Understanding Long-term Outcome from the Patients' Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy.

Melissa De Smet,Reitske Meganck

doi:10.5334/pb.432

Abstract

Objective:The complex phenomenon of psychotherapy outcome requires further conceptual and methodological developments that facilitate clinically meaningful research findings. In this study, we rely on an idiosyncratic and process-oriented understanding of treatment effects in order to investigate long-term outcome. A conceptual model of long-term outcome is presented that comprises both a taxonomy of change and explanatory factors.Method:A mixed methods naturalistic study was conducted in an inpatient psychotherapy setting. Long-term quantitative outcome data are complemented with a data-driven thematic analysis of interviews with 22 participants, five to six years after ending inpatient psychotherapy.Results:Long-term outcome findings show improved well-being for the majority of former patients and this until five to six years after treatment. From the patients’ perspectives, long-term changes can be situated on different interrelated existential levels: reconnection to others and (the meaning of) life, a revelation, an altered self, life changes, and altered expectations and ideas about recovery and treatment. The complex interplay of the person, the therapy centre, the outside world and the evolution over time helped explain the experienced changes and individual differences.Conclusion:The findings support the value of an idiosyncratic and process-oriented understanding of outcome and recovery as well as substantiate the importance of multiple methods and perspectives when studying the effects of psychotherapy.

Highlights

Understanding the effects or outcome of psychotherapy is essential for both research and clinical practice, yet the on-going discrepancy between both fields impedes a mutual dialogue (Castonguay, Barkham, Lutz & McAleavey, 2013; Kazdin, 2008)
As outcome research has a huge impact on clinical practice through health care policy (APA, 2006; McLeod, 2016), the question of how to define and determine the effects of therapy remains a central issue
Further conceptual and methodological developments are required in order to curtail the divide between research and clinical practice (Kazdin, 2008; McLeod, 2011)

Summary

Introduction

Understanding the effects or outcome of psychotherapy is essential for both research and clinical practice, yet the on-going discrepancy between both fields impedes a mutual dialogue (Castonguay, Barkham, Lutz & McAleavey, 2013; Kazdin, 2008). As outcome research has a huge impact on clinical practice through health care policy (APA, 2006; McLeod, 2016), the question of how to define and determine the effects of therapy remains a central issue. In studying the effects of therapy, outcome has traditionally been separated from the process of treatment (Hill & Lambert, 2004), resulting in an arbitrary differentiation. This misconception has ‘clouded the thinking regarding research design’, especially in outcome research, as ‘to some extent process research is outcome research, and outcome research is equivalent to process investigation’ Long-term follow-up studies have shown the value of investigating treatment outcome over a longer period of time, looking at treatment effects in a processoriented manner, yet to date such long-term outcome studies remain limited (Ekroll & Rønnestad, 2016)

Methods

Results

Discussion

Conclusion