Relationship of satisfaction to symptom change, follow-up adjustment, and clinical significance.

The relationship of client satisfaction to outcome was investigated for adult outpatients (N? = ?152) from 3 urban community mental health centers. Clients completed a problem self-rating and the Brief Symptom Inventory (BSI) at intake, 10 weeks later, and 5 months later. Therapists' ratings of client adjustment were obtained at intake and termination. Clients' ratings of satisfaction with treatment were obtained at 10-week and 5-month follow-up. Correlations between satisfaction and client measures of outcome (client rating and BSI) based on pre-post changes, posttreatment adjustment, and Jacobson and Truax's (1991) method of measuring clinical significance were not significant. Correlations between satisfaction and therapist outcome ratings were significant but low for pre-post changes and clinical significance. The utility of client satisfaction as an outcome measure is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment outcome and follow-up evaluation based on client case records in a mental health center.

Assessed the outcome of treatment of 121 mental health center clients (11–70 yrs of age), using therapist and independent global improvement ratings and independent ratings of notes in case records based on a client-specific goal-oriented outcome technique (Goal Attainment Scaling; GAS). Telephone follow-up of 50 clients provided a 2nd GAS assessment, client global improvement ratings, and 3 consumer satisfaction ratings. Findings indicate that (a) independently determined GAS scores and therapist and independent global ratings converged significantly, (b) the GAS procedure provided some increase in accuracy as well as an increase in specificity of outcome, and (c) client global ratings may reflect satisfaction with treatment rather than outcome. In view of the intercorrelations among measures and the relationship between GAS scores determined from case records and telephone interviews, case records may provide for accurate assessment of client problems and treatment success. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multiperspective comparison of satisfaction, symptomatic change, perceived change, and end-point functioning.

Measures of satisfaction have become increasingly popular as indications of psychotherapy outcome both in research and in practice. Several studies have explored the relationship between satisfaction and symptomatic change, with mixed results. The present study examines the relationship among satisfaction, symptomatic improvement, perceived change, and end-point functioning from multiple perspectives. Sixty-six clients from 2 Midwestern community mental health centers, 48 of their spouses and significant others, and their therapists participated in the study. Results indicated that satisfaction was not significantly related to symptomatic change. Satisfaction and perceived change were significantly related from all 3 perspectives. Satisfaction was also significantly related to end-point functioning from the client and significant other perspectives. The unique contribution of satisfaction data to a comprehensive outcome evaluation strategy is discussed. Researchers, administrators, and practitioners are encouraged to use satisfaction measures with a greater awareness of both their strengths and their limitations as outcome indicators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Indicators of Client Engagement: Influences on Alcohol Treatment Satisfaction and Outcomes.

This investigation explored the relationship of client engagement variables (client expectations, therapeutic/working alliance, and session attendance) with treatment satisfaction and posttreatment drinking-related outcomes using data from 2 outpatient alcohol treatment studies (N = 208). Path analysis was used to test a model in which engagement variables jointly influence client satisfaction with treatment and subsequent drinking-related outcomes. The proposed model fit well with the data and accounted for 14-23% of the variance in posttreatment outcomes. The relationships in the model suggest that the link between treatment satisfaction and outcome is clarified by examining client engagement variables, which relate indirectly to outcome by means of client satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of a cognitive restructuring program for treating posttraumatic disorders in adolescents.

The study explored the feasibility and efficacy of a manualized cognitive restructuring program for treating adolescents suffering from posttraumatic stress disorder (PTSD). Nine girls and 3 boys (mean age 16 years; range = 14–18), with PTSD, were recruited from a community mental health center and a tertiary health care center and enrolled in a pilot study. The adolescents were seen weekly for 12–16 weeks of individual treatment. Variables assessed included: trauma history, PTSD diagnosis and severity, depression, substance abuse, and client satisfaction. Twelve adolescents consented to treatment; 9 completed the program. The number of types of traumas reported averaged 6.5 (range = 1–13). Paired t tests were used to test prepost change for PTSD symptoms and depression, in completers. From baseline to posttreatment, there were statistically significant improvements in PTSD and depression. Treatment gains were maintained at 3 month follow-up. Preliminary results suggest the feasibility of implementing a manualized cognitive restructuring program to treat PTSD in adolescents. Completers rated themselves as improved and satisfied at posttreatment and 3-month follow-up. Feedback from referring clinicians also indicated high satisfaction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Homophobia in the therapist and gay or lesbian client: Conscious and unconscious collusions in self-hate.

Explores from a psychodynamic perspective negative biases (NBs) that interfere with or negatively impact the functioning of the gay or lesbian client. Therapist NBs are subsumed under homophobia and heterosexism, and client NBs are subsumed under internalized homophobia. Denial of these biases in the therapist and the client leads to a negative treatment outcome by many different conscious and unconscious collusions between therapist and client. Clinical examples of collusions are discussed according to the therapeutic stages of referral, history taking and diagnosis, treatment, collateral interventions, process, content, and outcome. Recommendations include correcting the problems in lack of training and education of mental health professionals and creating ongoing dialog regarding self-examination of homophobia among practicing psychotherapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social desirability, psychological distress, and consumer satisfaction with mental health treatment.

The purpose of the present study was to determine the strength of the relationship between social desirability, psychological distress, and consumer satisfaction with mental health treatment. More specifically, our goal was to assess whether socially desirable responding accounts for much more variance in reports of client satisfaction than in self-reports of psychological distress. The sample consisted of 82 clients in therapy at the Center for Eclectic Psychology, a clinic affiliated with a large francophone university. Subjects completed the Balanced Inventory of Desirable Responding, the Symptom Checklist-10, and the Client Satisfaction Questionnaire. Correlational analyses revealed that both consumer satisfaction reports and psychological distress scores were contaminated by socially desirable responding. These findings are discussed in terms of the validity of client satisfaction measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-deception, impression management, and consumer satisfaction with mental health treatment.

The strength of the relationship between two major components of social desirability (self-deception and impression management) and consumer satisfaction with mental health treatment was determined in a study of 81 former outpatients of a university psychology clinic. Ss completed the Self-Deception Questionnaire and the Other-Deception Questionnaire by H. A. Sackheim and R. C. Gur (1978) and the Client Satisfaction Questionnaire. Correlational analyses revealed that consumer satisfaction reports were associated with self-deception and impression management. These findings are discussed in terms of the validity of client satisfaction measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life: A review of theory and practice implications for individuals with long-term mental illness.

Reviews quality of life (QOL) models and findings applied to individuals with long-term mental illness as an illustration of approaches to QOL methodologies and models. Gap-discrepancy theories are discussed, and life satisfaction and adaptive functioning models of QOL and measurement instruments related to these models are described. QOL represents a viable means of investigating the subjective well-being of individuals with chronic mental illness. Despite psychiatric symptomatology, measuring QOL or subjective well-being represents a viable means of measuring client change or program outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal therapy and ability to display empathy, warmth and genuineness in psychotherapy.

Tested the hypothesis that number of hours of personal therapy would be positively associated with therapists' ability to display empathy, warmth, and genuineness in the treatment hour. 17 therapists, (graduate students in a clinical psychology doctoral program) submitted sample tapes of their therapy sessions and completed the MMPI and questionnaires regarding their therapy experience as a client. The tapes were rated by mental health professionals trained in the use of the Truax and Carkhuff scales for Accurate Empathy, Nonpossessive Warmth, and Genuineness. These scores were compared with number of hours of therapy experience as a client using a Spearman rank order correlation. Comparisons were significant for Empathy and Genuineness. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural control in psychotherapy with minority clients.

Reviews the literature on mental health services for minority clients, suggesting that these persons experience special problems with the traditional mental health delivery system. Epidemiological and attitude studies have indicated that minority client and majority therapist expectations for psychotherapy are often discrepant. Counseling and psychotherapy outcome research on therapist–client racial pairing has yielded inconclusive results at present. It is hypothesized that the therapist–client racial pairing may interact with level of therapist dominance in affecting psychotherapy outcome. Dominant majority clinicians may manipulate minority persons toward majority values, which may comprise a form of cultural control. Highly dominant clinicians are posited to function more effectively with culturally similar clients than with culturally different clients in that domination may be appropriate to a certain degree in culturally homogeneous settings. Low dominant clinicians are posited as being more effective than highly dominant clinicians with culturally different clients in that they would be more likely to attempt to understand the client's cultural perspective in a nonmanipulative manner. (100 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directions for clinical research and genomic research into the next decade: implications for informatics

Managed care continues to revolutionize the provision of mental health services in the United States. Long-term, open-ended therapies have been replaced by short-term, highly focused interventions. Increasingly, managed care organizations rely on standardized preferred practice guidelines to give direction and focus to social work and other therapeutic interventions. Critics argue that changes effected by managed care, particularly the use of treatment guidelines, depersonalize the client-worker relationship and significantly reduce the role of empathy in the therapeutic process. Moreover, these critics suggest that overall client satisfaction with mental health services has deteriorated. This article presents a study that examined clients' perceptions of empathy and overall satisfaction with managed behavioral health care when the clients were in unstructured individual therapy or in time-limited standardized group therapy. The results reveal no significant difference in the clients' perception of empathy or of their overall satisfaction regardless of the type of treatment they received. This article describes the rationale and design of the study, presents the results, and discusses the implications for social work practice.     

Examining the content of mental health intake assessments from a biopsychosocial perspective.

Psychotherapists' approach to intake assessment has a major impact on mental health case conceptualization and treatment. Despite the importance of this issue, very little is known about the actual intake assessment practices of therapists providing mental health care in the community. This appears to be the first study that has investigated which aspects of biological, psychological, and sociocultural functioning are documented by therapists in their client intake assessments, how thoroughly these issues are assessed, and how well the information collected is then integrated into the assessment findings and case conceptualization. The examination of 163 client files from 3 mental health clinics found that therapists were regularly collecting client information regarding a wide range of biopsychosocial issues, though not in a detailed or comprehensive manner. There was also little evidence that the information was being integrated in a manner designed to maximize treatment effectiveness. These findings have major implications for training and practice in mental health assessment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A continuum of care: More is not always better.

This article describes an $80-million project designed to test whether a continuum of mental health and substance abuse services for children and adolescents is more cost-effective than services delivered in the more typical fragmented system. The study showed that an integrated continuum was successfully implemented that had better access, greater continuity of care, more client satisfaction, and treated children in less restrictive environments. However, the cost was higher, and clinical outcomes were no better than those at the comparison site. The article concludes that reform of mental health systems alone is unlikely to affect clinical outcomes. Cooperation is needed between mental health providers and researchers to better understand how to improve services delivered in the community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health state preferences of persons with anxiety

We have described a program that integrates clinical approaches of infant mental health to infants and toddlers in foster care. The juxtaposition of a mental health program in a forensic setting creates a number of special features that we have highlighted. Unique from the clinical perspective, the team is explicitly relationship-focused, attempting to understand all of the young child's caregiving relationships as they affect development. We strive to enhance the quality of all of relationships in which infants participate, fostering healthy attachments and development. Also unique is the emphasis on system liaison, and making programmatic efforts to affect various systems involved in making custody determinations about infants and toddlers. Unique from the forensic perspective, we offer multidisciplinary expertise about an especially high-risk population, a comprehensive service delivery system in which we provide or coordinate and monitor all intervention efforts for a given family, a prevention orientation, and clinical follow-up with infants for as long as they are in care. The goals of the program include expediting permanency planning decisions, increasing continuity in high-quality foster care placements, increasing court satisfaction with mental health consultation, decreasing the number of court-ordered evaluations for adjudicated families, and increasing CPS satisfaction with available treatment and continuity of care. We believe that this approach integrates delivery of services to the youngest and most vulnerable victims of maltreatment and expedites permanency planning.     

Pellucid marginal corneal degeneration 12 years after penetrating keratoplasty for keratoconus

Historically the divisions between the mental health and substance abuse fields have been so deep that attempts to provide coordinated treatment across service sectors for people with dual diagnoses of psychiatric disorder and substance use disorder have failed. The authors describe a program in Maine designed to develop collaboratives, or communities of providers, who work together to offer coordinated mental health and substance abuse treatment and support. Surveys of provider agencies in one collaborative conducted one year and two years after the collaborative was established showed an increase in interagency referrals, joint assessments of clients, and jointly sponsored training and client services.     

Viscoelastic adherence to corneal endothelium following phacoemulsification

OBJECTIVE: The study examined the prevalence and correlates of criminal victimization and the relationship between victimization and client outcomes for homeless clients with mental illness. METHODS: Subjects were clients in community treatment programs participating in the Access to Community Care and Effective Services and Supports (ACCESS) program of the Center for Mental Health Services. Data were obtained through interviews conducted at program entry and at three and 12 months after entry with ACCESS clients in 18 sites during the first year of program operation (N = 1,839). Self-reports of victimization during the past two months as well as data on sociodemographic, health, and social adjustment indicators were obtained at each time point. Multiple regression was used to determine both the correlates of victimization among this population and the effect of recent victimization on client outcomes three and 12 months after program entry. RESULTS: Forty-four percent of the clients were the victims of at least one crime during the two months before entering the program. Women were significantly more likely than men to have been victimized. Multivariate analysis showed that the more severe the client's psychotic symptoms, alcohol abuse, and criminal history, the more likely he or she was to have been victimized. Recent victimization had a significant impact on client outcomes in terms of increased homelessness and decreased quality of life. Victimization shortly before program entry was also the single most important predictor of victimization at both follow-up points. CONCLUSIONS: These findings suggest the critical need for service providers who work with homeless people with serious mental illness to assess the extent to which they have been victims of crime and to address issues of victimization and safety along with psychiatric and social adjustment problems.     

Client and therapist session satisfaction over the course of psychotherapy.

Examined the patterns of therapist and client session-by-session satisfaction (SSS) over the course of psychotherapeutic treatment as they varied by eventual outcome. The theoretical literature proposes 1 of 2 models for SSS evaluation patterns over the course of therapy for successful dyads: either linear increase over time or a curvilinear pattern. These models were examined using 23 therapist–client dyads at a university counseling center. The highly successful dyads demonstrated the curvilinear pattern for both the client and therapist evaluations and the linear pattern for the therapist, while the least successful group did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies for preparing clients for treatment. A review

Substantial numbers of mental health clients do not return following their initial therapy visits or drop out of treatment prematurely. Two general classes of strategies designed to reduce premature attrition and enhance treatment participation are reviewed. Research on psychotherapy preparatory techniques (role induction, vicarious therapy pretraining, and experiential pretraining) indicates that these educational techniques are effective in reducing early treatment attrition and may be especially effective with populations at high risk for dropout (e.g., lower socioeconomic groups, chronically mentally ill clients, and institutionalized juvenile delinquents). Motivational interviewing, a technique originally developed for clients with alcohol problems, is designed to reduce client ambivalence toward therapy and change and enhance commitment to and motivation for treatment. Research in the alcohol field suggests that a session of pretreatment motivational interviewing enhances treatment outcome. Both motivational interviewing and psychotherapy preparatory techniques are relatively brief and easy to incorporate into existing mental health care.