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The examination of treatment failure has substantial value in advancing psychological practice as illustrated by the articles in this special issue. Treatment failure is not well defined and includes at least two independent phenomena: nonresponse and deterioration. After discussing the important distinction between nonresponse to treatment and client worsening, some general findings are highlighted. These include client, therapy, and therapist dimensions. The retrospective study of nonresponse to treatment can lead to important modifications in treatment protocols and can influence theory as well as clinical intervention. However, there is a need for methods suitable for routine care that monitor treatment response and make suggestions for changes in real time. A system for accomplishing this task in routine care is briefly described. (Contains 1 table.)

The principle aim of this study was to estimate the number of sessions of psychotherapy needed for clients suffering from psychiatric illness to return to a normal state of functioning or reliably improve. This would be helpful for treatment planning and policy decisions regarding how much therapy is enough. The progress of 125 clients entering psychological treatment in two university training clinics was tracked on a session-by-session basis using a naturalistic design. Recovery and reliable improvement were the bi-nomial events of interest used in a survival analysis that estimated the number of weekly treatment sessions needed to meet criteria. Using survival analysis it was estimated that it would take about 8 sessions for 50% of clients to show reliable improvement and 21 sessions for about 85% to meet this criterion. Recovery took more treatment, with 50% of clients estimated to recover after 14 sessions and 70% requiring 23. On the basis of the present results we conclude that the present policy of the Australian Government in both the public and private sector regarding the number of sessions needed for clients entering psychological treatments to show a benefit is much less than is, in fact, necessary. The findings of the current study are roughly consistent with those found elsewhere and suggest a minimum benefit should be closer to 20 sessions. The current policy appears to be suitable for only about one-third of clients who carry the burden of psychological illness. (Contains 3 figures.)

Objective: Outcome research has documented worsening among a minority of the patient population (5% to 10%). In this study, we conducted a meta-analytic and mega-analytic review of a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure. Method: Original data from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6,151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were reanalyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians so that they could intervene before treatment failure occurred. Meta-analytic and mega-analytic approaches were applied in intent-to-treat and efficacy analyses of the effects of feedback interventions. Results: Three forms of feedback interventions--integral elements of this quality assurance system--were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (clinical support tools and the provision of patient progress feedback to therapists). Conclusions: The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome. (Contains 10 footnotes and 6 tables.)

Concern about the effects of counseling on ethnic minority clients has been repeatedly raised. Before embarking on a formal course of multicultural counseling sensitivity for counseling center staff, baseline client outcome data were sought as a method for evaluating the effects of this intervention. Archival data from a university counseling center were analyzed to assess the treatment outcome for four ethnic minority groups. Clients who identified themselves as Native American, Latino/a, African American, or Asian/Pacific Islander and who had both pre- and post-test scores on the Outcome Questionnaire-45 were selected for study. Each ethnic group member was matched with a Caucasian client based on initial level of disturbance, gender, marital status, and age. Every group of clients improved from intake to the termination of therapy. However, no differences in outcome were found between any ethnic group and its matched control group of Caucasians. Surprisingly, Native American clients (N = 50) had the most positive outcomes. (Contains 2 tables.)

Psychotherapy outcome can be enhanced by early identification of potential treatment failures before they leave treatment. In adults, compelling data are emerging that provide evidence that an early warning system that identifies potential treatment failures can be developed and applied to enhance outcome. The present study reports an analysis of early warning algorithms to identify treatment failures among child/adolescent patients (ages 3-18). The progress of 300 patients who had completed treatment was analyzed to see if algorithms could identify those children who ultimately had a negative outcome. Results indicated that the rationally derived method had a 77% success rate for identifying child/adolescent patients who were reliably worse or had deteriorated by the time that therapy was terminated.

This study tested the appropriateness of Outcome Questionnaire-45 norms for Asian and Pacific Islander students. Both groups scored higher, based on participants' self-reported general functioning, than the norms and more frequently met criteria for clinical classification, a possible indication of greater distress. This article discusses findings and therapeutic applications.

Sensitivity to change of the Outcome Questionnaire (OQ; M. J. Lambert et al., 1996) items, subscales, and total score was evaluated for clients receiving personal counseling in university counseling center settings. OQ data collected for 248 university students who did not receive treatment and 5,553 students who received treatment from 527 therapists employed in 40 university counseling centers nationwide were included in the analyses. Comparisons between the treated and untreated groups indicated that the OQ total score, all of the subscales, and 34 of the 45 items met 2 preset criteria for change sensitivity, providing support for the OQ as an appropriate index of outcome in counseling center clients. The 11 OQ items that failed to demonstrate change sensitivity were aimed at assessing aspects of interpersonal functioning, related to specific physical symptoms, or were susceptible to floor effects. The possibility of using change sensitivity results in revising the OQ for optimal use in counseling center settings is addressed, and general implications for outcome test development are discussed.

Examines whether feedback regarding client progress and the use of clinical support tools (CSTs) affected client outcome and number of sessions attended. Results showed that clients in the feedback plus CST group stayed in therapy longer and had superior outcomes. Nearly twice as many clients in the feedback plus CST group achieved clinically significant or reliable change. (Contains 46 references and 2 tables.) (GCP)

A study involving 83 college students, 83 community residents, and 103 patients was conducted to establish cutoff scores on the Inventory of Interpersonal Problems (IPP) (L. Horowitz and others, 1988) for judging clinically significant improvement in interpersonal functioning. The IPP could distinguish among students, patients, and an asymptomatic community sample, and cutoff scores were established. (SLD)

Proposed organizational and conceptual scheme consisting of content, source, technology, and time orientation dimensions to impose order on assessment of counseling outcome. Demonstrated scheme's utility through review of and application to outcome studies from two leading counseling journals over past three years. Further illustrates scheme through in-depth application to one specific outcome study. (Author/NB)

Treatment studies using the Zung Self-Rating Scale, the Beck Depression Inventory, and the Hamilton Rating Scale for Depression as dependent measures were reviewed to determine whether these scales provide comparable data for assessing treatment effects. Results indicated that the Zung and the Beck showed less change in depression following treatment than did the Hamilton. (Author/BL)