Clinical dilemmas of routine outcome monitoring and clinical feedback: a qualitative study of patient experiences

Purpose Routine outcome monitoring (ROM) and clinical feedback systems (CFS) are becoming increasingly prevalent in mental health services. Their overall efficacy is unclear, but quantitative evidence suggests they can be useful tools for preventing treatment failure and enhancing therapeutic outcomes, especially for patients who are not progressing in therapy. The body of qualitative material, however, is smaller and less refined. We need to know more about how ROM/CFS is used in psychotherapy, and why it is helpful for some patients, but not others. Methods We recorded therapy sessions of 12 patients who were using a CFS as part of their therapies at an outpatient clinic in Norway. We then conducted video-assisted interviews and follow-up interviews with patients. Data were analyzed with systematic text condensation. Results Analysis revealed three themes: (1) triggering reflections, emotions, and self-awareness, (2) Ambivalent and ambiguous self-presentation, and (3) potential for feeling understood and talking about what matters. Conclusion Answering questions in a CFS is an interpretative and intentional process of self-presentation and the results from ROM/CFS must be interpreted and explored in conversation to be clinically useful. When they are, they have potential for enhancing the therapeutic process by stimulating self-awareness, reflexivity, and allowing access to new therapeutic topics. Further research should explore this how-to aspect of ROM/CFS with different CFS and different types of patients. Integrating clinical feedback in therapeutic practice can be conceptualized as a clinical skill, which should be a part of training programs for therapists.

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“…Fig. 2 Systematic text condensation analysis experiences with using ROM/CFS in sessions, is presented elsewhere [26].…”

Section: Stage 4 -Synthesizingmentioning

confidence: 99%

Complexity and potentials of clinical feedback in mental health: an in-depth study of patient processes

2020

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Routine Outcome Monitoring and Clinical Feedback in Psychotherapy: Recent Advances and Future Directions

McAleavey,

de Jong,

Nissen-Lie

et al. 2024

Adm Policy Ment Health

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In the past decade, there has been an increase in research related to the routine collection and active use of standardized patient data in psychotherapy. Research has increasingly focused on personalization of care to patients, clinical skills and interventions that modulate treatment outcomes, and implementation strategies, all of which appear to enhance the beneficial effects of ROM and feedback. In this article, we summarize trends and recent advances in the research on this topic and identify several essential directions for the field in the short to medium term. We anticipate a broadening of research from the focus on average effects to greater specificity around what kinds of feedback, provided at what time, to which individuals, in what settings, are most beneficial. We also propose that the field needs to focus on issues of health equity, ensuring that ROM can be a vehicle for increased wellbeing for those who need it most. The complexity of mental healthcare systems means that there may be multiple viable measurement solutions with varying costs and benefits to diverse stakeholders in different treatment contexts, and research is needed to identify the most influential components in each of these contexts.

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Clinical dilemmas of routine outcome monitoring and clinical feedback: a qualitative study of patient experiences

Cited by 2 publications

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Complexity and potentials of clinical feedback in mental health: an in-depth study of patient processes

Complexity and potentials of clinical feedback in mental health: an in-depth study of patient processes

Routine Outcome Monitoring and Clinical Feedback in Psychotherapy: Recent Advances and Future Directions

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