Skip to main content
SpringerLink
Log in

Lending an Ear to Feedback Systems: Evaluation of Recovery and Non-Response in Psychotherapy in a German Outpatient Setting

  • Brief Report
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Systems providing feedback on treatment progress have been implemented in outpatient psychotherapy. They are recognized as a helpful tool to identify possible treatment failures. This report presents the ideas underlying the planning of feedback interventions and the implementation of such programs into practice settings. Strategies to identify patients at risk for treatment failure (rationally- and empirically-derived decision rules) are presented. Additionally, evidence for the usefulness of feedback systems is discussed. The report ends with the description of an ongoing feedback intervention study in private practices in Germany (aimed at gathering information on 400 therapists with 2,000 patients).

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • Barkham, M., Margison, F., Leach, C., Lucock, M., Mellor-Clark, J., Evans, C., et al. (2001). Service profiling and outcomes benchmarking using the CORE-OM: Toward practice-based evidence in the psychological therapies. Clinical outcomes in routine evaluation-outcome measures. Journal of Consulting and Clinical Psychology, 69, 184–196.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.

    Article  Google Scholar 

  • Beutler, L. E. (2001). Comparisons among quality assurance systems: From outcome assessment to clinical utility. Journal of Consulting and Clinical Psychology, 69, 197–204.

    Article  PubMed  CAS  Google Scholar 

  • Brabec, B., & Meister, R. (2001). A nearest-neighbor model for regional avalanche forecasting. Annals of Glaciology, 32, 130–134.

    Article  Google Scholar 

  • Breslin, F. C., Sobell, M. B., Sobell, L. C., Buchan, G., & Cunningham, J. A. (1997). Towards a stepped care approach to treating problem drinkers: The predictive utility of within-treatment variables and therapist prognostic ratings. Addiction, 92, 1479–1489.

    Article  PubMed  CAS  Google Scholar 

  • Derogatis, L. R. (1993). BSI. Brief symptom inventory. Administration, scoring, and precedures manual (4th ed.). Minneapolis, MN: National Computer Systems.

    Google Scholar 

  • Ehlers, A., & Margraf, J. (2001). Fragebogen zu körperbezogenen Ängsten, Kognitionen und Vermeidung (AKV) [Questionnaire on body-directed anxieties, cognitions, and avoidance] (2., überarbeitete und neunormierte Auflage). Weinheim: Beltz.

  • Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The global assessment scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.

    PubMed  CAS  Google Scholar 

  • Filzmoser, P., Maronna, R., & Werner, M. (2008). Outlier identification in high dimensions. Computational Statistics & Data Analysis, 52, 1694–1711.

    Article  Google Scholar 

  • Finch, A. E., Lambert, M. J., & Schaalje, B. G. (2001). Psychotherapy quality control: The statistical generation of expected recovery curves for integration into an early warning system. Clinical Psychology and Psychotherapy, 8, 231–242.

    Article  Google Scholar 

  • Fisher, D. G., Pilon, D., Hershberger, S. L., Reynolds, G. L., LaMaster, S. C., & Davis, M. (2009). Psychometric properties of an assessment for mental health recovery programs. Community Mental Health Journal, 45, 246–250.

    Article  PubMed  CAS  Google Scholar 

  • Franke, G. H. (2000). Brief symptom inventory von L. R. Derogatis (Kurzform der SCL-90-R)—Deutsche version [German short version of the SCL-90-R]. Göttingen: Beltz Test GmbH.

    Google Scholar 

  • Fydrich, T., Nagel, A., Lutz, W., & Richter, R. (2003). Qualitätsmonitoring in der ambulanten Psychotherapie: Modellprojekt der Techniker Krankenkasse (TK) [Quality assurance in outpatient psychotherapy: The TK Study]. Verhaltenstherapie, 13, 291–295.

    Article  Google Scholar 

  • Garner, D. M. (1991). Eating disorders inventory-2: Professional manual. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., et al. (2005). A lab test and a algorithmus for identifying patients at risk for treatment failure. Journal of Clinical Psychology, 61, 155–163.

    Article  PubMed  Google Scholar 

  • Harmon, S. C., Lambert, M. J., Smart, D. W., Nielsen, S. L., Hawkins, E. J., & Whipple, J. (2005). Outcome enhancement for non-responding clients: A controlled test of patient and therapist feedback on weekly progress, therapeutic alliance, readiness for change, and social support on session allocation and outcome. Paper presented at the 36th International Meeting of the Society for Psychotehrapy Research, Montreal, Canada.

  • Hawkins, E. J., Lambert, M. J., Vermeersch, D. A., Slade, K. L., & Tuttle, K. C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14, 308–327.

    Article  Google Scholar 

  • Horowitz, L. M., Strauss, B., & Kordy, H. (2000). Inventar zur erfassung interpersonaler probleme (IIP-D) [Inventory of Interpersonal Problems, German Version]. Göttingen: Beltz Test GmbH.

    Google Scholar 

  • Howard, K. I., Kopta, M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159–164.

    Article  PubMed  CAS  Google Scholar 

  • Howard, K. I., Moras, K., Brill, B. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of psychotherapy. Efficacy, effectiveness and patient progress. American Psychologist, 51, 1059–1064.

    Article  PubMed  CAS  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.

    Article  PubMed  CAS  Google Scholar 

  • Klepsch, R., Zaworka, W., Hand, I., Lünenschloss, K., & Jauering, G. (1993). Hamburger Zwangsinventar—Kurzform (HZI-K). Manual [Hamburg Inventory for obsessive-compulsive disorders—short form]. Göttingen: Beltz.

    Google Scholar 

  • Lambert, M. J. (2007). What we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychotherapy Research, 17, 1–14.

    Article  Google Scholar 

  • Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001a). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159–172.

    Article  PubMed  CAS  Google Scholar 

  • Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Handbook of psychotherapy and behavior change (5th ed., pp. 139–193). New York: Wiley.

    Google Scholar 

  • Lambert, M. J., & Ogles, B. M. (2009). Using clinical significance in psychotherapy outcome research: The need for a common procedure and validity data. Psychotherapy Research, 19, 493–501.

    Article  PubMed  Google Scholar 

  • Lambert, M. J., Whipple, J. L., Bishop, M. J., Vermeersch, D. A., Gray, G. V., & Finch, A. E. (2002). Comparison of empirically-derived and rationally-derived methods for identifying patients at risk for treatment failure. Clinical Psychology and Psychotherapy, 9, 149–164.

    Article  Google Scholar 

  • Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301.

    Article  Google Scholar 

  • Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D. A., Nielsen, S. L., & Hawkins, E. J. (2001b). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11, 49–68.

    Article  Google Scholar 

  • Laynard, R., Clark, D., Knapp, M., & Mayraz, G. (2007). Cost-benefit analysis of psychological therapy. National Institute Economic Review, 202, 90–98.

    Article  Google Scholar 

  • Luborsky, L., Barber, J. P., Siqueland, L., Johnson, S., Najavits, L. M., Frank, A., et al. (1996). The revised Helping Alliance questionnaire (HAq-II): Psychometric properties. Journal of Psychotherapy, Practice and Research, 5, 260–271.

    Google Scholar 

  • Lueger, R. J., Howard, K. I., Martinovich, Z., Lutz, W., Anderson, E. E., & Grissom, G. (2001). Assessing treatment progress of individual patients using expected treatment response models. Journal of Consulting and Clinical Psychology, 69, 150–158.

    Article  PubMed  CAS  Google Scholar 

  • Lutz, W. (2002). Patient-focused psychotherapy research and individual treatment progress as scientific groundwork for an empirical based clinical practice. Psychotherapy Research, 12, 251–273.

    Article  Google Scholar 

  • Lutz, W., Lambert, M. J., Harmon, S. C., Tschitsaz, A., Schürch, E., & Stulz, N. (2006a). The probability of treatment success, failure and duration—What can be learned from empirical data to support decision making in clinical practice? Clinical Psychology and Psychotherapy, 13, 223–232.

    Article  Google Scholar 

  • Lutz, W., Leach, C., Barkham, M., Lucock, M., Stiles, W. B., Evans, C., et al. (2005a). Predicting change for individual psychotherapy clients on the basis of their nearest neighbors. Journal of Consulting and Clinical Psychology, 73, 904–913.

    Article  PubMed  Google Scholar 

  • Lutz, W., Martinovich, Z., & Howard, K. I. (1999). Patient profiling: An application of random coefficient regression models to depicting the response of a patient to outpatient psychotherapy. Journal of Consulting and Clinical Psychology, 67, 571–577.

    Article  PubMed  CAS  Google Scholar 

  • Lutz, W., Saunders, S. M., Leon, S. C., Martinovich, Z., Kosfelder, J., Schulte, D., et al. (2006b). Empirically and clinically useful decision making in psychotherapy: Differential predictions with treatment response models. Psychological Assessment, 18, 133–141.

    Article  PubMed  Google Scholar 

  • Lutz, W., Stulz, N., & Köck, K. (2009a). Patterns of early change and their relationship to outcome and follow-up among patients with major depressive disorders. Journal of Affective Disorders, 118, 60–68.

    Article  PubMed  Google Scholar 

  • Lutz, W., Stulz, N., Martinovich, Z., Leon, S., & Saunders, S. M. (2009b). Methodological background of decision rules and feedback tools for outcomes management in psychotherapy. Psychotherapy Research, 19, 502–510.

    Article  PubMed  Google Scholar 

  • Lutz, W., Tholen, S., Kosfelder, J., Tschitsaz, A., Schürch, E., & Stulz, N. (2005b). Evaluation und störungsspezifische Rückmeldung des therapeutischen Fortschritts in der Psychotherapie. [Evaluation and feedback of psychotherapeutic progress in psychotherapy]. Verhaltenstherapie, 15, 168–175.

    Article  Google Scholar 

  • Newnham, E., & Page, A. C. (2010). Bridging the gap between best evidence and best practice in mental health. Clinical Psychology Review, 30, 127–142.

    Article  PubMed  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Newbury Park: Sage Publications.

    Google Scholar 

  • Rief, W., Hiller, W., & Heuser, J. (1997). SOMS—Das Screening für somatoforme Störungen (Manual zum Fragebogen) [Screening for somatoform disorders]. Bern: Huber.

    Google Scholar 

  • Rousseeuw, P. J., & Van Zomeren, B. C. (1990). Unmasking multivariate outliers and leverage points. Journal of the American Statistical Association, 85, 633–651.

    Article  Google Scholar 

  • Schepank, H. (1995). BSS. Der Beeinträchtigungs-Schwere-Score. Ein Instrument zur Bestimmung der Schwere einer psychogenen Erkrankung. Manual und Testmappe [The score of functional impairment: An instrument for the assessment of the severity of psychological disorders]. Göttingen: Beltz Test.

    Google Scholar 

  • Sperry, L., Brill, P. L., Howard, K. I., & Grissom, G. R. (1996). Treatment outcomes in psychotherapy and psychiatric interventions. New York: Brunner/Mazel.

    Google Scholar 

  • Stulz, N., Gallop, R., Lutz, W., Wrenn, G. L., & Crits-Christoph, P. (2010). Examining differential effects of psychosocial treatments for cocaine dependence: An application of latent trajectory analyses. Drug and Alcohol Dependence, 106, 164–172.

    Article  PubMed  Google Scholar 

  • Stulz, N., Lutz, W., Leach, C., Lucock, M., & Barkham, M. (2007). Shapes of early change in psychotherapy under routine outpatient conditions. Journal of Consulting and Clinical Psychology, 75, 864–874.

    Article  PubMed  Google Scholar 

  • Tasca, G. A., & Gallop, R. (2009). Multilevel modeling of longitudinal data for psychotherapy researchers: I. The basics. Psychotherapy Research, 19, 429–437.

    Article  PubMed  Google Scholar 

  • Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was partially supported by grants from the Swiss National Science Foundation (SNF), Nr. PP001-102651 and 1114-064884.01 (Wolfgang Lutz). The authors thank the Techniker Krankenkasse and Dr. Thomas Ruprecht as their coordinator as well as Dr. Werner Wittmann and his team for the cooperation in the project. All Authors certify the responsibility for the manuscript.

Author information

Authors and Affiliations

  1. Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany

    Wolfgang Lutz, Jan R. Böhnke & Katharina Köck

Authors
  1. Wolfgang Lutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan R. Böhnke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katharina Köck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wolfgang Lutz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lutz, W., Böhnke, J.R. & Köck, K. Lending an Ear to Feedback Systems: Evaluation of Recovery and Non-Response in Psychotherapy in a German Outpatient Setting. Community Ment Health J 47, 311–317 (2011). https://doi.org/10.1007/s10597-010-9307-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-010-9307-3

Keywords

Search

Navigation