While the beneficial effects of psychotherapy have been well documented, the fact remains that 5 to 10 percent of clients get worse while in treatment (Lambert & Ogles, 2004) and a large minority of patients show little response (Hansen, Lambert, & Forman, 2003). The effects of four interventions, aimed at reducing deterioration and enhancing positive outcomes were examined in an Immediate Electronic Feedback sample of 1101 patients whose outcome was contrasted across experimental groups and with two archival groups: the Week-Delayed Feedback group, consisting of archival data from 1374 patients and the treatment-as-usual control group consisting of archival data from 1445 patients. Results indicate that feedback to therapists improved outcome across clients, especially for signal-alarm cases. Therapist feedback effects were enhanced by the use of manually based Clinical Support Tools, but not by providing direct feedback to clients about their progress. There were no significant differences in outcome between the Week-Delayed CST feedback and the 2-Week-Delayed CST feedback groups; however, clients in the Week-Delayed CST feedback condition, attended 3 less sessions, on average, than their 2-Week-Delayed CST feedback counterparts. Furthermore, a significantly greater number of people in the Week-Delayed CST Feedback group ended treatment in the Recovered/Improved classification of the Jacobson/Truax model.

While most clients show improvement in therapy, anomalously, 5% to 10% actually worsen, and a significant minority of clients shows little or no response to therapy. Earlier studies developed clinical support tools (CSTs) designed to provide feedback to therapists about potential problem areas and to improve the likelihood of a positive outcome for clients identified as at-risk for a negative outcome in therapy (Harmon et. al. 2007; Slade, Lambert, Harmon, Smart, & Bailey, 2008; Whipple et al., 2003). While varying from study to study, the CSTs looked at five domains: therapeutic alliance, motivation to change, social support, life events, and perfectionism. More than 100 questions were used to assess these domains. The major goal of this study was to streamline the CST measures to increase efficiency. Toward that end, a new instrument consisting of 37 questions was developed by administering questionnaires to 169 patients at a rural Utah mental health center. In addition, the life events and social support questions were given to 76 students at Brigham Young University and 88 randomly selected residents of Utah County. Using item response analysis and mean scores for each dimension, subscale cut scores were developed for four dimensions: therapeutic alliance, motivation for therapy, social support, and life events. The perfectionism subscale was dropped from the questionnaire because perfectionism was deemed to be too stable to be useful for the intended use of the measure. Cut scores were also developed for each individual question. These subscale and individual item cut scores are intended to help clinicians identify potential problem areas to be explored during the course of therapy.

Diese publikationsgestützte Dissertation umfasst Arbeiten zum Thema Monitoring und Feedback in der stationären Psychosomatik. In zwei Arbeiten wurde untersucht, ob die Effektivität von psychosomatischen Behandlungen gesteigert werden kann, wenn Therapeuten regelmäßig Feedbackberichte der Monitoring- und Feedbacksoftware OQ-Analyst erhalten Hier zeigte sich, dass Feedback den Outcome von Patienten mit erhöhtem Risiko einer Verschlechterung verbessern kann. Bei den restlichen Patienten dagegen konnte Feedback den Therapieprozess nur schwach und nur kurzfristig für eine Behandlungswoche verbessern. In einer weiteren Arbeit wurde untersucht, ob sich unterschiedliche Belastungsgrade im wöchentlichen Monitoring differenziell verändern. Hierfür wurde das ICD-10-Symptomrating herangezogen. Die Ergebnisse lieferten Hinweise darauf, dass sich depressive Beschwerden und Angstbeschwerden schon in der ersten Behandlungswoche verbessern, somatoforme Beschwerden jedoch erst im späteren Behandlungsverlauf. Die vierte Arbeit setze sich mit der Fragestellung auseinander, ob Therapiebeziehung, soziale Unterstützung, Motivation, und Lebensereignisse mit bedeutsamen Verbesserungen und bedeutsamen Verschlechterungen assoziiert sind. Während alle vier Bereiche mit bedeutsamen Verbesserungen verknüpft waren, waren nur soziale Unterstützung und Lebensereignisse mit bedeutsamen Verschlechterungen assoziiert. / This dissertation is based on four publications on monitoring and feedback in psychosomatic in-patient therapy. In two publication it was investigated whether the effectiveness of psychosomatic in-patient therapy can be increased when therapists routinely receive the feedback reports of the monitoring and feedback software OQ-Analyst. Feedback could improve the outcome of patients at risk of treatment failure. For the remaining patients, feedback could optimize the therapy process only slightly for one treatment week. In another publication, the ICD-10-Symptom-Rating was used to explore how different symptoms change on a weekly basis. While depressive symptoms and symptoms of anxiety disorders improved already in the first treatment week, more treatment weeks were required to improve somatoform symptoms. In a fourth publication, associations between considerable positive as well as considerable negative change and the therapeutic alliance, social support, motivation, and life events were investigated. While all four factors were associated with considerable improvements, only social support and life events correlated with considerable deteriorations.