Exploring therapist characteristics as potential moderators of the effects of client feedback on treatment outcome

Abstract

Although studies have shown that client feedback can improve treatment outcome, little is known about which factors might possibly moderate the effects of such feedback. The present study investigated potential therapist variables that might influence whether frequent client feedback is effective, including the Big Five personality traits, internal/external feedback propensity and self‐efficacy. Data from two previous studies, a quasi‐experimental study and a randomized controlled trial, were combined. The sample consisted of 38 therapists and 843 clients (55.4% females, mean age = 42.05 years, SD = 11.75) from an outpatient mental health institution. The control condition consisted of cognitive‐behavioural therapies combined with low frequency monitoring of clients' symptoms. In the experimental condition, high‐intensity (i.e., frequent) client feedback as an add‐on to treatment as usual was provided. Outcomes were measured as adjusted post‐treatment symptom severity on the Symptom Checklist‐90 and drop out from treatment. The final model of the multilevel analyses showed that therapists with higher levels of self‐efficacy had poorer treatment outcomes, but when high‐intensity client feedback was provided, their effectiveness improved. Furthermore, higher self‐efficacy was associated with a higher estimation of therapists' own effectiveness, but therapists' self‐assessment of effectiveness was not correlated with their actual effectiveness. The results of this study might indicate that therapists with high levels of self‐efficacy benefit from client feedback because it can correct their biases. However, for therapists with low self‐efficacy, client feedback might be less beneficial, possibly because it can make them more insecure. These hypotheses need to be investigated in future research.

The effect of therapist characteristics on the use and outcome of systematic client feedback in outpatient mental healthcare

“…As stated in the introduction, research in this particular field is relatively new and several relevant characteristics are found, but there is still little consistency. de Jong et al (2012) found effects of internal propensity and self‐efficacy de Jong and de Goede (2015) of organizational factors, prevention focus and promotion focus, and Janse et al (2023) found an effect of self‐efficacy.…”

“…However, therapist effects on the use and outcome of SCF has been analysed sparsely. To our knowledge, only one study has been conducted to investigate whether therapist characteristics influence the actual use of SCF or treatment added with SCF (de Jong et al, 2012) and only a few studies have examined therapist effects on treatment added with SCF (de Jong & de Goede, 2015; Janse et al, 2023; Lutz et al, 2015).…”

“…The most recent scientific contributions on therapist characteristics and progress feedback are from Wampold and Owen (2021) and Janse et al (2023). Wampold and Owen concluded that feedback can provide an improvement on outcomes, especially for NOT patients.…”

“…This added value increases when therapists have a positive attitude towards feedback and a good relationship with their organization. Finally, Janse et al (2023) found an interaction effect of patient factors, provision of feedback and therapist characteristics, showing that high self‐efficacy was associated with worse outcome when feedback was not provided and with better outcome when high‐intensity SCF was added. On the other hand, therapists with lower self‐efficacy showed poorer outcomes when high‐intensity SCF was provided but better outcomes when only low‐intensity SCF was provided.…”

Belief updating is an important contribution, but not the whole story.

“…Therefore, it is not extremely surprising that a similar effect may be present with feedback. Reese et al (2009) and Janse et al (2023) report results that, together, suggest such effects are present. To summarize, both found evidence that a greater intensity and integration of feedback into treatment led to better outcomes for therapists with higher self-efficacy.…”