujawniają badania skoncentrowane na perspektywie pacjenta -z jakością odbytych sesji terapeutycznych oraz odpowiednio długim czasem trwania psychoterapii (Saunders, Howard i Orlinsky, 1989). Ponadto wykazano, że pacjenci deklarujący uzyskanie w terapii poprawy częściej stwierdzali, iż doświadczali w relacji z psychoterapeutą równości i autonomii (McElvaney i Timulak, 2013).…”