Preliminary evidence on the effectiveness of psychological treatments delivered at a university counseling center.

Abstract

Treatment data from a university counseling center (UCC) that utilized the Outcome Questionnaire-45.2 (OQ-45; M. J. Lambert et al., 2004), a self-report general clinical symptom measure, was compared against treatment efficacy benchmarks from clinical trials of adult major depression that utilized similar measures. Statistical analyses suggested that the treatment effect size estimate obtained at this counseling center with clients whose level of psychological distress was above the OQ-45 clinical cutoff score was similar to treatment efficacy observed in clinical trials. Analyses on OQ-45 items suggested that clients elevated on 3 items indicating problematic substance use resulted in poorer treatment outcomes. In addition, clients who reported their relational status as separated or divorced had poorer outcomes than did those who reported being partnered or married, and clients reporting intimacy issues resulted in greater numbers of sessions. Although differential treatment effect due to training level was found where interns and other trainees had better pre-post outcome than did staff, interpretation of this result requires great caution because clients perceived to have complicated issues are actively reassigned to staff. More effectiveness investigations at UCCs are warranted.

Effectiveness of routine psychotherapy: Method matters

“…Another limitation is that, even though average changes in general psychological symptoms suggest equivalence between clinical routine and RCTs in the Minami et al ( , 2009) studies, specific symptoms that are targeted in treatment (e.g., symptoms of depression or eating disorders) may not show the same pattern. As described by McAleavey, Nordberg, Kraus, and Castonguay (2012), specific measures cannot be inferred from general ones.…”

“…The studies of benchmarking presented here, especially the Minami et al ( , 2009) studies, raise an important question for the field of psychological treatments. Although the lack of randomization in these studies prevents inference about whether psychotherapy is the causative factor, these studies certainly suggest that, on average, routine treatments can be as effective as what are usually deemed the "state-of-the-art" (i.e., scientifically supported) treatments, performed by expertly trained and supervised therapists in RCTs.…”

“…The results showed that, for individuals who started treatment above the clinical cut score on the OQ-30, the routine treatments were clinically superior to no-treatment and clinically equivalent to efficacy trial treatments. Minami et al (2009) used similar methods to evaluate a single counseling center's treatment efficacy, and found that, for clients who started treatment elevated in distress, the amount of change observed in this center was clinically equivalent to efficacy benchmarks for MDD and clinically superior to natural history.…”

“…While this strategy provides excellent information about subpopulations of clients meeting certain criteria, it fails to examine the effect of routine practice on the general population of clients in therapy. Alternatively, many of the studies that have examined clients in routine care (e.g., Barkham et al, 2012;Minami, et al, 2009) have tracked improvement using general symptom distress measures, which cover many domains of psychological functioning but may not have a direct clinical interpretation other than "distress" or "symptoms." Thus, in this paper, we assessed change across several symptom domains using a multidimensional measure of psychological symptoms, rather than focus on a single dimension of functioning.…”

“…For example, one important statistical artifact is regression to the mean, which in this case would describe the commonly-observed phenomenon that larger effect sizes are generally observed for individuals who enter treatment at higher levels of symptoms. This can be ameliorated by a waitlist or natural history control condition, provided random assignment is used, but the use of a cut score to separate clinical from nonclinical participants (as is common in these studies; e.g., Barkham et al, 2012;Minami et al, 2009) creates an inflated initial mean symptom score at pretreatment, and is thus subject to regression to the population average over time 1 .…”