Client Treatment Outcomes Research Articles

Art therapy and neuroscience: evidence, limits, and myths.

The evidence base for the effectiveness of art therapy continues to grow, even as a mechanistic understanding of how art therapy works remains limited. One promising avenue for increasing our understanding of how and why art therapy works is through the lens of neuroscience. A neuroscience-based approach to art therapy provides opportunities for improving understanding of the neural processes that underlie the complex interaction between perception, cognition, emotion and behavior that play out in the art therapy process. Understanding how therapeutic change occurs can result in improved treatment and better outcomes for clients. However, it can be tricky to connect art therapy and psychological theory directly to neural responses. The purposes of this perspective are to provide an overview of the current evidence and limits of neurobiological concepts of neuroplasticity, mirror systems, and interoception as applied to art therapy practice, and to provide updated information about outdated concepts that are still actively used in clinical practice. Critical analysis and understanding of the current scientific knowledge base can then be used to guide art therapy practice and support the development of hypothesis-based research to determine the primary mechanisms that drive the observed effects of art therapy interventions.

Applying Comfort Theory to Improve Outcomes for People in Sickle Cell Crisis.

When people with sickle cell disease in vaso-occlusive crisis need hospitalization, they often experience fragmented and disparate treatment. Racial, gender, and socioeconomic treatment bias by providers, including nurses, is complicated by the current reactionary United States (US) controlled substance policies. To provide high-quality and respectful care, nurses can use Kolcaba's Comfort Theory as the framework for a holistic plan to assess, deliver individualized interventions, and evaluate outcomes for people experiencing vaso-occlusive crisis. Once in the electronic medical record, it can guide care during future hospitalizations. By refocusing on the nursing value of providing comfort care to individuals in distress, nurses can change treatment outcomes for clients.

Healthcare provider perspectives on the facilitators, barriers and unexplored opportunities to support the recovery of clients on medications for opioid use disorder in Kenya

IntroductionOpioid use is associated with significant burden of disease. Medications for opioid use disorder such as methadone are effective treatments. This study aimed to identify the healthcare provider perspectives on facilitators, barriers and unexplored opportunities toward achieving optimal clinical outcomes for clients on methadone treatment.MethodThe study conducted at a methadone treatment clinic in Kenya, used an exploratory study design to explore healthcare provider experiences of providing care to patients on methadone treatment. Interviews lasting an average of 30–40 min were transcribed verbatim and analyzed thematically using NVivo 12 software.ResultsEleven participants were enrolled and three themes were identified namely: (a)The impact of methadone treatment on clients whereby methadone was perceived to possess transformative attributes enabling clients to regain some semblance of control of their lives including finding gainful employment and relationship restoration; (b) Threats to client recovery which include factors at the individual level such lack of training and factors at the system levels such as inadequate staff, and; (c) Thinking outside the box whereby participants proposed diverse strategies to support clients’ full engagement in care including private–public partnerships to support travel logistics.ConclusionsHealthcare providers caring for clients on methadone treatment exhibited an understanding of the facilitators, barriers and opportunities for improving treatment outcomes for clients on methadone. Finding innovative solutions to mitigate the barriers identified can increase client retention and treatment outcomes.

Enhancing Psychological Wellbeing Practitioner (PWP) practice for depression and anxiety in the context of personality difficulties: a pilot audit of CPD workshop feedback

Abstract Psychological Wellbeing Practitioners (PWPs) are central to NHS Talking Therapies services for depression and anxiety (TTad; formerly ‘IAPT’). This workforce has been trained to deliver low-intensity treatments for mild to moderate depression and anxiety. In practice, PWPs routinely work with more complex clients, likely due to a combination of reasons. Over half of referrals experience concurrent personality difficulties, which are linked to poorer treatment outcomes, and PWPs describe feeling unskilled to work with these clients. This study aimed to develop and pilot a Continuing Professional Development workshop for PWPs about enhancing practice in the context of concurrent personality difficulties; and evaluate acceptability, feasibility and potential impacts on clinical skills and attitudes. This is an audit of routine feedback from a pilot of the workshop offered in a single TTad PWP workforce (n=139). The workshop was successfully developed and a series of five workshops were delivered to 74% of the PWP workforce. Feedback was overwhelmingly positive, and a majority of PWPs reported improved confidence in key skills covered during the workshop, and a positive attitude towards working with clients with personality difficulties after the workshop. PWPs described enhanced capability, opportunity and motivation to undertake work with this client group following the workshop. The workshop showed potential to improve PWP confidence and skill to support TTad clients in the context of personality difficulties, although it is not yet known if this translates to better treatment outcomes for clients. Implications for practice and future research are discussed. Key learning aims (1) Understand the feasibility of gathering feedback and outcome data of a Continuing Professional Development (CPD) workshop delivered in routine practice for PWPs. (2) Understand PWP perspectives on attending a CPD workshop to support tailoring PWP treatments for depression and anxiety in the context of personality difficulties. (3) Reflect on potential opportunity to enhance PWP treatments in the context of personality difficulties via brief training workshops. (4) Consider how COM-B can be used to explore barriers and enablers to PWPs implementing new learning to their practice.

Race Matching in Predicting Relational Therapy Outcome: a Machine Learning Approach

ABSTRACT This study explores the relationship between therapist-client race/ethnicity matching on client treatment outcomes and whether other demographic factors contribute to treatment outcomes in a training clinic. An ANCOVA was conducted to examine the differences between race match and mismatch groups. A random forest algorithm was used to determine how racial matching conditions and other factors, such as gender, predict treatment outcomes. We found significant relationships between therapist-client race/ethnicity matching conditions and treatment outcomes for clients who received at least 10 sessions of therapy. However, results of the random forest algorithm indicated that race/ethnicity matching is one of the weakest predictors of treatment outcomes. Clinical implications and the limitations of the study are discussed.

Treatment and Partner Notification Outcomes for Clients Diagnosed With Chlamydia and Gonorrhea Through GetCheckedOnline Compared With Sexually Transmitted Infection Clinics in British Columbia, Canada.

ABSTRACT Background Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline GCO), an internet based testing service in British Columbia (BC). Methods We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016-2017 was matched to two STI clinic cases by diagnosis, gender, age group, and specimen collection date. Data was collected through chart review with outcomes compared using appropriate statistical tests. Results Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254/257, 98.9%) and clinic (513/514, 99.8%) cases, as was engagement in partner notification (250/257 (97.2%) vs. 496/514 (96.5%)). There was no difference in the proportion of notified partners between GCO (159/270, 58.9%) and clinic cases (253/435, 58.2%) although a greater proportion of partners reported by clinic cases were notified by STI nurses (43/435, 9.9%) vs. GCO cases (6/270, 2.2%). Conclusions GCO clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for partner notification among clinic clients may be related to having had an initial in-person testing visit.

Therapist initial attachment style, changes in attachment style during training, and client outcome in psychodynamic psychotherapy.

This study extended the cross-sectional therapist attachment literature by examining longitudinal changes of therapist attachment avoidance and anxiety in relation to client treatment outcome. Data consisted of 942 Outcome Questionnaire-45 assessments (Lambert et al., 1996, 2004) of 213 clients working with 30 therapists from a university clinic that provided psychodynamically/interpersonally oriented individual therapy, and yearly therapist self-report of attachment styles using the Experience in Close Relationships Scale (Brennan et al., 1998) over 2-4 years of training at a university clinic. Using multilevel growth modeling, we found that initial attachment anxiety or avoidance alone were not associated with treatment outcomes. Instead, therapists with small increases in attachment avoidance, from a low avoidance baseline, were more effective in helping clients reduce psychological distress than their peers. Findings suggest that small increases in attachment avoidance may be a beneficial development for trainees, as it may reflect a process of learning emotional boundary regulation (Skovholt & Rønnestad, 2003) and taking on the observer aspect of the participant-observer role (Sullivan, 1953). Current findings challenged the assumption that higher therapist attachment avoidance and anxiety is always associated with worse client outcome and suggested the importance of continuous self-reflection to understand how one's own attachment change impacts their clinical practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparing treatment and substance use in case-managed and non-case managed clients receiving opiate replacement therapy with a co-existing mental illness: a cross-sectional study

ABSTRACT Objectives This study examines the differences in clinical presentation, treatment, and clinical outcomes for clients with co-existing psychiatric and substance use disorders (CED) undergoing opioid replacement therapy (ORT) through a physician-led metropolitan specialist addiction clinic (SAC), in comparison to clients who receive concurrent community mental health case management (CMH-CM). Method A cross-sectional study of data extracted from electronic medical records was conducted on all active clients identified with CED who were actively engaged with the SAC for ORT over a 2-month period. Results Of 310 clients on ORT, 21% (N = 64) had a CED. CMH-CM was concurrent in a minority of those with a CED (N = 18, 28%). CMH-CM clients were significantly more likely to have a single psychiatric diagnosis (X2 9.2627; P < .01), a diagnosis of psychotic disorder (X2 8.2197; P < .01), and be prescribed antipsychotics (X2 12.863; P < .01). Multiple psychiatric diagnoses (X2 9.2627; P < .01) and a diagnosis other than psychotic disorder (X2 6.7046; P < .01) were significantly more common in Non-CM clients. Conclusions In the absence of fully integrated addiction and CMH services, the provision of evidence-based treatment requires building clinical capacity to identify and manage CED across mental health and addiction services.

Understanding the Effect of the COVID-19 Pandemic on Substance Use Disorder Treatment Facility Operations and Patient Success: Evidence From Mississippi.

Background:The COVID-19 pandemic has led to disruptions in the provision of care at substance use disorder (SUD) treatment facilities. Stresses associated with the pandemic could also negatively impact treatment outcomes for clients. The aim of this study is to evaluate how SUD treatment facilities in Mississippi changed their operations following the start of the pandemic. The change in client success rates at the facilities is also assessed.Methods:An online survey was completed by 12 SUD treatment facilities in Mississippi between February and May 2021.Results:Generally, the facilities’ capacity to provide treatment to clientele was moderately affected by the pandemic. Facilities in the sample also adapted a variety of policies to limit the spread of COVID-19. Changes in the services provided by facilities was observed in the survey responses. For client success rates reported by the facilities, there was a decrease in the number of facilities stating that more than 80% of their clients completed treatment across the pre- and post-pandemic periods. However, the number of facilities with more than 80% of their clients successfully finishing treatment has increased in recent months.Conclusions:To continue serving their clientele during the pandemic, facilities enacted COVID-19-related policies and began offering new services such as telehealth. Although client success rates decreased at the beginning of the pandemic, they have returned to pre-pandemic levels in recent months. Our results indicate that SUD treatment facilities and clients have improved in terms of giving and receiving care as the pandemic has progressed.

Determined to improve: An exploration of therapist perspectives about their development.

Scholars note that therapist performance is one of many factors that contribute to client treatment outcomes. Given that the performance of therapists matters, researchers have identified several methods and models for improving therapist effectiveness. However, scholars have yet to explore highly effective therapists' perspectives on their motivation to develop, the methods they use, and the impact of their efforts to develop. The present study used a consensual qualitative research (Hill & Knox, 2021) approach to explore dynamics underlying therapist development of expertise. Semistructured interviews were conducted with 12 therapists whose outcome data placed them in the top 25% of clinicians of their respective clinics, according to their supervisors. The researchers reached consensus at each stage of analysis as they organized data into domains, core ideas, and cross-analysis. Domains and corresponding subdomains were: (a) struggle with personal, external, and response to barriers subdomains, (b) therapist characteristics with striving, presence, skills, and values subdomains, and (c) development with early career, formal, feedback, relational, personal/identity subdomains. Implications for practice and areas for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Closer Look at Involuntary Treatment and the Use of Transport Service in Outdoor Behavioral Healthcare (Wilderness Therapy)

Outdoor behavioral healthcare (OBH or wilderness therapy) is an out-of-home adolescent treatment option serving tens of thousands of youths annually for behavioral, substance, and mental health issues in the United States. About half of OBH participants attend involuntarily and are transported by services specialized for “uncooperative” youth. Transportation has been argued by some researchers to have little impact on youth in treatment, and Tucker and colleagues found little difference in outcomes between not transported and transported youth. Ethical and empirical concerns arise from these findings, and we apply a critical perspective to address these concerns. Specifically, we examined the claim in OBH research that being transported has no significant bearing on client treatment outcomes. We propose that the findings of no difference were random, rather than systematic, because they were constructed on a post hoc measure of perceived voluntariness. To demonstrate, we used data from OBH to construct five different measures of voluntary/involuntary, also fabricated post hoc. All five operationalizations resulted in statistically significant differences across a variety of social and psychological outcomes, demonstrating inconsistencies across the findings. Further independent and rigorous research is called for in OBH to understand the use and ethics of forced transportation, coercion, and involuntary treatment.

PSYCHOLOGICAL WELL-BEING OF DRUG ADDICTS IN PREDICTING TREATMENT OUTCOMES

Purpose of the study: This study aims to investigate whether psychological well-being could predict treatment outcomes in drug addicts after they had received solution-based psychosocial intervention in a drug treatment setting. The psychological well-being of individuals is an important variable in discussing treatment outcomes after they were given psychosocial interventions.&#x0D; Methodology: This study utilized a quasi-experimental research design using non-randomized pre-and post-test single group design. Fifty-seven participants were selected and they completed a pre- and post-assessment on psychological well-being changes and treatment outcomes questionnaire. Paired t-test and Pearson correlation were used to analyze the relationship between these two variables, while multiple linear regression was used to further explore whether participants' psychological well-being could predict their treatment outcomes.&#x0D; Main Findings: Results indicated a significant relationship between these two variables and more than twenty percent in treatment outcomes were explained by psychological variance. Few contextual meanings of psychological symptoms should need to be emphasized in discussing the findings and future research direction.&#x0D; Applications of this study: Having studied whether psychological well-being could predict treatment outcomes of drug addicts would benefit counselors and social workers who deal with addiction clients. The element of psychological well-being, such as mental health must be included in the treatment plan to increase the success of recovery amongst drug addict clients.&#x0D; The novelty of this study: The conclusions from this study offer significant insight into the utilization of solution-focused intervention in non-Western populations and the relation between psychological well-being and treatment outcomes for drug addict clients. The findings expand the existing literature review on the psychological well-being of drug addicts in a way it takes into accounts the cultural context in discussing the outcomes.

An Indigenous American Conceptualization of Substance Abuse and Its Treatment

ABSTRACT Alcohol misuse has persisted in Indian country for generations. These disparities persist despite recent advances in services that often promote some combination of western-oriented conceptualizations of treatment with traditional healing and cultural practices. The intractability of alcohol and drug problems in many Indigenous communities suggests that current expressions of treatment are not sufficient to address substance misuse in these communities and effectively prepare clients for the post-treatment experiences of recovery. The focus of this paper is to generate hypotheses about what may be missing from the treatment today to improve treatment outcomes for Indigenous clients, and then propose ways for how treatment may be transformed from its current mostly western-oriented perspective to foundationally align with an Indigenous American worldview concerning well-being and health. Advancing treatment for American Indians and Alaska Natives includes consideration for how to address the consequences of colonialism that persist in ways that systematically harm the well-being and health of clients, how to align treatment models with Indigenous beliefs concerning an interdependent communalistic existence, and how to transform treatment to a holistic healing model that addresses alcohol and other substance misuse in the context of relationships.

Feedback in Couple and Family Therapy: A Randomized Clinical Trial

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC ("treatment as usual" or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire-45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed.

The Relationship Between Client Regulatory Focus and Treatment Use Intentions, Attitudes, Credibility Beliefs, and Outcome Expectations for Psychotherapy

Client variables in psychotherapy have been shown to play an important role in psychotherapy, explaining a significant amount of variance in treatment engagement, the therapeutic alliance, and psychotherapy outcomes; however, little is known about how the client variables develop. Specifically, there may be internal characteristics of the client that underlie several client attitudinal variables that play a role in psychotherapy. The purpose of this study was to test one particular client internal characteristic (regulatory focus) as a predictor of the psychotherapy use intentions, attitudes, credibility beliefs, and outcome expectations that clients hold. Participants from a nation-wide sample of adult clients (N = 663) and a sample of college students (N = 192) completed measures of regulatory focus, treatment use intentions, attitudes toward psychotherapy, credibility beliefs, and outcome expectations. Taken together, participants’ promotion-focus and prevention-focus scores significantly predicted treatment use intentions, attitudes, credibility beliefs, and outcome expectations. Specifically, across both samples a greater promotion-focus was significantly associated with more positive attitudes, credibility beliefs, and expectations. In contrast, a greater prevention-focus was significantly associated with more negative attitudes and not significantly related to credibility beliefs for psychotherapy. These results suggest that researchers and clinicians may want to focus on increasing promotion-focused goals and attitudes in clients in order to increase psychotherapy treatment-seeking and engagement.

Is evidence-based treatment helping my patient? Utilizing modified Brinley plots to measure clinical change.

Using both group (nomothetic) and individual (idiographic) approaches to measuring clinical change may provide more information about the effectiveness of an intervention than either approach alone. The current study re-examined previously published data from two randomized clinical trials of omega-3 fatty acids and Individual-Family Psychoeducational Psychotherapy as treatment for mood disorders in youth, using modified Brinley plots, a method of illustrating individuals' treatment response in the context of group information. Although the original nomothetic approach provided information about the average effect of treatment, modified Brinley plots gave more information about individual children's outcomes. Practicing clinicians in particular could use modified Brinley plots to track treatment trajectories and outcomes for specific clients and subsequently use these data to inform treatment planning.

Client predictors of the therapeutic alliance in individual resiliency training for first episode psychosis

Individuals experiencing their first episode of psychosis (FEP) are often reluctant to seek treatment, and are difficult to engage and retain in mental health services. The therapeutic alliance (TA), or the affective and collaborative bond between therapist and client, is predictive of better treatment outcomes for clients with FEP; thus, it is important to understand the predictors of the TA in order to determine how best to foster a positive alliance with these individuals. The primary aim of the present study was to examine whether baseline client characteristics, including severity of symptoms, social functioning, and insight, were associated with the TA. The exploratory aim was to examine associations between demographic variables (age, race, and gender) and the TA. The present study included a subsample of participants (n = 134) who received Individual Resiliency Training (IRT) as part of the NAVIGATE treatment in the Recovery After An Initial Schizophrenia Episode Early Treatment Program study. Four trained research assistants rated the TA from early audiotaped sessions of IRT. Multilevel modeling was utilized given the nested data structure. Results indicated that more severe positive and less severe negative symptoms were significantly and uniquely associated with a better therapeutic alliance, as was female gender. The findings suggest that client symptom profiles should be considered when developing a TA with FEP clients.

Who let the dogs out? Therapy dogs in clinical practice.

Animal-assisted therapy (AAT) is a growing field in Australia, and therapy dogs are becoming increasingly common in clinical settings. This paper aims to highlight the current issues facing AAT in Australia and to make recommendations on how to progress the field. We acknowledge that there are several ways that therapy dogs may enhance treatment outcomes for clients, such as reductions in stress and acute anxious arousal, and improvements in engagement and rapport. These psychological and physiological advantages, however, may not be sustained once interaction with the dog ceases. Clinicians require adequate training and support to develop and implement interventions that are based on sound theoretical foundations, and take advantage of the adjunctive benefits of animal presence. A series of recommendations are made for the professionalisation of AAT, including the development of consensus definitions, clinical governance, accreditation, research and evaluation.

A collaborative approach to psychotherapy termination.

Collaboration has been recognized as an important relationship variable in psychotherapy that is linked to client treatment outcomes. Although many therapists seek to build a collaborative working relationship with their clients when making treatment decisions, collaboration is also an important technique that can be used to help clients plan for a successful termination. Collaborative termination strategies can first be used in the initial session in order to address clients' termination expectations. Strategies can also be used throughout treatment to help clients focus on their treatment goals. Last, collaborative termination strategies should be used in the final session to help clients take ownership of their gains and to equalize the therapeutic relationship. In this article, we provide specific recommendations for collaborating with clients in preparing for psychotherapy termination. Case examples demonstrating these strategies are also provided. (PsycINFO Database Record

Evaluation of a general practitioner-led cardiometabolic clinic: Physical health profile andtreatment outcomes for clients on clozapine.

The present study is a review of a cardiometabolic clinic for consumers taking clozapine. This clinic was recently established and co-located with the clozapine clinic at a regional hospital in New South Wales, Australia, to enhance engagement and improve the physical health outcomes of consumers taking antipsychotic medication. A descriptive analysis of clients' (n=73) information collected during routine care for the first 6months of the clinic's operation, from January 2016 to July 2016, was conducted. First-visit data were analysed to establish a client profile, consisting of weight, height, blood pressure, pulse, a range of blood measurements, smoking status, alcohol consumption, and eating and exercise habits. Data collected for clients who had three or more visits with the general practitioner (n=40) were analysed separately for outcomes. Two case studies are used to depict the service received and client profile. At the first appointment, the majority of clients had metabolic syndrome that was mostly left untreated; many of these clients were commenced on metformin. The outcomes are positive, and show that the majority of clients lost weight (82.5%) and had a reduction in body mass index (84.6%); nearly half (44.4%) had a reduction in waist circumference. The majority of clients self-reported increased physical activity (72.5%, n=29) and positive dietary changes (77.5%, n=31) since their first appointment. The model trialled by the cardiometabolic clinic integrated a specialist mental health and primary care service, and demonstrates success in engaging clients with severe mental illness in physical health care. Co-location is conceptualized as critical for positive patient outcomes and high levels of engagement.