Individualized patient-progress systems: Why we need to move towards a personalized evaluation of psychological treatments.

Abstract

Patient-focused psychotherapy research refers to the monitoring, prediction, and evaluation of patient progress in therapy. This is traditionally based on repeated standardized measurement and followed by the provision of nomothetic feedback to both therapists and patients based on those measures. Patient progress throughout therapy can also use idiographic assessments, which involve using personalized instruments to elicit information that is truly specific to each patient. This article introduces the concept of individualized progress research, which combines nomothetic and idiographic measures, and presents the individualized patient-progress system (IPPS; Sales et al., 2011, 2011a, 2011b), a hybrid patient-progress system. There are benefits to using a hybrid approach: Nomothetic instruments compare clients whereas idiographic assessments provide a better understanding of each clinical case. Preliminary feedback of therapists piloting the IPPS suggests that this system is helpful to clinical tasks such as monitoring individual-family-group psychotherapy change, assisting clinicians in addressing patients' realistic needs, and stimulating patients' self-reflection about therapy. Keywords: idiographic assessment, individualized patient progress, tracking systems, routine evaluation, personalized evaluation, metric-frequency similarity, MF calculator, IPPS, hybrid outcome, literature review The relevance of patient monitoring has been acknowledged by both psychotherapy researchers and professional organisations. According to the Recommendations of the American Psychological Association's Division 29 Task force on Evidence-Based Therapy Relationships chaired by Norcross (201 1), Practitioners are encouraged to routinely monitor patients' responses to the therapy relationship and ongoing treatment. Such monitoring leads to increased opportunities to reestablish collaboration, improve the relationship, modify technical strategies, and avoid premature termination, (http://www.div 1 2,org/task-force-evidence-basedtherapy-relationships) Theoretically rooted in the patient-focused approach, tracking systems traditionally follow a nomothetic approach. These systems use standardized, quantitative self-report questionnaires (e.g.. Outcome Questionnaire System; Lambert, Hansen, & Harmon, 2010; Treatment Outcome Package; Kraus & Castonguay, 2010; Clinical Outcome Routine Evaluation (CORE)-PC; Barkham, MellorClark, Connell, Evans, & Margison, 2010). They also provide therapists with nomothetic feedback, such as progress charts or tables that include patient scores throughout dierapy, in comparison with clinical and nonclinical populations (clinical cutoffs). Some also include alerts, or clinical flags, to highlight areas of major concern such as a brief red note stating that the patient presents signs of deterioration in a certain area (e.g., interpersonal problems; CORE-PC; Barkham et al., 2010). Numerous studies have demonstrated that providing dierapists with nomothetic feedback may potentially reduce symptomatology and improve treatment outcomes, including patient functioning and well-being (e.g., Bickman, Andrade, Kelley, Breda, & Riemer, 2011; Dyer, Page, & Hooke, 2011; Jong & Timman, 2011; Lambert et al., 2003; Miller, Duncan, & Sorrell, 2006; Reese, Toland, Slone, & Norsworthy, 2010; Witold, Harris, & Lambert, 201 1). Feedback may also influence the therapists' clinical decisions, such as selecting topics for discussion with patients or determining the dosage of treatment to be administered (Kelley et al., 2011; Lutz et al., 2009). Research has shown that therapists find feedback from nomothetic measures useful for approximately 60% of dieir caseload (Rottger, Rubel, & Lutz, 201 1). The feedback assisted clinicians in tasks such as enhancing treatment motivation, supporting patient strengths and the therapeutic relationship, and discussing information with patients when unfavourable progress was observed. …