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

Solstad, Stig Magne; Kleiven, Gøril Solberg; Castonguay, Louis G.; Moltu, Christian

doi:10.1080/10503307.2020.1788741

Cited by 21 publications

(18 citation statements)

References 38 publications

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“…IPR is a qualitative research method utilizing video or audio recordings to support the interviewee’s recollection of every moment in the session. While IPR was originally developed for supervision, the method has increasingly been used in recent years for the purpose of studying psychotherapy micro-processes ( Elliott, 1986 ; Kleiven et al, 2020 ; Solstad et al, 2021a , b ). In psychotherapy research, IPR typically entails video recording the therapeutic interaction; the recording is then viewed by the client and/or therapist shortly afterward, at the same time as the research interview.…”

Section: Methodsmentioning

confidence: 99%

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

et al. 2022

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ObjectiveTo explore how therapists and clients act dyadically to establish a therapeutic relationship during the first five sessions of psychotherapy. The study aimed to identify both relational facilitative and hindering processes occurring in routine care.MethodsUsing the method ‘interpersonal process recall’ (IPR), we videotaped the third and fifth session of 12 psychotherapy dyads, and conducted video-assisted interviews with each therapist and client separately. In total, the data material consist of 47 IPR interviews. Data were analyzed using a thematic approach.ResultsThe analysis process revealed two main groups. The first group consisted of dyads with a positive relational outcome, and the second group consisted of dyads with a troubled or frail relational outcome. During the initial phase of therapy, clients described feeling overwhelmed by fear and shame. Positive relational development occurred when these emotions were successfully accommodated and replaced with a growing sense of safety with the therapist. However, the relationship became troubled when the client experienced an increase in shame and/or fear during the first sessions. When forming a therapeutic relationship, it is vital that the client experience the therapist as genuine and skilled, and that the therapist is able to engage and connect deeply with the client on a person-to-person level. The article further provides a discussion on how these dyadic experiences align with the working alliance and real relationship, and how the two consolidate during the first sessions of psychotherapy.ConclusionThe current study explored the complex relational processes underlying the formation of the therapeutic relationship. Core aspects of the real relationship are prerequisites to forming a collaborative working alliance in which both therapist and client are actively engaged. Facilitating a positive relationship is crucial in the early phase of psychotherapy, and therapists can actively identify and repair ruptures at this time.

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Section: Methodsmentioning

confidence: 99%

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

et al. 2022

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“…It has been shown that using these feedback reports can have a positive influence on treatment outcome (De Jong et al, 2021 ; Kendrick et al, 2016 ; Lambert et al, 2018 ; Lutz, et al, 2015 ; Schibbye et al, 2014 ). Some studies show that feedback reports could further enhance treatment effectiveness if they were accessible to both the therapist and the patient (Fortney et al, 2017 ; Gondek et al, 2016 ; Moltu et al, 2016 ; Solstad et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, some research has shown that patients want to discuss their ROM scores with their therapist and that they prefer a direct way of discussing scores and exploring the underlying reasons for their responses (Solstad et al, 2020 ). This, in combination with the finding that feedback reports could enhance treatment effectiveness more if they were accessible to both the therapist and the patient (Fortney et al, 2017 ; Gondek et al, 2016 ; Moltu et al, 2016 ; Solstad et al, 2020 ), shows that it is important that feedback reports are designed to be understandable and easy to work with for patients. This highlights the need to consider both the therapist and the patient when developing feedback reports.…”

Section: Introductionmentioning

confidence: 99%

“…Although some DCEs have been used in mental health care, psychologists’ and patients’ preferences for feedback reports on expected treatment outcome have not been well investigated. Research has been limited to preferences about feedback reports on patients’ current symptoms and functioning (Hovland & Moltu, 2019 ; Hovland et al, 2020 ; Moltu et al, 2016 ; Solstad et al, 2019 , 2020 ). For example, Moltu et al ( 2016 ) found that patients preferred feedback reports that included information about external factors that could potentially affect treatment outcomes (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ and Psychologists’ Preferences for Feedback Reports on Expected Mental Health Treatment Outcomes: A Discrete-Choice Experiment

Hilhorst

Stappen

Lokkerbol

et al. 2022

Adm Policy Ment Health

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In recent years, there has been an increasing focus on routine outcome monitoring (ROM) to provide feedback on patient progress during mental health treatment, with some systems also predicting the expected treatment outcome. The aim of this study was to elicit patients’ and psychologists’ preferences regarding how ROM system-generated feedback reports should display predicted treatment outcomes. In a discrete-choice experiment, participants were asked 12–13 times to choose between two ways of displaying an expected treatment outcome. The choices varied in four different attributes: representation, outcome, predictors, and advice. A conditional logistic regression was used to estimate participants’ preferences. A total of 104 participants (68 patients and 36 psychologists) completed the questionnaire. Participants preferred feedback reports on expected treatment outcome that included: (a) both text and images, (b) a continuous outcome or an outcome that is expressed in terms of a probability, (c) specific predictors, and (d) specific advice. For both patients and psychologists, specific predictors appeared to be most important, specific advice was second most important, a continuous outcome or a probability was third most important, and feedback that includes both text and images was fourth in importance. The ranking in importance of both the attributes and the attribute levels was identical for patients and psychologists. This suggests that, as long as the report is understandable to the patient, psychologists and patients can use the same ROM feedback report, eliminating the need for ROM administrators to develop different versions.

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“…The remaining two papers adopt such a translational approach, and describe the clinical tasks, advantages, and challenges emerging from ROM/ CF. Solstad et al (2021) report a dilemma: ROM influences treatment whether it is used explicitly by therapists or not. They find that therapists can incorporate ROM into the treatment meaningfully across patients and phases of care, and suggest how this requires clinical skill and attunement to individual patients.…”

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confidence: 99%

Understanding routine outcome monitoring and clinical feedback in context: Introduction to the special section

McAleavey

Moltu

2021

Psychotherapy Research

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The practice of routine outcome monitoring and providing clinical feedback has been widely studied within psychotherapy. Nevertheless, there are many outstanding questions regarding this practice. Is it an evidence-based adjunct to ongoing psychotherapies, or an ineffective complication of treatment? If it is effective, through what mechanism(s) does it act? Is it effective with all patient populations, treatment types, and service delivery mechanisms, or does its impact vary across context? What choices in the implementation process affect the utility of patient-reported data feedback on psychotherapy outcomes? The studies in this special section explore these questions using a wide variety of methods and significantly expand the reach of studies on feedback. Together, these studies represent a snapshot of a maturing field of study: Initial discoveries are developed into more robust theories and applied in a wider range of contexts, while the limits of that theory are tested. They also signal directions for future clinical and research work that may improve patient care in psychosocial interventions into the future.

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

Cited by 21 publications

References 38 publications

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

Patients’ and Psychologists’ Preferences for Feedback Reports on Expected Mental Health Treatment Outcomes: A Discrete-Choice Experiment

Understanding routine outcome monitoring and clinical feedback in context: Introduction to the special section

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