Any data on therapist actual use of the CST manual and whether it was found to be beneficial or useful by clinicians? I'm interested in data beyond the value of feedback regarding progress on the OQ (Outcome Questionnaire) and regarding reasons for poor progress on the ASC (Assessment for Signal Clients: alliance, motivation, social support, life events).
My experience is somewhat tangential using an adapted CST as part of a feedback system that used different outcome measures but used the ASC routinely.
I am convinced that the overall clinical setting and the mindset of clinicians and managers are vital variables here as is the patient population. I think that in the UK, at least there has been a drift away from clinical psychologists seeing themselves individually as active researchers but this does not mean that they have necessarily become good users of research even such eminently practical research as exemplified by Mike's work. Furthermore there has been a cultural dilution with the advent of psychological therapists without a scientific background.
While our forthcoming paper (Lucock et al.) and indeed the Pychotherapy Research Special issue (2016?) should give you some hard data, my belief is that the way ahead is more about developing cultures (where therapists are receptive to feedback and accept that when things are not going well they need to stop think and go in another direction) [I have just been moving my rather large van in a rather confined space!] rather than systems. Systems are great but they can only function in the right culture. lambert himself spoke on this at SPR Barcelona but I am not sure how much the negative data gets published.
If the CST is to work it probably needs to be an interactive device that pulls and pushes the therapist into changing direction trying new tactics getting help and advice and using other resources. Of course good supervision or the combination of CST supervision and outcome data could do this. We also need therapists who are prepared to carry on working when they are out of their comfort zone and statistically are more likely to produce less results than if they abandon the client and move onto someone else who is easier to work with. ie a system that rewards persistence and flexibility.
Thank you, Jeremy, for your thoughtful response. I do agree the culture or, put another way, all the stakeholders (clinicians, patients, administrators) need to be considered and included in the development & implementation of such systems. I also agree that the CST must be developed to be more user-friendly & interactive. In this regard, our team is working on a video-enhanced version & exploring interactive videos for training with regard to negotiating ruptures in the therapeutic alliance. We plan to post these tools on a website in the coming months. Thanks again, Chris
Dear John,
This paper may be of interest to you:
Progress monitoring and feedback in psychiatric care reduces depressive symptoms
Elizabeth A. Newnham ; Geoff R. Hooke
Journal of affective disorders, December 2010 Volume 127, Issues 1-3, Pages 139–146
DOI: http://dx.doi.org/10.1016/j.jad.2010.05.003
Abstract
Background
To date, the monitoring of patient progress using standardized assessments has been neglected in hospital-based psychiatric care. Findings in outpatient psychotherapy have demonstrated clinically significant benefits for providing feedback to the sizeable minority of patients who were otherwise unlikely to experience positive outcome (Lambert, 2007). However, a similar system for presenting feedback on patient progress has not yet been assessed for group therapy within psychiatric inpatient settings. The current study aimed to develop and evaluate the effectiveness of a feedback system suitable for use in psychiatric services.
Methods
In a nonrandomized trial, 1308 consecutive inpatients and day patients, whose diagnoses were primarily depressive and anxiety disorders, completed the World Health Organization's Wellbeing Index (WHO-5) routinely during a ten-day cognitive behavioral therapy group. The first cohort (n=461) received treatment as usual. The second cohort (n=439) completed monitoring measures without feedback, and for patients in the third cohort (n=408), feedback on progress was provided to both clinicians and patients midway through the treatment period.
Results
Feedback was effective in reducing depressive symptoms (F(1,649)=6.29, p.05).
- Badges
- Science topic
- Similar topics
- Geoscience
- Asia
- India