Negative outcome in psychotherapy: A critical review.

Mohr, David C.

doi:10.1111/j.1468-2850.1995.tb00022.x

Cited by 287 publications

(304 citation statements)

References 81 publications

(136 reference statements)

Supporting

Mentioning

251

Contrasting

Unclassified

Order By: Relevance

“…For those claimants completing the programme, effect sizes were large. Evidence suggests that a relatively small but nontrivial minority can deteriorate following psychological intervention, with estimates ranging from 3 to 10% (Mohr, 1995;Strupp, Hadley, & Gomez-Schwartz, 1977) -the deterioration and harm rates in the current research were in line with these estimates. This research indicates that programme design can usefully be based on cognitive-behavioural principles (such as avoidance, coping and behavioural activation) and that such elements can be sensitively adapted to formulate and intervene with the health related unemployed (Lysaker, Bell, Davis, Bryson & Lancaster, 2005;Proudfoot, Guest, Carson, Dunn, & Gray, 1997;Winspear, 2008).…”

Section: Discussionsupporting

confidence: 77%

Predicting return to work from health related welfare following low intensity cognitive behaviour therapy

Kellett

Purdie

Bickerstaffe³

et al. 2013

Behaviour Research and Therapy

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 77%

Predicting return to work from health related welfare following low intensity cognitive behaviour therapy

Kellett

Purdie

Bickerstaffe³

et al. 2013

Behaviour Research and Therapy

View full text Add to dashboard Cite

“…Therapist variables that have been associated with negative outcome include lack of empathy, negative countertransference, overuse of transference interpretations, and disagreement with patients about therapy process (Mohr, 1995). Type and amount of training, theoretical orientation, and gender were not predictive of patient outcome (Okiishi et al, 2006), while studies of therapist competence, have yielded contradictory results (Ginzburg et al, 2012;Webb, de Rubeis & Barber, 2010).…”

Section: Discussionmentioning

confidence: 99%

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Saxon

Barkham

Foster

et al. 2016

Clin Psychology and Psychoth

View full text Add to dashboard Cite

Background In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well‐being. Methods The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one‐to‐one therapy and completed a Clinical Outcomes in Routine Evaluation‐Outcome Measure (CORE‐OM) at pre‐treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE‐OM at pre‐treatment and post‐treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics. Results Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52). Conclusions The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor.

show abstract

“…It is important to note that no patients were psychologically harmed, which would indicate that the groups were a safe approach to treating mixed anxiety and depression. It is useful to consider rates of harm during psychological therapy (Lilienfeld, 2007) as a relatively small minority can deteriorate with estimates ranging RUNNING HEAD: Group CBT for mixed anxiety and depression in older adults from three to 10% (Mohr, 1995;Strupp, Hadley, & Gomez-Schwartz, 1977). Further research needs to explore any group factors creating deterioration/harm and document when it happens during groups.…”

mentioning

confidence: 99%

Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

Bains

Scott

Kellett

et al. 2014

Aging & Mental Health

View full text Add to dashboard Cite

Objectives. There is a dearth of older adult literature regarding group treatment for comorbid anxiety and depression. This research evaluated the effectiveness of a low intensity group psychoeducational approach. Method.Patients attended six sessions of a manualised cognitive-behavioural group programme. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and short-term follow-up and staff rated patients regarding their functioning at the same time points. Patients rated the alliance and their anxiety and depression at each group session. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression.Results. Eight groups were completed with 34 patients, with a drop-out rate of 17%.Staff and patient rated outcome measures showed significant improvements in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47 %) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression and the alliance was stable over time.Conclusion. The intervention evaluated shows some clinical and organisational promise. The group approach needs to be further explored and tested in research with greater methodological control.Keywords: older adult, CBT, group, co-morbid anxiety/depression. RUNNING HEAD: Group CBT for mixed anxiety and depression in older adults Depression and anxiety co-occur at high rates in older adult populations; Beekman et al., (2000) found that 47.5% of those with major depressive disorder had co-morbid anxiety disorders and 26.1% of people with anxiety disorders had co-morbid major depressive disorders. Katona, Manela and Livingstone (1997) found high rates of co-morbid generalised anxiety disorder (GAD) in older adults diagnosed with depression and Flint (1999) noted that late-life GAD was typically associated with depression. Co-morbidity in older adults is twice more likely in women than men, with more severely depressed individuals more likely to suffer with severe anxiety and vice versa (Schoevers, Beekman, Deeg, Jonker & van Tilburg, 2003).Despite this well evidenced overlap between anxiety and depression in older people, there is a relative lack of research regarding one-to-one and group psychotherapy interventions. Whilst group cognitive behaviour therapy (CBT) is recommended by NICE for working age adults with anxiety and depression for example (NICE Guideline 90, 2009), there are no specific guidelines in relation to older adults due to lack of evidence. Only one study has evaluated group CBT treatment of mixed anxiety and depression (Schimmel-Spreeuw, Linssen & Heeren, 2000) with outpatient elderly depressed women. Statistically significant reductions in depression, anxiety and neuroticism were observed from pre to post pre to follow-up comparisons.A recent review of older adult group CBT specifically ...

show abstract

Negative outcome in psychotherapy: A critical review.

Cited by 287 publications

References 81 publications

Predicting return to work from health related welfare following low intensity cognitive behaviour therapy

Predicting return to work from health related welfare following low intensity cognitive behaviour therapy

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

Contact Info

Product

Resources

About