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Schwerpunktbeitrag

Nutzung von psychometrischem Feedback als empirische Unterstützung des Supervisionsprozesses bei Ausbildungstherapien

Published Online:September 28, 2017https://doi.org/10.1026/1616-3443/a000413

Abstract

Zusammenfassung.Theoretischer Hintergrund: Trotz der gut belegten generellen Wirksamkeit von Psychotherapie wird die Zahl der Patienten, die nicht auf eine Therapie ansprechen oder sich sogar im Verlauf verschlechtern, auf etwa ein Drittel geschätzt. Da Therapeuten im Vergleich zu empirischen Algorithmen weniger gut in der Lage sind negative Entwicklungen zu entdecken oder zu prognostizieren, brauchen sie zusätzliche Unterstützung in Form von kontinuierlichen Rückmeldungen über den Fortschritt ihrer Patienten. Solche Feedbackinterventionen können als empirisch basierte Unterstützung des Supervisions- oder Intervisionsprozesses verstanden werden. Diese Interventionen haben ihre Wirksamkeit zur Reduktion therapeutischer Misserfolge in zahlreichen Einzelstudien und Meta-Analysen wiederholt zeigen können. Fragestellung: Wie nutzen Therapeuten ein solches Feedback in ihrer praktischen Arbeit und in welchem Ausmaß spielen Therapeutenfaktoren dabei eine Rolle? Methode: In der vorliegenden Studie wurden 72 Therapeuten für 648 ihrer Patienten unmittelbar nach der Therapie dazu befragt, wie sie das psychometrische Feedback genutzt haben. Therapeutenunterschiede wurden mittels Mehrebenenmodellen ermittelt. Ergebnisse: Es konnte gezeigt werden, dass Therapeuten für einen Großteil ihrer Patienten das Feedback verwendeten. In etwa einem Drittel der Fälle gab es den Therapeuten den Anstoß zusätzliche Hilfen (z. B. Supervision/Intervision) zu beanspruchen. Ähnlich einer personengestützten Supervision wurde für über die Hälfte der Patienten das Feedback genutzt um therapeutische Interventionen anzupassen. Ob und in welcher Form es genutzt wurde hing jedoch stark von dem Therapeuten ab. Je nach Verwendungsart konnten Therapeutenunterschiede zwischen 27 % und 52 % der Feedbacknutzung erklären. Die Wahrscheinlichkeit, dass Therapeuten die Nutzungsmöglichkeiten des Feedbacks anwendeten war größer, wenn diese angaben im Durchschnitt zufriedener mit den grafischen Rückmeldungen zu sein. Schlussfolgerungen: Diese Ergebnisse machen deutlich, dass es zu einem großen Teil nicht nur vom Therapieverlauf oder den Charakteristika der jeweiligen Patienten abhängt wie Therapeuten das Feedback nutzen, sondern auch von Variablen, die den Therapeuten betreffen.


Using Psychometric Feedback as Empirical Support for Supervision Processes in Psychotherapy Training

Abstract.Background: Despite the well-evidenced general effectiveness of psychotherapy, an estimated one third of patients do not respond to – or even deteriorate – during therapy. As therapists are less able to recognize and prognosticate negative developments in comparison with empirical algorithms, they require further support in the form of continuous feedback of their patients’ progress. Such feedback interventions can be seen as empirically based support of the supervision and intervision process. These interventions have repeatedly demonstrated their effectiveness for the reduction of treatment failure in numerous single studies and meta-analyses. Objective: The current study investigates how therapists use feedback in their clinical work. Additionally, we quantified to what extent therapist factors influence the use feedback. Method: Therefore, 72 therapists were surveyed about how they used psychometric feedback immediately after having finished therapy with 648 of their patients. Differences between therapists were determined by employing multilevel models. Results: We were able to show that therapists used feedback for a large portion of their patients. In approximately one third of the cases, usage prompted the therapists to employ extra support (e. g., supervision, intervision). Similar to staff-based supervision, feedback was used to adjust therapeutic interventions for over half of the patients. However, when and how it was used was largely dependent on the individual therapist. Depending on the type of utilization, therapist differences were able to explain between 27 % and 52 % of feedback use. The probability that therapists used the possible applications of feedback was greater when they also indicated being more satisfied with the graphic feedback on average. Conclusion: These results underline that how therapists use feedback depends not only on therapy progress or specific patient characteristics, but also to a large degree on therapist variables.

Literatur

  • Amble, I., Gude, T., Stubdal, S., Andersen, B. J. & Wampold, B. E. (2015). The effect of implementing the Outcome Questionnaire-45.2 feedback system in Norway: A multisite randomized clinical trial in a naturalistic setting. Psychotherapy Research, 25, 669 – 677. First citation in articleCrossref, Google Scholar

  • Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., Lutz, W., Rubel, J. & Schiefele, A. K., et al. (2015). Therapeutic bond judgments: Congruence and incongruence. Journal of Consulting and Clinical Psychology, 83, 773 – 784. First citation in articleCrossref, Google Scholar

  • Bar-Kalifa, E., Atzil-Slonim, D., Rafaeli, E., Peri, T., Rubel, J. & Lutz, W. (2016). Therapist-client agreement in assessments of clients’ functioning. Journal of Consulting and Clinical Psychology, 84, 1127 – 1134. First citation in articleCrossref, Google Scholar

  • Baldwin, S. A. & Imel, Z. E. (2013). Therapist effects: Findings and methods. In M. J. LambertEd., Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 258 – 297). New York, NY: John Wiley & Sons, Inc. First citation in articleGoogle Scholar

  • Bates, D., Maechler, M., Bolker, B. & Walker, S. (2014). lme4: Linear mixed-effects models using Eigen and S4. R package version, 1 (7), 1 – 23. First citation in articleGoogle Scholar

  • Bickman, L., Kelley, S. D., Breda, C., Andrade, A. R. de & Riemer, M. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62, 1423 – 1429. First citation in articleCrossref, Google Scholar

  • Byrne, S. L., Hooke, G. R., Newnham, E. A. & Page, A. C. (2012). The effects of progress monitoring on subsequent readmission to psychiatric care: A six-month follow-up. Journal of Affective Disorders, 137, 113 – 116. First citation in articleCrossref, Google Scholar

  • Castonguay, L. G., Barkham, M., Lutz, W. & McAleavey, A. A. (2013). Practice-oriented research: Approaches and applications. In M.J. LambertEd.. Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 85 – 133). New York, NY: John Wiley & Sons, Inc. First citation in articleGoogle Scholar

  • De Jong, K., Sluis, P. van, Nugter, M. A., Heiser, W. J. & Spinhoven, P. (2012). Understanding the differential impact of outcome monitoring: Therapist variables that moderate feedback effects in a randomized clinical trial. Psychotherapy Research, 22, 464 – 474. First citation in articleCrossref, Google Scholar

  • De Jong, K., Timman, R., Hakkaart-Van Roijen, L., Vermeulen, P., Kooiman, K. & Passchier, J., et al. (2014). The effect of outcome monitoring feedback to clinicians and patients in short and long-term psychotherapy: A randomized controlled trial. Psychotherapy Research, 24, 629 – 639. First citation in articleCrossref, Google Scholar

  • Douglas, S. R., Jonghyuk, B., Andrade, A. R. V. de, Tomlinson, M. M., Hargraves, R. P. & Bickman, L. (2015). Feedback mechanisms of change: How problem alerts reported by youth clients and their caregivers impact clinician-reported session content. Psychotherapy Research, 25, 678 – 693. First citation in articleCrossref, Google Scholar

  • Dyer, K., Hooke, G. R. & Page, A. C. (2016). Effects of providing domain specific progress monitoring and feedback to therapists and patients on outcome. Psychotherapy Research, 26, 297 – 306. First citation in articleCrossref, Google Scholar

  • Falkenström, F., Finkel, S., Sandell, R., Rubel, J. A. & Holmqvist, R. (2017). Dynamic models of individual change in psychotherapy process research. Journal of Consulting and Clinical Psychology, 85, 537 – 549. First citation in articleCrossref, Google Scholar

  • Flückiger, C., Regli, D., Zwahlen, D., Hostettler, S. & Caspar, F. (2010). Der Berner Patienten- und Therapeutenstundenbogen 2000. Zeitschrift für Klinische Psychologie und Psychotherapie, 39, 71 – 79. First citation in articleLink, Google Scholar

  • Franke, G. H. (1995). SCL-90-R. Die Symptom-Checkliste von Derogatis – Deutsche Version. Göttingen: Beltz Test. First citation in articleGoogle Scholar

  • Franke, G. H. (2000). Brief symptom inventory (BSI) von LR Derogatis (Kurzform der SCL-90-R). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W. & Shimokawa, K., et al. (2005). A lab test and an algorithm for identifying patients at risk for treatment failure. Journal of Clinical Psychology, 61, 155 – 163. First citation in articleCrossref, Google Scholar

  • Hatfield, D., McCullough, L., Frantz, S. H. B. & Krieger, K. (2010). Do we know when our clients get worse? An investigation of therapists′ability to detect negative client change. Clinical Psychology and Psychotherapy, 17, 25 – 32. First citation in articleGoogle Scholar

  • Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z. & Lutz, W. (1996). Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51, 1059 – 1064. First citation in articleCrossref, Google Scholar

  • Hox, J. J., Moerbeek, M. & Schoot, R. van de (2010). Multilevel analysis: Techniques and applications. New York: Routledge. First citation in articleCrossref, Google Scholar

  • Köck, K. & Lutz, W. (2012). Therapieverlaufs- und Ergebnismessung im Rahmen einer patientenorientierten Psychotherapieforschung. PiD – Psychotherapie im Dialog, 13 (01), 10 – 16. First citation in articleCrossref, Google Scholar

  • Krägeloh, C. U., Czuba, K. J., Billington, D. R., Kersten, P. & Siegert, R. J. (2015). Using feedback from patient-reported outcome measures in mental health services: A scoping study and typology. Psychiatric Services, 66, 224 – 241. First citation in articleCrossref, Google Scholar

  • Lambert, M. (2007). Presidential address: What we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychotherapy Research, 17, 1 – 14. First citation in articleCrossref, Google Scholar

  • Lambert, M. J. (2013). The Efficacy and Effectiveness of Psychotherapy. In M. J. LambertEd.. Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 169 – 218). New York, NY: John Wiley & Sons, Inc. First citation in articleGoogle Scholar

  • Lambert, M. J., Bailey, R. J., Kimball, K. & Shimokawa, K. (2007). Clinical Support Tools Manual – Brief Version – 40: OQ-Measures LLCC. First citation in articleGoogle 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. First citation in articleCrossref, Google Scholar

  • Lucock, M., Halstead, J., Leach, C., Barkham, M., Tucker, S. & Randal, C., et al. (2015). A mixed-method investigation of patient monitoring and enhanced feedback in routine practice: Barriers and facilitators. Psychotherapy Research, 25, 633 – 646. First citation in articleCrossref, Google Scholar

  • Lutz, W., Böhnke, J. R., Köck, K. & Bittermann, A. (2011). Diagnostik und psychometrische Verlaufsrückmeldungen im Rahmen eines Modellprojektes zur Qualitätssicherung in der ambulanten Psychotherapie. Zeitschrift für Klinische Psychologie und Psychotherapie, 40, 283 – 297. First citation in articleLink, Google Scholar

  • Lutz, W., De Jong, K. & Rubel, J. (2015). Patient-focused and feedback research in psychotherapy: Where are we and where do we want to go? Psychotherapy Research: Journal of the Society for Psychotherapy Research, 25, 625 – 632. First citation in articleCrossref, Google Scholar

  • Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K. & Gorman, J. M., et al. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of consulting and clinical psychology, 82, 287. First citation in articleCrossref, Google Scholar

  • Lutz, W., Leon, S. C., Martinovich, Z., Lyons, J. S. & Stiles, W. B. (2007). Therapist effects in outpatient psychotherapy: A three-level growth curve approach. Journal of Counseling Psychology, 54, 32 – 39. First citation in articleCrossref, Google Scholar

  • Lutz, W. & Rubel, J. (2015). Warum die Psychotherapieforschung in Deutschland ausgebaut werden sollte/könnte/müsste. PPmP-Psychotherapie· Psychosomatik· Medizinische Psychologie, 65, 161 – 162. First citation in articleCrossref, Google Scholar

  • Lutz, W., Rubel, J., Schiefele, A.-K., Zimmermann, D., Böhnke, J. R. & Wittmann, W. W. (2015). Feedback and Therapist effects in the context of treatment outcome and treatment length. Psychotherapy Research, 25, 647 – 660. First citation in articleCrossref, Google Scholar

  • Lutz, W., Tholen, S., Schürch, E. & Berking, M. (2006). Die Entwicklung, Validität und Reliabilität von Kurzformen gängiger psychometrischer Instrumente zur Evaluation des therapeutischen Fortschrittes in Psychotherapie und Psychiatrie: Diagnostica, 52, 11 – 25. First citation in articleLink, Google Scholar

  • Lutz, W., Wittmann, W., Böhnke, J., Rubel, J. & Steffanowski, A. (2013). Das Modellprojekt der TK zum Qualitätsmonitoring in der ambulanten Psychotherapie aus Sicht der Evaluatoren–Ein Plädoyer für mehr Psychotherapieforschung in Deutschland. PPmP – Psychotherapie· Psychosomatik· Medizinische Psychologie, 63, 225 – 228. First citation in articleGoogle Scholar

  • Mander, J., Schlarb, A., Teufel, M., Keller, F., Hautzinger, M. & Zipfel, S., et al. (2015). The individual therapy process questionnaire: Development and validation of a revised measure to evaluate general change mechanisms in psychotherapy. Clinical Psychology & Psychotherapy, 22, 328 – 345. First citation in articleCrossref, Google Scholar

  • Miller, S. D., Duncan, B. L., Brown, J., Sorrell, R. & Chalk, M. B. (2006). Using formal client feedback to improve retention and outcome: Making ongoing, real-time assessment feasible. Journal of Brief Therapy, 5 (1), 5 – 22. First citation in articleGoogle Scholar

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

  • Orlinsky, D. E, Botermans, J.-F. & Rønnestad, M. H. (2001). Towards an empirically grounded model of psychotherapy training: Four thousand therapists rate influences on their development. Australian Psychologist, 36, 139 – 148. First citation in articleCrossref, Google Scholar

  • Poston, J. M. & Hanson, W. E. (2010). Meta-analysis of psychological assessment as a therapeutic intervention. Psychological Assessment, 22, 203 – 212. First citation in articleCrossref, Google Scholar

  • Probst, T., Lambert, M. J., Loew, T. H., Dahlbender, R. W., Göllner, R. & Tritt, K. (2013). Feedback on patient progress and clinical support tools for therapists: Improved outcome for patients at risk of treatment failure in psychosomatic in-patient therapy under the conditions of routine practice. Journal of Psychosomatic Research, 75, 255 – 261. First citation in articleCrossref, Google Scholar

  • R Core Team (2016). R: A language and environment for statistical computing. Wien: R Foundation for Statistical Computing. Retrieved from http://www.R-project.org First citation in articleGoogle Scholar

  • Rubel, J., Lutz, W., Kopta, S. M., Köck, K., Minami, T. & Zimmermann, D., et al. (2015). Defining early positive response to psychotherapy: An empirical comparison between clinically significant change criteria and growth mixture modeling. Psychological assessment, 27, 478 – 488. First citation in articleCrossref, Google Scholar

  • Rubel, J. A., Rosenbaum, D. & Lutz, W. (2017). Patients’ in-session experiences and symptom change: Session-to-session effects on a within- and between-patient level. Behaviour Research and Therapy, 90, 58 – 66. First citation in articleCrossref, Google Scholar

  • Sapyta, J., Riemer, M. & Bickman, L. (2005). Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology, 61, 145 – 153. First citation in articleCrossref, Google Scholar

  • Saxon, D. & Barkham, M. (2012). Patterns of therapist variability: therapist effects and the contribution of patient severity and risk. Journal of Consulting and Clinical Psychology, 80, 535 – 546. First citation in articleCrossref, Google Scholar

  • Saxon, D., Barkham, M., Foster, A. & Parry, G. (2016). The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies. Clinical Psychology & Psychotherapy, 24, 575 – 588. First citation in articleGoogle Scholar

  • Schiefele, A. K., Lutz, W., Barkham, M., Rubel, J., Böhnke, J. & Delgadillo, J., et al. (2016). Reliability of therapist effects in practice-based psychotherapy research: A guide for the planning of future studies. Administration and Policy in Mental Health and Mental Health Services Research. Advance online publication. https://doi.org/10.1007/s10488-016-0736-3 First citation in articleGoogle Scholar

  • Shimokawa, K., Lambert, M. J. & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298 – 311. First citation in articleCrossref, Google Scholar

  • Simon, W., Lambert, M. J., Busath, G., Vazquez, A., Berkeljon, A. & Hyer, K., et al. (2013). Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: A randomized controlled study. Psychotherapy Research, 23, 287 – 300. First citation in articleCrossref, Google Scholar

  • Simon, W., Lambert, M. J., Harris, M. W., Busath, G. & Vazquez, A. (2012). Providing patient progress information and clinical support tools to therapists: Effects on patients at risk of treatment failure. Psychotherapy Research, 22, 638 – 647. First citation in articleCrossref, Google Scholar

  • Strauss, B. M., Lutz, W., Steffanowski, A., Wittmann, W. W., Boehnke, J. R. & Rubel, J., et al. (2015). Benefits and challenges in practice-oriented psychotherapy research in Germany: The TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy. Psychotherapy Research, 25, 32 – 51. First citation in articleCrossref, Google Scholar

  • Walfish, S., McAlister, B., O’Donnell, P. & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110, 639 – 644. First citation in articleCrossref, Google Scholar

  • Whipple, J. L., Lambert, M. J., Vermeersch, D. A., Smart, D. W., Nielsen, S. L. & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50 (1), 59 – 68. First citation in articleCrossref, Google Scholar

  • White, M. M., Lambert, M. J., Ogles, B. M., Mclaughlin, S. B., Bailey, R. J. & Tingey, K. M. (2015). Using the Assessment for Signal Clients as a feedback tool for reducing treatment failure. Psychotherapy Research, 25, 724 – 734. First citation in articleCrossref, Google Scholar

  • Wittchen, H. U., Zaudig, M. & Fydrich, T. (1997). Skid. Strukturiertes klinisches Interview für DSM-IV. Achse I: Psychische Störungen. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Worthen, V. E. & Lambert, M. J. (2007). Outcome oriented supervision: Advantages of adding systematic client tracking to supportive consultations. Counselling and Psychotherapy Research, 7 (1), 48 – 53. First citation in articleCrossref, Google Scholar

  • Zimmermann, D., Rubel, J., Page, A. C. & Lutz, W. (2017). Therapist Effects on and Predictors of Non‐Consensual Dropout in Psychotherapy. Clinical Psychology & Psychotherapy, 24, 312 – 321. First citation in articleCrossref, Google Scholar