Dissertations / Theses on the topic 'Psychotherapy – Outcome assessment'

This study examined the impact therapeutic assessment (TA) had on participants recruited from the UNT Psychology Clinic's waiting list. Using a pretest-posttest design, participants completed measures prior to and following their assessment. UNT Psychology Clinic archive data was used to compare this sample to clients who received traditional information gathering assessments with implicit measures, those receiving assessments relying on only self-report measures, and those who did not receive an assessment before beginning psychotherapy. The findings of this study vary based on the criteria being examined. Due to the small sample in the experimental group, no statistical significance was found through null hypothesis testing. However, the TA group's scores on the Outcome Questionnaire – 45 (OQ) and the Working Alliance Inventory (WAI) indicated better outcomes than those without a TA, with large effect sizes. Furthermore, those who received a TA were more likely than those without a TA to score below the clinically significant cutoff levels on the OQ. The study raises issues for consideration in what is deemed "effective" in therapeutic efficacy research.

In this study, two primary hypotheses drawn from Cognitive-Experiential Self-Theory (Epstein, 1994, 1998, 2003) and the treatment preference literature (Arnkoff, Glass, & Shapiro, 2002) were tested in the broader contexts of similarity/matching research and eclecticism in psychotherapy. Specifically, it was hypothesized that client-therapist similarity/dissimilarity in terms of (a) their Rational and Experiential Thinking styles (Pacini & Epstein, 1999), and (b) their preferences for a Cognitive ("Thinking") versus an Experiential ("Feeling") theoretical orientation (Hutchins, 1984), would affect the process and outcome of early therapy. Forty-seven client-therapist dyads participated in the study. In the seven hierarchical linear regressions conducted, no statistically significant effects were found on any of the dependent variables (working alliance, empathic understanding, session depth, session smoothness, satisfaction with treatment, perceived change, and objective change). Study limitations included its modest statistical power to detect small and moderate effect sizes.Three exploratory questions were also investigated in a sample of 89 clients and 79 therapists and were found to be statistically significant. Specifically, client rational and experiential thinking styles made substantial contributions in the expected direction in predicting client preference for a cognitive versus an experiential treatment. Similarly, therapist experiential thinking style was predictive of therapist treatment preference. These findings suggest that client and therapist personality (thinking styles) are more significant predictors of treatment preference than variables such as gender and clinical experience (as a therapist or a client). Last, rational thinking style was predictive of client intrapersonal adjustment, and experiential thinking style was predictive of client social adjustment.
Department of Counseling Psychology and Guidance Services

A review of the adult psychotherapy outcome literature reveals decades of empirical studies that support the efficacy of group treatment for mental health concerns (Burlingame, Fuhriman, & Mosier, 2003; Horne & Rosenthal, 1997). Although research demonstrates positive results for the utilization of group therapy, between 33-50% of clients drop out before treatment is completed (Baekeland & Lundwall, 1975; Wierzbicki & Pekarik, 1993). Methods for improving psychotherapy retention have been addressed through the application of a client feedback model (i.e., monitoring treatment outcome routinely). Although using client feedback has been found to be beneficial for improving retention and even enhancing client outcome in both individual (Lambert et al., 2001a; Lambert et al., 2002; Miller, Duncan, Brown, Sorrell, & Chalk, 2006; Reese, Norsworthy, & Rowlands, 2009; Whipple et al., 2003) and couples psychotherapy (Anker, Duncan, & Sparks, 2009; Reese, Toland, Slone, & Norsworthy, 2010), evidence of client feedback efficacy in a group format is limited but worthy of investigation given the positive individual and couples therapy findings. In the current study, I evaluated the effects of client feedback in group psychotherapy using a randomized clinical trial design. Participants (N = 85) attended psychotherapy groups that were randomly assigned to a client feedback (Feedback) or treatment as usual (TAU) condition. Clients in the Feedback condition were predicted to experience a statistically significantly higher pre-post gain on the ORS compared to group clients in the TAU when controlling for their initial functioning. The effect size (ES) for Feedback between treatment conditions was found to be d = 0.35 on the Outcome Rating Scale when initial treatment functioning was controlled, which is a medium ES (Cohen, 1988). Additionally, statistically significantly more clients in the Feedback condition experienced reliable and clinically significant change, attended statistically significantly more sessions, and dropped out at a lower rate than clients in the TAU condition. Results of this study were similar to those generated by other studies that evaluated the efficacy of client feedback with individuals (Reese et al., 2009) and couples (Anker et al., 2009; Reese et al., 2010). Study limitations and implications for future work are provided.

The present study examined the emotional responses of 112 dyads of same-sex friends in early and middle childhood as they competed against each other on 3 identical games, enabling each child in the pair to experience 3 outcome conditions: winning, losing, and tying. Emotional reactions were videotaped and rated for degree of enjoyment and discomfort. In addition, following the 3 games, children were individually interviewed and asked to report their levels of happiness regarding winning, losing, and tying. The social context of a dyad is more closely associated with female social interaction which tends to be egalitarian. It was hypothesized that boys' well-documented greater comfort with competition relative to girls would be attenuated in the context of a dyad. Results indicated that boys showed more comfort and enjoyment throughout the competitive process than did girls. However, both boys and girls showed equal levels of comfort and enjoyment for the win and tie outcomes, indicating boys, like girls, were also concerned with doing the same as their friend. A developmental difference was also seen as the children in middle childhood reported less happiness than the kindergarten children when they experienced the win outcome. The results are discussed in terms of the necessity of considering the social context in which competition occurs when investigating gender differences in competition.

The Clinical Support Tools (CST) was developed to help therapists organize and target potential problems that might account for negative outcomes in psychotherapy. The core of CST feedback is The Assessment for Signal Clients (ASC). The purpose of this study was to describe and identify patterns of problems that typically characterize off-track cases. A cluster analysis of 107 off-track clients revealed three client types: those whose problems were characterized by alliance and motivational difficulties; those characterized by social support and life event difficulties; and those whose problems had an indistinguishable pattern. Loglinear modeling showed that if patients had less therapeutic alliance problems they were also less likely to have motivational problems. Findings were also consistent with the cluster analysis, which showed that a relatively higher percentage of not-on-track participants received signal alerts for the social support items and scale. Individuals whose progress goes off-track appear to have their greatest difficulty with social support, losses, and therapy task agreement.

The current trend in psychiatric health care is towards comprehensive primary healthcare for all South Africans. This has been has been achieved by the restructuring of the National Health System (NHS) into national, provincial, district, and community levels, which provide outpatient and inpatient care at primary, secondary, and tertiary care levels. Assessment and treatment in the form of physical and psychosocial interventions form an integral part of psychiatric care. The value of personality assessment and, in particular, the potential for matching patient personality types with effective treatment options, may play a role in facilitating effective health care in the future. An overview of the literature indicates that little research has been done regarding the area of personality traits of psychiatric patients in South Africa. This study aims to explore and describe the personality traits or profile of individuals attending a private psychiatric day care facility in The Nelson Mandela Metropole (i.e., Parkwood Day Clinic). The sample consisted of 196 participants (104 male and 92 female) who attended a group programme from April 2000 to April 2001. As part of the programme, patients were required to com plete a series of pencil-and-paper measures. The questionnaires selected for this study included a biographical questionnaire, which was used to describe the biographical variables of the sample with regard to gender, age and marital status, and The Revised NEO Personality Inventory (NEO PI-R) (Costa & McCrae, 1992a), which was used as a measure of personality. The NEO PI-R is considered a concise measure of the five major domains of personality and some of the more important traits that define each domain. Together, the five domains Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A) and Conscientiousness (C), and the six facets within each domain, allow for a comprehensive assessment of adult personality. xiv An exploratory, descriptive method was used in the study, and the data was analysed using descriptive and inferential statistics, including correlations, cluster analysis, and multivariate analysis of variance. Key findings include the following: Results from the NEO PI-R domains showed a personality profile of very high scores for N, and average scores for E, O, A, and C. Within the sample, cluster analysis revealed five distinct personality profile clusters. For the biographical variable gender, significant differences were found between males and females on N, with the majority of males scoring in the category of Very High and High, and the majority of females scoring in the Average category. For the variable age, the results indicated significant differences on A, with participants in the young adulthood group scoring significantly lower on A than participants in the middle adulthood group. For marital status, on the domain of O, significant differences were found between the divorced or widowed and the married, with the married scoring in the Low category and the divorced or widowed in the Average category. On the domain of C, significant differences were noted between the singles group and the currently or previously married groups, with the single group tending to score lower on C than both other groups. These findings reveal a need for further research into personality traits and psychiatric samples, as consideration of personality traits based on the profile established, may be useful in matching patients’ characteristics with optimal treatment options.

The ability to monitor client change in psychotherapy over time is vital to quality assurance in service delivery as well as the continuing improvement of psychotherapy research. Unfortunately, there is not currently a comprehensive, affordable, and easily utilized outcome measure for psychotherapy specifically normed and standardized for use in psychology training clinics. The current study took the first steps in creating such an outcome measure. Following development of an item bank, factor analysis and item-response theory analyses were applied to data gathered from a stratified sample of university (n = 101) and community (n = 261) participants. The factor structure did not support a phase model conceptualization, but did reveal a structure consistent with the theoretical framework of the research domain criteria (RDoC). Suggestions for next steps in the measure development process are provided and implications discussed.

Previous studies have suggested that participation in psychosocial support groups such as the Foundation House (Clubhouse) model have psychological benefits for patients with major mental disorders. In this research, 47 members of the Lorikeet Clubhouse in Shenton Park, WA completed the Brief Symptom Inventory, the Level of Expressed Emotion Scale and the Coping Scale for Adults to investigate whether differences existed between active and inactive Clubhouse members. Analyses of variance found no group differences on these measures, although trends in the data suggest that Clubhouse participation have a protective effect for members who report high levels of expressed emotion (EE) in their home. These conclusions are tentative due to the small sample size. Members perceived the Clubhouse to have lower levels of EE than their home environments, however these measures were correlated.

In the current study, the utility of paired-stimulus preference assessment in identifying stimulus preferences was evaluated with adults with schizophrenia. In addition, the effects of two establishing operations (i.e., deprivation, satiation) on stimulus selection during paired-stimulus preference assessment were evaluated. Specifically, paired-stimulus preference assessments were conducted across conditions of (a) control, in which participants were given free access to premeasured portions of each of four stimuli prior to the preference assessment at five scheduled times; (b) deprivation, in which participants were given free access to premeasured portions of three of the four stimuli at five scheduled times and were deprived of one of the four stimuli for 48 hr prior to the preference assessment; and (c) satiation, in which participants were given no access to three of the four stimuli at five scheduled times and were free access to one of the four stimuli for 15 min prior to the preference assessment. The paired-stimulus preference assessment resulted in preference hierarchies for 3 of the 4 participants and identified two highly preferred stimuli for 1 of the 4 participants. Overall, across participants, deprivation resulted in increased selection of stimuli, and satiation resulted in decreased selection of stimuli, relative to control. However, some variation across stimuli and participants occurred in each condition. The implications of the current findings are discussed.

This study is a phenomenological investigation of psychotherapists' experience receiving quantitative and evaluative feedback on job performance. Participants were licensed psychologists working at a university counseling center. They were given feedback reports that compared their clients' psychotherapy outcomes with the outcomes of their colleagues' clients. Psychotherapy outcomes were measured using the Outcome-Questionnaire 45 (OQ-45), a self-report outcome instrument designed for tracking client progress through repeated measurement. Feedback reports included data about where psychotherapists' outcomes ranked (in quartiles) in comparison to the rest of the counseling center. Interviews were conducted with participants to gain a deeper understanding of their experience receiving quantitative and evaluative feedback. Interviews were conducted, transcribed, and analyzed in accordance with the phenomenological method as explained by Wertz (2005) and the descriptive psychological phenomenological method as explained by Giorgi (2003). Content of interviews was grouped into four emergent themes: Ego Responses, Interpretation, Credibility, and Application. Responses indicated that participants felt both threatened and reassured by their feedback. Those who reported feeling reassured were more inclined to see this as a validation of their approach to psychotherapy while those who felt threatened were more inclined to see the feedback as an assessment of identity. Many indicated that they struggled to understand terminology on the feedback reports as well as the statistical methodology used to analyze the data. Those who struggled to interpret the feedback reports were more likely to distrust or dismiss the results. While very few participants were dismissive of the notion that the feedback reports were valid measures of therapist efficacy, many were ambivalent about this question. Participants did not indicate making concrete behavioral changes as a result of receiving the feedback, although a few reported that the feedback induced introspection about "what is good psychotherapy," as well as dialogues with colleagues.

The primary aim of this study was to investigate the content and extent of psychotherapy patients’ disclosures to their spouses or significant others about their experiences in therapy, the perceived impact of disclosure about therapy on the spousal relationship, and its perceived impact on the therapeutic relationship and on treatment satisfaction. Adult psychotherapy patients (N = 84) in individual treatment, who identified themselves as either married or in a significant romantic relationship completed the Disclosure About Therapy Inventory – Revised (DATI-R; Khurgin-Bott & Farber, 2014), a revision of the Disclosure About Therapy Inventory (see Khurgin-Bott & Farber, 2011). This 52-question survey was designed to explore the extent and content of patients’ disclosures to their therapists, and the extent and content of their disclosures about therapy to their spouses or significant others (“partners”). The DATI-R also includes three outcome measures: the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crand, & Larson, 1995) measures the quality of participants’ relationships with their partners, the Working Alliance Inventory – Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) assesses the quality of their relationships (alliances) with their therapists, and the outcome items of the Disclosure to Therapist Inventory-III (DTI-III) assess their satisfaction with their treatment. Findings indicate that overall, patients were very disclosing to their therapists and moderately disclosing to their partners about their therapy. No demographic variables (including gender, marital status, duration of psychotherapy, and duration of marriage/relationship) were significantly associated with or predictive of the extent of patients’ self-disclosure about therapy. A significant positive association was found between the extent of disclosure to partners about therapy and the extent of self-disclosure to therapists. Greater extent of disclosure about therapy to partners was also associated with better quality of therapeutic alliances and with higher relationship satisfaction (with partners). Additionally, the quality of therapeutic alliances was strongly predictive of better treatment outcomes. These findings suggest that married (or coupled) patients in individual psychotherapy may benefit from the open discussion of their experiences in therapy with their spouses or significant others, or at least that such openness is characteristic of patients in satisfactory relationships (both therapeutic and marital). These findings are discussed in the context of the methodological limitations of the current study and the particular characteristics of the sample, and clinical implications and directions for future research are explored.

M.A.
In accordance with literature indications that have established the need for psychotherapeutic outcome assessment instruments to determine the effects of psychotherapy, an exploratory and comparative study was conducted with anxiety disorder clients in private practice settings. The purpose of the study was to verify the recommendations made in the literature for the use of an idiographic method of outcome assessment (the Dyad Grid), as opposed to typically applied normative methods (the IPAT Anxiety Scale). The nature of the suggestions concerning the application of an idiographic method of outcome assessment, required the development of a theoretical framework which integrated the assessment procedure in an explanatory manner. To this end, the personal construct psychology view of anxiety was discussed in relation to repertory grid technique and prior outcome assessment research conducted with the Dyad Grid. On the basis of the personal construct approach to anxiety, a pre-test post-test research design was used to establish the utility of the Dyad Grid to discriminate between beneficial and nonbeneficial psychotherapy outcomes with anxiety disorder clients. The outcome results of the Dyad Grid assessments were compared with the results obtained from the IPAT Anxiety Scale, in conjunction with qualitative post-therapeutic ratings of benefit, or a lack of benefit, made by the client and therapist. The findings obtained on the basis of 14 case-studies are encouraging. The Dyad Grid displayed a statistically significant level of agreement with the client and therapist ratings of therapeutic outcome (onetailed, p = 0,05), whereas the IPAT Anxiety Scale did not. Though limited to a sample of convenience, and subject to an idiographic methodological bias, the discussion of the results indicated that the study provides support for the use of idiographic procedures as an alternative to nomothetic methods of outcome assessment. It is concluded that the initial success of the Dyad Grid in assessing psychotherapy outcome as beneficial or non-beneficial warrants further investigation with a large sample research design.

Evidence-Based Practice (EBP), the philosophy underpinning professional service in the health care industry in the U.S.A. and U.K., has been accepted as a paradigm for psychological practice by the American Psychological Association (APA). The APA recommends that professionals base their clinical decisions on scientifically supported research and an understanding of their clients' specific ecological disposition. Clients are considered to have a right to efficacious interventions based on objective research findings, effective service and a high standard of care. Sub-divisions of EBP are Evidence-Based Treatments (EBT) and Evidence-Based Assessment (EBA). . South African educational psychologists have a meagre assessment ‘toolkit’ - outdated, culturally insensitive, non-standardised tests for culturally and linguistically diverse clients. Children from diverse backgrounds would have higher standards of care and more efficacious interventions were psycho-educational assessments to be culturally-sensitive. Without such instruments, ethical management of interventions is questionable, although universally, psychologists have found innovative ways of adapting their praxis to the difficulty. However, all practices and/or interventions are not based on research evidence, nor can be necessarily considered good practice. In the U.S.A. with its abundance of assessment instruments, EBA is a means of ensuring the scientific foundation for professional practice, consequently reliable, valid, culturally-sensitive assessment instruments have been produced. Findings in this study, derived from conversations with a sample of educational psychologists, revealed they were already accommodating cultural and linguistic diversity. Awareness of the value of EBA would support educational psychologists, bring them on par with worldwide praxis and enhance their professionalism.
Teacher Education
D. Ed. (Psychology of Education)