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

Abstract

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.

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

“…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.…”

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

“…In recent years, however, this perspective has been challenged. While a thermometer will read, but not influence, a person’s temperature, inviting patients to rate their experiences during psychotherapy may, for example, direct attention to particular areas and away from others, influence perceptions, reinforce certain topics, and implicitly communicate what the provider finds relevant to the patient (Solstad et al, 2020 , 2021b ). These fundamental differences between physical and psychological measures have been increasingly explored, revealing reasons to consider measurement to be an active and essential part of the therapeutic process.…”

Using feedback tools to enhance the quality and experience of care

“…The accompanying paper [14] reports early evaluation results for the underlying patient-reported outcome measures' (PROMs) psychometric properties and it highlights opportunities arising from engagement with the target population for this process. The third paper [15] focuses on the question of how continuous feedback systems are perceived by patients-an evaluation that forms a critical part of any implementation process, but there is still relatively little systematic evidence available as the authors argue. The results reinforce the observation that PROMs are communicative tools and their use is a contextspecific intentional process, a perspective that informs the implementation, use, and research on PROMs increasingly [16][17][18][19][20].…”