Negative experiences in psychotherapy from clients' perspective: A qualitative meta-analysis.

OBJECTIVE: A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy. METHOD: A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported. RESULTS: A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients' experiences, which fell into four broad clusters: therapists' misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. CONCLUSION: Clients' negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.

Trajectories of change in weekly and biweekly therapy.

Higher therapy session frequency has been found to result in faster recovery, but few studies have considered that clients follow diverse trajectories of change in psychotherapy. It is unknown how session frequency may affect the sizes and shapes of change trajectories. The present study examined clients' change trajectories in weekly and biweekly therapy in a naturalistic setting, as well as predictors of these trajectories. Using a sample of 5,102 clients receiving 3-10 therapy sessions at a university counseling center, we identified 886 clients attending approximately weekly therapy and 1,753 clients attending approximately biweekly therapy. We examined the change trajectories of the weekly and biweekly samples using latent growth mixture modeling (LGMM). Three trajectories were identified in weekly therapy: slow change (78.33%), early improvement (17.61%), and worse before better (4.06%), and in biweekly therapy: slow change (80.38%), early improvement (13.52%), and worse before better (6.1%). The worse before better subgroup in weekly therapy experienced greater deterioration than those in biweekly therapy. The slow change and early improvement subgroups in weekly therapy showed treatment outcome comparable to those of their respective counterparts in biweekly therapy. Clients' intake symptoms, including eating concerns, frustration/anger, depression, and academic concerns, significantly predicted change trajectories. Compared to biweekly therapy, weekly therapy leads to higher chances of early improvement and shortens the duration of suffering but results in greater deterioration for individuals who deteriorate in therapy. The impact of session frequency on treatment outcome varies across clients, and session frequency should be adjusted individually. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah.

BACKGROUND: Pornography has become mainstream in society, including in the state of Utah, which is a highly religious, conservative state. AIM: The purpose of this study is to gather basic descriptive norms for pornography use in the state of Utah (given its unique religious profile), establish clinical cutoffs based on frequency and duration of pornography consumption, and begin to establish a clinical picture of problematic pornography use in a regionally representative sample. METHODS: We recruited a representative sample of 892 Utahns via CloudResearch.com. Participants completed the following measures: Consumption of Pornography - General (COPS); Problematic Pornography Use Scale; Clear Lake Addiction to Pornography Scale; The Inventory of Depression and Anxiety Symptoms (Second Version). OUTCOME: Documentation of pornography use norms among Utahns. RESULTS: In our sample, 79% reported viewing pornography in their lifetime (85% of men, 75% of women). The most common frequency of pornography viewing was weekly or monthly among men, and monthly or every 6 months among women, which is comparable to national averages. Men and women showed significantly different pornography use frequencies. We demonstrate a relationship between higher levels of pornography use and higher perceived levels of pornography use as a problem or "addiction" and depression scores and explore the typical demographics of our highest pornography users. CLINICAL TRANSLATION: This study will aid clinicians in using the COPS to derive normal pornography use compared to above average pornography use among pornography users from a religious background, especially for clinicians who seek to provide normative data to clients presenting with problematic pornography use like in motivational interviewing interventions. STRENGTHS AND LIMITATIONS: Strengths include our measures generally demonstrated strong validity, we provide the beginnings of sound clinical implementation of the COPS for benchmarking pornography use in a clinical setting in Utah, and that our sample was representative of the state of Utah according to current census data. Limitations include those commonly seen in survey-based data collection methods, and that findings from our unique Utah sample may not be as relevant among other religious or cultural samples. CONCLUSION: Our findings provide an updated picture of pornography use in the state of Utah and suggest that even those high in religiosity continue to use pornography. Our results can provide a spectrum of pornography use, aiding a pornography user in treatment to be able to compare his or her use to this norm. Esplin CR, Hatch SG, Ogles BM, et al. What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah. J Sex Med 2022;19:823-833.

Treatment success or failure? Using a narrative interview to supplement ROM.

Although routine outcome monitoring (ROM) has been demonstrated to improve therapy efficiency and effectiveness, categorizations of improvement or deterioration using ROM measures (typically global symptoms) may not always be consistent with the lived experience of the client. A recent line of investigation examines these discrepancies and recommends supplementing ROM with additional measures or narrative interviews. In this case study, we use qualitative analysis of a posttreatment interview to specifically examine the client's perspective of discordant outcome when ROM indicated that the client deteriorated during treatment and the client reported retrospective improvement. We find that the interview provides a unique and helpful narrative perspective that supplements ROM. Findings suggest it may be useful to supplement ROM with approaches that extend beyond global symptom measurement and that outcomes from aggregated patient-focused research may be more complex than anticipated.

Using the Assessment for Signal Clients as a feedback tool for reducing treatment failure.

OBJECTIVE: The Clinical Support Tools (CSTs) were 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. The purpose of this study was to describe and identify patterns of problems that typically characterize off-track cases. METHOD: The responses and scores from 107 off-track clients from a hospital-based outpatient clinic were analyzed. RESULTS: A cluster analysis of the 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. Log-linear 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. CONCLUSIONS: Individuals whose progress goes off-track while in psychotherapy appear to have their greatest difficulty with social support, followed closely by motivation for therapy and therapeutic alliance.

Common factors: post hoc explanation or empirically based therapy approach?

Laska, Gurman, and Wampold (2014, pp. 467-481) seek to expand the lens of evidence-based practice by incorporating the common factors perspective. We comment on Laska et al.'s arguments along with the methods used to reach their conclusions. Although we share their view that the common factors explanation for therapeutic equivalence across various orientations observed in the treatment outcome literature is both parsimonious and supported by the scientific evidence, we take issue with their suggestion that there exists a common factors "approach" to treatment in general or evidence-based practice more specifically. We provide clarification and friendly amendments to their language and perspective on the psychotherapy process and outcome research literature and its application in evidence-based practice.

The effects of parent participation on child psychotherapy outcome: a meta-analytic review.

Forty-eight child psychotherapy outcome studies offering direct comparisons of an individual child treatment group to a combined parent-child/family therapy treatment group were included in this meta-analytic review. Results indicate that combined treatments produced a moderate effect beyond the outcomes achieved by individual child treatments, with an average weighted effect size that is within the medium range (d = 0.27). Moderator analysis indicated that, compared to non-cognitive-behavioral individual child treatments, cognitive-behavioral individual child treatments were closer in effectiveness to the overall more effective treatments that included parent participation. Results suggest that including parents in the psychotherapeutic treatment of children adds benefits beyond the outcomes achieved by individual child therapies. More research is needed on factors affecting parents' engagement and consistent participation in child psychotherapy treatment and on clinician's utilization of parents as therapy coparticipants.

Parent and adolescent satisfaction with mental health services: does it relate to youth diagnosis, age, gender, or treatment outcome?

Consumer satisfaction with treatment is important information for providers of mental health services. The goal of the current study was to examine the relationship between youth and parent satisfaction ratings and the following youth variables: gender, age, primary diagnosis, and changes in functioning and symptomatology after 6 months of services. Results demonstrated that in a large sample of youth receiving community mental health services satisfaction with services differed as a function of the adolescents' clinician-derived primary diagnosis, age, and reported changes in symptoms and functioning. Although significant, these variables accounted for only a small portion of the variance in satisfaction. Additionally, the relationship between parent and youth ratings of satisfaction was low, but significant. The implications of these findings are discussed as well as future directions for clinicians and researchers.

Therapist effects: facilitative interpersonal skills as a predictor of therapist success.

This study examined sources of therapist effects in a sample of 25 therapists who saw 1,141 clients at a university counseling center. Clients completed the Outcome Questionnaire-45 (OQ-45) at each session. Therapists' facilitative interpersonal skills (FIS) were assessed with a performance task that measures therapists' interpersonal skills by rating therapist responses to video simulations of challenging client-therapist interactions. Therapists completed the Social Skills Inventory (SSI) and therapist demographic data (e.g., age, theoretical orientation) were available. To test for the presence of therapist effects and to examine the source(s) of these effects, data were analyzed with multilevel modeling. Of demographic predictor variables, only age accounted for therapist effects. The analysis with age, FIS, and SSI as predictors indicated that only FIS accounted for variance in outcomes suggesting that a portion of the variance in outcome between therapists is due to their ability to handle interpersonally challenging encounters with clients.

Using clinical significance in psychotherapy outcome research: the need for a common procedure and validity data.

It is recommended that an estimate of clinical significance be included in all psychotherapy outcome studies and that this estimate be based on the work of Jacobson and Truax (1991). The concept of clinical significance is defined and put in the context of broadly accepted statistical methods along with its advantages and a rationale for using the Jacobson methods. One implication of this recommendation is that the use of the term will have a standard meaning. Examples of loss of meaning are provided and suggest that conclusions about best practices will be affected unless such a voluntary step is taken. Some problems with the concept of clinical significance are noted and a call for validity studies is made.

Models of case mix adjustment for Ohio Mental Health Consumer Outcomes among children and adolescents.

Outcome data collection systems provide the opportunity for comparing agencies, programs, and therapists. However, the political stakes of comparisons raise important issues regarding their perceived validity. The goal of case-mix adjustment is to eliminate potential biasing factors that might render comparisons as inappropriate or irrelevant. In this paper, case-mix adjustment variables are identified using regression analysis followed by developing models of case mix adjustment using a sample of youth participants in the Ohio Mental Health Consumer Outcomes System. Results indicate that certain client level variables do predict outcomes. The total variance accounted for by variables other than baseline ratings of the outcome measure was small. When comparing agencies using adjusted and unadjusted models, some agencies did vary relative to other agencies. As with previous studies, however, the rank order of agencies was largely unchanged and the correlation between adjusted and unadjusted outcomes among agencies was significant.

Why some clinicians use outcome measures and others do not.

Due to their potential as helpful clinical tools, it is necessary to understand the reasons why certain practitioners are currently using outcome measures and certain others are not. This study investigated the reasons why clinicians use outcome measures based upon factors such as work setting, theoretical orientation and source of payment. Similar analyses were conducted for reasons that clinicians do not use outcome measures. Findings suggest that several practical barriers are the primary reasons for not using outcome measures, although a subset of clinicians have additional concerns. Results also emphasized the need for clinicians to be trained on how to maximize the clinical benefits of formalized outcome assessment.

The influence of outcome measures in assessing client change and treatment decisions.

This study investigated the influence that information in the form of outcome measures and client verbal reports can have on treatment decisions and clinician judgment of client change. A random national sample of psychologists (N=810, 45% response rate) were given clinical vignettes and asked questions regarding their view of client progress and subsequent treatment decisions. Despite clinicians reporting that verbal report is more influential in their actual clinical practice than outcome measure information, both sources of information had an equal impact on judgments of client change. Negative information (from either source) influenced clinicians more than positive information. Outcome measure information indicating client deterioration led more clinicians to choose to alter treatment than client verbal report of deterioration. Information indicating client improvement led some clinicians to continue treatment in the same manner as they had been. Insight-oriented therapists were more likely to continue treatment-as-usual than were cognitive-behavioral therapists.

Nutrition and eating in female college athletes: a survey of coaches.

The purpose of the present study was to gather information from coaches regarding their monitoring/management of athlete eating and weight, knowledge of nutritional health issues, availability of prevention/intervention services for athletes at their school, experience with athletes exhibiting symptoms of eating and body image disturbances, and their attitudes toward eating and weight in the sport. A total of 303 coaches (51% response rate) involved in six sports (i.e., gymnastics, swimming, basketball, softball, track, and volleyball) at all levels of collegiate competition (NCAA Divisions I, II, III, and NAIA) completed a 40-item survey. Gender was found to be related to differential responding on only one of the 40 items, while sport and level of competition were related to responses on multiple items. Gymnastics coaches and NCAA Division I coaches differed significantly from coaches of other sports and divisions in that they reported more monitoring/management behaviors, had more experience with athletes exhibiting eating disturbances, and had more resources available for preventing and treating athletes with eating disorders. Gymnastics coaches also differed from other coaches on a number of items related to their attitudes toward eating and weight in the sport. Many coaches have encountered disturbed eating among their athletes, and some of their coaching attitudes and behaviors may inadvertently increase the risk for such disturbances. Implications for clinical and sport psychologists providing prevention or intervention services to intercollegiate athletes are discussed.

An empirical typology of youth with severe emotional disturbances.

Cluster analysis was used to identify groups of children and adolescents with severe emotional disturbances on the basis of 8 child risk factor questions gathered at intake. The sample of 171 youth was divided into 5 clusters: (a) physically abused, (b) suicide attempt risk, (c) delinquent risk, (d) low risk, and (e) sexually abused. Differences were noted among clusters on a variety of measures of functioning, and cluster groups were different in terms of diagnosis and demographic variables (age, gender, and number of arrests). Youth in Clusters 2 and 3 demonstrated lower functioning on various measures, with Cluster 2 yielding the poorest functioning. Cluster analysis does not supplant diagnosis but may be a useful supplement in identifying meaningful subgroups of youth.