Revisiting and reenvisioning the outcome problem in psychotherapy: An argument to include individualized and qualitative measurement.

Abstract

We review the historical debate about the assessment of psychotherapy outcome, along with the current status of outcome research. Although strides in statistical techniques have allowed us to conclude that psychotherapy is effective, we argue that typical statistical measurement does not allow researchers to demonstrate the complexity of change for individuals. We thus recommend that researchers include individualized and qualitative approaches in their assessments of psychotherapy outcome.

Understanding Long-term Outcome from the Patients’ Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy

“…Moreover, changes in outcome scores may not represent or correspond to an individual’s functioning in daily life, nor can it give insight into how an individual interpreted the questions asked. Standardized outcome measures are therefore considered “arbitrary metrics” requiring real-life contextualization (Blanton & Jaccard, 2006; Hill, Chui & Bauman, 2013; Kazdin, 2006). …”

“…In this regard, the perspective of the patient undergoing treatment is increasingly considered an essential source of information (Binder, Holgorsen & Nielsen, 2009; McLeod, 2016; Strupp & Hadley, 1977; Valkonen, Hanninen & Lindfors, 2011). This first -person perspective stands for the subjective experience, personal view or opinion of patients and must be considered distinct from a researcher or third -person perspective represented in the pre-defined questions and answers of standard outcome scales (Englebert, Follet & Valentiny, 2017; Englebert et al, 2018; Hill et al, 2013). …”

Interactions between Obsessional Symptoms and Interpersonal Ambivalences in Psychodynamic Therapy: An Empirical Case Study

“…Next, with the aim to illuminate different aspects of (the wide spectrum of possible changes in) the studied variables (e.g., Hill et al, 2013), extensive multiple method and multiple source data sets were analyzed. Symptomatic and interpersonal functioning, and their according associations, were assessed regularly throughout treatment and follow-up, in both a quantitative and qualitative fashion, from perspectives of patient, therapist, and researchers.…”

The role of clinical judgment in integration of indicators of outcome in psychotherapy research

“…In the 1960s, therapists' opinion was the standard to assess effectiveness of therapy (Ogles, 2013). Subsequently, client reports were incorporated as a valid indicator of therapy outcome (Wolf, 1978), and recently, the judgement of third parties, independent observers or raters, have been included, providing more objective information about outcome (Hill, Chui & Baumann, 2013). The recognition of the limitations each of these informants has suggested the need for a multi-informant approach (client, therapist, carers, external observers, or judges) in which at least two perspectives are considered.…”

“…Growing awareness of the importance of 'ecological validity' 1 in clinical research has focused attention on the development of instruments and strategies to assess outcome that are more amenable to naturalistic settings (Ogles, 2013). Awareness of the limitations of standardised checklists, regardless of informant (Hill et al, 2013), has prompted a shift towards a multimodal strategy (standardised measures, direct observation, interviews, therapy transcripts, etc. ) in which more than one modality is included to increase the robustness of conclusions.…”