A recent study highlighted discrepancies between qualitative client self-reports of outcome and OQ-45 reports. Specifically, only 8.8% of clients who deteriorated during a course of therapy based on the OQ-45 perceived that they had deteriorated, while 50% of these clients perceived that they had improved in therapy (Top et al., 2018). This phenomenon, where different means of tracking outcomes yield divergent results, has been called “paradoxical outcome.” The trend suggests that the most advanced forms of tracking psychotherapy outcomes might not detect important facets of outcome from the perspective of psychotherapy clients. The current study is a qualitative investigation of the experience of psychotherapy clients who reported improvements in therapy despite meeting criteria for deterioration per the Outcome Questionnaire-45.2 (OQ-45; Lambert et al., 1996). We used a consensual qualitative research (CQR) protocol (Hill, 2012). CQR uses group consensus to detect themes in participant interviews. Common themes included attributing negative changes to factors outside of therapy, endorsing complicated circumstances, and reporting positive outcomes that were not well detected by the OQ-45. More results and their implications are discussed.

The Outcome Questionnaire (OQ-45; Lambert et al., 1996) has been widely employed as a psychotherapy outcome monitoring measure following research findings that support various aspects of its validity and sensitivity to change. Despite its broad usage in both clinical and research settings, some of its psychometric properties are not definite. The three subscales of the OQ-45 are designed to measure three distinct, but related, aspects of psychological functioning. However, neither the one- nor three-factor models have been supported by previous research. Likewise, the results of the current study supported neither of those factor structures. It was suspected that heterogeneity in data might have led to the lack of the confirmatory factor analysis model fit. Therefore, factor mixture modeling (FMM), a combination of confirmatory factor analysis and latent class analysis, was employed to investigate potential heterogeneity of the data. Among the series of factor mixture models with varying numbers of classes that were fitted, the two-class, unconditional FMM based on the revised three-factor solution was decided to best describe the data under analysis. Although three covariates of clinical status, sex, and race were selected as known sources of heterogeneity and incorporated into the FMMs (i.e., conditional model), the findings were contradictory to expectations. The implications of these findings in counseling were discussed in terms of aggregating OQ-45 scores and its score interpretation. Furthermore, this study demonstrates the process involved and dilemmas encountered in choosing the best fitting FMM. There is currently no criterion for assessing individual model fit. Instead, models’ fit are compared using various information criteria (IC). And, as was found in the current study, these ICs are frequently contradictory. Thus, the process of identifying the best fitting model cannot rest solely on fit indices but must also depend on interpretation of models and consideration of the ultimate use of the results. In the current study, consideration of transition matrices and the pattern of latent means across classes contributed as much to model selection as fit index interpretation. / text

This study examines the intersection of religion, mental health, and psychotherapy, specifically focusing on the concept of religious injury or harm. The literature review reveals a gap in research regarding the identification of religion as a potential source of emotional pain in religious individuals. To address this gap, this longitudinal study utilized intake data from 1303 clients and follow-up data from 748 clients three months after the completion of psychotherapy treatment. Primary objectives of the study were to examine whether religious commitment changes over the course of psychotherapy, explore if religious commitment influences mental health counseling outcomes, and better understand the relationship between psychological distress, religious commitment, and therapy outcomes among individuals who perceive religion as having harmed them. The results demonstrate that regardless of religious injury status, psychological distress decreased throughout the treatment period. Furthermore, psychotherapy not only reduced psychological distress but also altered client's religious commitment. Higher religious commitment at follow-up appeared to mitigate the negative effects of religious harm on therapy outcomes, resulting in lower levels of religious harm and improved therapy outcomes. These findings suggest that psychotherapy can effectively alleviate psychological distress and modify religious commitment for individuals who perceive religion as harmful. This research contributes to the existing literature on psychology and religion and emphasizes the need for further exploration of the complex relationship between religion, mental health, and therapeutic interventions.

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Because of the lasting impact that traumatic family events can have on psychological well-being, students who present for services at college counseling centers may be experiencing problems and symptoms associated with earlier trauma. Many college counseling centers utilize the Counseling Concerns Survey developed by the Research Consortium of Counseling and Psychological Services in Higher Education (1991) and the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) as intake instruments to assess students who present for counseling. The major components of the Counseling Concerns Survey are the 18-item Family Experiences Questionnaire, which identifies history of family trauma, and the 42-item Presenting Problems List, which assesses students' major areas of distress. The OQ-45 measures symptom severity. While it is generally assumed that family trauma during childhood and adolescence can negatively impact future mental health and well-being, it has been unclear how specific traumatic family experiences reported on the Family Experiences Questionnaire are related to specific presenting problems as listed on the Presenting Problems List or symptom severity as measured by the OQ-45. The purpose of this study was to examine this relationship and to ascertain discernible patterns. Data from the intake instruments of 20,495 students who sought counseling services at a large western U.S. university from 1997 to 2007 was analyzed. Logistic regression of each of the 18 traumatic family history experiences was performed, using the initial OQ-45 score, the 42 Presenting Problems List items, and five Presenting Problems List factors (Draper, Jennings, & Baron, 2003) as "predictors" of the types of trauma the students might have experienced. Results showed that although family trauma of a variety of types was associated with symptom severity and various presenting problems, there did not seem to be an overall discernible pattern. The results suggest that trauma seems to have a diffuse association with presenting problems and symptom severity. However, some family traumas are associated with a greater number of presenting problems, and these traumas were identified.

Providing clinicians with a clearer understanding of how clients' recover over the entire course of therapy has important implications for referral and treatment strategies. The present study compares rates of change in 160 clients in group therapy with 6632 clients in individual therapy and 864 clients receiving both individual therapy and group therapy. Therapeutic outcomes were measured using the Outcome Questionnaire-45. Data was analyzed using Hierarchical Linear Modeling (HLM), also called Multi-Level Modeling (MLM), to produce recovery curves for clients in each group. Recovery curves showed that most change occurred in the early part of group therapy and slowed near the end. Rates of change for clients in group, individual and conjoint therapy formats were also compared. This study reports that no significant differences in rates of recovery were found between group and individual or group and conjoint treatment formats. However, a significant difference was detected when individual and conjoint treatments were compared, with the individual sample improving at a faster rate.