Treatment satisfaction following routine outpatient cognitive-behavioral therapy of adolescents with mental disorders: a triple perspective of patients, parents and therapists


The present study investigates treatment satisfaction (TS) rated by multiple informants (patient, parent, therapist) following routine outpatient cognitive-behavioral therapy (CBT) within a large sample (n = 965) of clinically referred adolescents aged 11–20 years. Moreover, potential predictors of TS were analyzed (patient-related variables, mental disorder characteristics, socio-demographic factors and treatment variables). Overall, our results show a high treatment satisfaction in patient, parent and therapist ratings, with the therapists being the most critical raters (completely/predominantly satisfied: 87.8% in patient, 92.0% in parent, and 64.0% in therapist ratings). Correlations between the three raters were only small to moderate, but statistically significant. Regression analysis examining differential effects found that mental disorder characteristics (parent- and patient-reported symptoms at post) and treatment variables (especially cooperation of patients and parents as rated by therapists) explained most of the variance in TS, whereas patient-related or socio-demographic variables did not emerge as relevant predictors of TS. The amounts of explained variance were R 2adj.  = 0.594 in therapist rating, R 2adj.  = 0.322 in patient rating and R 2adj.  = 0.203 in parent rating.

This is a preview of subscription content, log in to check access.


  1. 1.

    Wittchen U, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(9):655–679.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Merikangas K, He J, Burstein M, Swanson S, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49(10):980–989.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60:709–717.

    Article  PubMed  Google Scholar 

  4. 4.

    Hofstra MB, van der Ende J, Verhulst FC (2002) Child and adolescent problems predict DSM-IV disorders in adulthood: a 14-year follow-up of a Dutch epidemiological sample. J Am Acad Child Adolesc Psychiatry 41:182–189.

    Article  PubMed  Google Scholar 

  5. 5.

    de Haan AM, Boon AE, de Jong JTVM, Hoeve M, Vermeiren RRJM (2013) A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clin Psychol Rev 33(5):698–711.

    Article  PubMed  Google Scholar 

  6. 6.

    Lewinsohn PM, Shankman SA, Gau JM, Klein DN (2004) The prevalence and co-morbidity of subthreshold psychiatric conditions. Psychol Med 34:613–622.

    Article  PubMed  Google Scholar 

  7. 7.

    MacLeod K, Brownlie E (2014) Mental health and transitions from adolescence to emerging adulthood: developmental and diversity considerations. Can J Community Ment Health 33(1):77–86.

    Article  Google Scholar 

  8. 8.

    Walter D, Dachs L, Faber M, Goletz H, Görtz-Dorten A, Hautmann C, Kinnen C, Rademacher C, Schuermann S, Metternich-Kaizman TW, Döpfner M (2017) Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study. Eur Child Adolesc Psychiatry 27(1):65–77.

    Article  PubMed  Google Scholar 

  9. 9.

    McNicholas F (2012) To adhere or not, and what we can do to help. Eur Child Adolesc Psychiatry 21(12):657–663.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Athay MM, Bickman L (2012) Development and psychometric evaluation of the youth and caregiver Service Satisfaction Scale. Adm Policy Ment Health 39(1–2):71–77.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Garland AF, Haine RA, Boxmeyer CL (2007) Determinates of youth and parent satisfaction in usual care psychotherapy. Eval Program Plan 30(1):45–54.

    Article  Google Scholar 

  12. 12.

    Biering P (2010) Child and adolescent experience of and satisfaction with psychiatric care: a critical review of the research literature. J Psychiatr Ment Health Nurs 17(1):65–72.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Achenbach TM, McConaughy SH, Howell CT (1987) Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 101(2):213–232.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Karver MS (2006) Determinants of multiple informant agreement on child and adolescent behavior. J Abnorm Child Psychol 34(2):242–253.

    Article  Google Scholar 

  15. 15.

    Kapp C, Perlini T, Jeanneret T, Stéphan P, Rojas-Urrego A, Macias M, Halfon O, Holzer L, Urben S (2017) Identifying the determinants of perceived quality in outpatient child and adolescent mental health services from the perspectives of parents and patients. Eur Child Adolesc Psychiatry 26(10):1269–1277.

    Article  PubMed  Google Scholar 

  16. 16.

    Barber AJ, Tischler VA, Healy E (2006) Consumer satisfaction and child behaviour problems in child and adolescent mental health services. J Child Health Care 10(1):9–21.

    Article  PubMed  Google Scholar 

  17. 17.

    Garland AF, Aarons GA, Saltzman MD, Kruse MI (2000) Correlates of adolescents’ satisfaction with mental health services. Ment Health Serv Res 2(3):127–139.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Mattejat F, Remschmidt H (1998) Fragebogen zur Beurteilung der Behandlung (FBB). Handanweisung [Therapy Evaluation Questionnaire (TEQ). Manual]. Hogrefe, Göttingen

    Google Scholar 

  19. 19.

    Turchik JA, Karpenko V, Ogles BM, Demireva P, Probst DR (2010) Parent and adolescent satisfaction with mental health services: does it relate to youth diagnosis, age, gender, or treatment outcome? Community Ment Health J 46(3):282–288.

    Article  PubMed  Google Scholar 

  20. 20.

    Godley SH, Fiedler EM, Funk RR (1998) Consumer satisfaction of parents and their children with child/adolescent mental health services. Eval Program Plan 21(1):31–45.

    Article  Google Scholar 

  21. 21.

    Marriage K, Petrie J, Worling D (2001) Consumer satisfaction with an adolescent inpatient psychiatric unit. Can J Psychiatry 46(10):969–975.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Copeland VC, Koeske G, Greeno CG (2004) Child and mother client satisfaction questionnaire scores regarding mental health services: race, age, and gender correlates. Res Soc Work Pract 14(6):434–442.

    Article  Google Scholar 

  23. 23.

    Bunge EL, Maglio AL, Musich FM, Savage C (2014) Consumer satisfaction with private child and adolescent mental health services in Buenos Aires. Child Youth Serv Rev 47(3):291–296.

    Article  Google Scholar 

  24. 24.

    Lambert W, Salzer M, Bickman L (1998) Clinical outcome, consumer satisfaction, and ad hoc ratings of improvement in children’s mental health. J Consult Clin Psychol 66(2):270

    CAS  Article  Google Scholar 

  25. 25.

    Stüntzner-Gibson D, Koren PE, DeChillo N (1995) The Youth Satisfaction Questionnaire: what kids think of services. Fam Soc 76(10):616–624

    Article  Google Scholar 

  26. 26.

    Day C, Michelson D, Hassan I (2011) Child and adolescent service experience (ChASE): measuring service quality and therapeutic process. Br J Clin Psychol 50(4):452–464.

    Article  PubMed  Google Scholar 

  27. 27.

    Schneider N, Korte A, Lenz K, Pfeiffer E, Lehmkuhl U, Salbach-Andrae H (2010) Subjektive Therapiebeurteilung jugendlicher Patientinnen mit Essstörungen und deren Übereinstimmung mit Eltern- und Therapeutenbeurteilungen [Subjective evaluation of DBT treatment by adolescent patients with eating disorders and the correlation with evaluations by their parents and psychotherapists]. Z Kinder Jugendpsychiatr Psychother 38(1):51–57.

    Article  PubMed  Google Scholar 

  28. 28.

    Mattejat F, Remschmidt H (1993) Evaluation von Therapien mit psychisch kranken Kindern und Jugendlichen. Entwicklung und Überprüfung eines Fragebogens zur Beurteilung der Behandlung (FBB) [Evaluation of therapies with children and adolescents with mental disorders. Development and evaluation of a therapy evaluation questionnaire (TEQ)]. Z Klin Psychol 22(2):192–233

    Google Scholar 

  29. 29.

    Kinnen C, Döpfner M (2013) Zusammenhang von therapeutischer Beziehung mit Symptomminderung und Behandlungszufriedenheit in der Behandlung von Kindern und Jugendlichen mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und/oder Störungen des Sozialverhaltens [The relationship of therapeutic alliance with a symptom reduction and treatment satisfaction in the therapeutic treatment of children and adolescents with ADHD and/or conduct disorder]. Z Kinder Jugendpsychiatr Psychother 41(2):133–144.

    Article  PubMed  Google Scholar 

  30. 30.

    Shapiro JP, Welker CJ, Jacobson BJ (1997) The Youth Client Satisfaction Questionnaire: development, construct validation, and factor structure. J Clin Child Psychol 26(1):87–98.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Bjorngaard JH, Wessel AH, Osborg OS, Hanssen-Bauer K (2008) User satisfaction with child and adolescent mental health services: impact of the service unit level. Soc Psychiatry Psychiatr Epidemiol 43:635–641.

    Article  PubMed  Google Scholar 

  32. 32.

    Keller F, Peter S, Fegert JM, Naumann A, Goldbeck L (2006) Behandlungsbewertungen von Jugendlichen im Verlauf einer stationär-psychiatrischen Behandlung [Consumer satisfaction trajectories of adolescents during inpatient psychiatric treatment]. Z Kinder Jugendpsychiatr Psychother 34(5):367–376.

    Article  PubMed  Google Scholar 

  33. 33.

    Gerkensmeyer JE, Austin JK (2005) Development and testing of a scale measuring parent satisfaction with staff interactions. J Behav Health Serv Res 32(1):61–73.

    Article  PubMed  Google Scholar 

  34. 34.

    Holmboe O, Iversen HH, Hanssen-Bauer K (2011) Determinants of parents’ experiences with outpatient child and adolescent mental health services. Int J Ment Health Syst 5(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Measelle JR, Weinstein RS, Martinez M (1998) Parent satisfaction with case managed systems of care for children and youth with severe emotional disturbance. J Child Fam Stud 7(4):451–467.

    Article  Google Scholar 

  36. 36.

    Achenbach TM (2010) Multicultural evidence-based assessment of child and adolescent psychopathology. Transcult Psychiatry 47:707–726.

    Article  PubMed  Google Scholar 

  37. 37.

    Döpfner M, Plück J, Kinnen C, Arbeitsgruppe Deutsche Child Behavior Checklist (2014) Manual deutsche Schulalter-Formen der Child Behavior Checklist von Thomas M. Achenbach. Elternfragebogen über das Verhalten von Kindern und Jugendlichen (CBCL/6-18R), Lehrerfragebogen über das Verhalten von Kindern und Jugendlichen (TRF/6-18R), Fragebogen für Jugendliche (YSR/11-18R) [Manual of the German versions of the Child Behavior Checklist for school-aged children and adolescents by Thomas M. Achenbach. Child Behavior Checklist (CBCL/6-18R), Teacher Report Form (TRF/6-18R), Youth Self-Report (YSR/11-18R)]. Hogrefe, Göttingen

  38. 38.

    Brestan EV, Jacobs JR, Rayfield AD, Eyberg SM (1999) A consumer satisfaction measure for parent–child treatments and its relation to measures of child behavior change. Behav Ther 30(1):17–30.

    Article  Google Scholar 

  39. 39.

    Garland AF, Aarons GA, Hawley KM, Hough RL (2003) Relationship of youth satisfaction with mental health services and changes in symptoms and functioning. Psychiatr Serv 54(11):1544–1546.

    Article  PubMed  Google Scholar 

  40. 40.

    Noser K, Bickman L (2000) Quality indicators of children’s mental health services: do they predict improved client outcomes? J Emot Behav Disord 8(1):9–18.

    Article  Google Scholar 

  41. 41.

    Döpfner M, Görtz-Dorten A, Lehmkuhl G (2008) DISYPS-II: Diagnostik-System für psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV [DISYPS-II: Diagnostic system for psychiatric disorders in children and adolescents], 3rd edn. Hans Huber, Bern

    Google Scholar 

  42. 42.

    Görtz-Dorten A, Döpfner M (2008) Diagnose-Checklisten aus dem Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter (DISYPS-II) - Gütekritereien und klinische Anwendung [Diagnostic-Checklists of the Diagnostic System for Mental Disorders in Childhood and Adolescence (DISYPS-II)—psychometric criteria and clinical application]. Klin Diagn Eval1 1(4):378–394

    Google Scholar 

  43. 43.

    Schmeck K, Poustka F, Döpfner M, Plück J, Berner W, Lehmkuhl G, Fegert JM, Lenz K, Huss M, Lehmkuhl U (2001) Discriminant validity of the Child Behaviour Checklist CBCL-4/18 in German samples. Eur Child Adolesc Psychiatry 10(4):240–247.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Döpfner M, Berner W, Schmeck K, Lehmkuhl G, Poustka F (1995) Internal consistencies and validity of the CBCL and the TRF in a German sample: a cross cultural comparison. In: Sergeant J (ed) Eunethydis: European approaches to hyperkinetic disorder. Egg, Zürich, pp 51–81

    Google Scholar 

  45. 45.

    Döpfner M, Steinhausen H-C (2012) Kinder-Diagnostik-System (KIDS) [children-diagnostic-system (KIDS)], vol 3: Störungsübergreifende Verfahren zur Diagnostik psychischer Störungen [transdiagnostic instruments to assess mental health disorders]. Hogrefe, Göttingen

    Google Scholar 

  46. 46.

    World Health Organization (1996) Multiaxial classification of child and adolescent psychiatric disorders: the ICD-10 classification of mental and behavioural disorders in children and adolescents. University Press, Cambridge

    Google Scholar 

  47. 47.

    Tewes U (1985) Hamburg-Wechsler-Intelligenztest für Kinder - revidierte Auflage [Hamburg-Wechsler test of intelligence for children—revised]. Huber, Bern

    Google Scholar 

  48. 48.

    von Aster M, Neubauer A, Horn R (2006) Wechsler Intelligenztest für Erwachsene WIE. Deutschsprachige Bearbeitung und Adaptation des WAIS-III von David Wechsler [Wechsler test of intelligence for adults WIE. German adaptation of the WAIS-III by David Wechsler]. Pearson, Frankfurt

    Google Scholar 

  49. 49.

    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. L. Erlbaum Associates, Hillsdale

    Google Scholar 

  50. 50.

    Bowerman BL, O’Connell RT (1990) Linear statistical models: an applied approach. Duxbury Press, Belmont

    Google Scholar 

  51. 51.

    Myers RH (1990) Classical and modern regression with applications. Duxbury, Boston

    Google Scholar 

  52. 52.

    Menard S (1995) Applied logistic regression analysis. Sage University Papers Series, Quantitative applications in the social sciences, 07-106. Sage, Thousand Oaks

    Google Scholar 

  53. 53.

    Field A (2013) Discovering statistics using IBM SPSS statistics, 4th edn. SAGE Publications, London

    Google Scholar 

  54. 54.

    Nevill RE, Lecavalier L, Stratis EA (2018) Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder. Autism 22:84–98.

    Article  PubMed  Google Scholar 

  55. 55.

    Freitag C, Jensen K, Elsuni L, Sachse M, Herpertz-Dahlmann B, Schulte-Rüther M, Hänig S, von Gontard A, Poustka L, Schad-Hansjosten T, Wenzl C, Sinzig J, Taurines R, Geißler J, Kieser M, Choemkery H (2016) Group-based cognitive behavioural psychotherapy for children and adolescents with ASD: a randomized, multicentre, controlled SOSTA—net trial. J Child Psychol Psychiatry 57:596–605.

    Article  PubMed  Google Scholar 

  56. 56.

    Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD (1979) Assessment of client/patient satisfaction: development of a general scale. Eval Program Plan 2:197–207.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Daniel Walter.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study has been approved by the ethics committee at the University of Cologne and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 23 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Viefhaus, P., Döpfner, M., Dachs, L. et al. Treatment satisfaction following routine outpatient cognitive-behavioral therapy of adolescents with mental disorders: a triple perspective of patients, parents and therapists. Eur Child Adolesc Psychiatry 28, 543–556 (2019).

Download citation


  • Treatment satisfaction
  • Routine treatment
  • Cognitive-behavioral therapy
  • Adolescents