Bruce Wampold, PhD
Now that we have agreed (hopefully) that Measurement-Based Care (MBC) is a method that improves psychotherapy outcomes, we are faced with the logical next question: What should be measured?
Over the years, specific instruments have been developed and used for MBC, including the Outcome Questionnaire (OQ), Treatment Outcome Package (TOP), and the Outcome Rating Scale (ORS), among many others. Some commonly used measures for MBC involve assessing symptom level (for example, the Symptom Checklist, SCL-90 or abbreviated measures). Other MBC measures assess various aspects of the process of psychotherapy, particularly the therapeutic alliance. All of the instruments have some advantages and disadvantages.
At CarePaths, we selected measures and procedures according to several principles:
Here’s what we settled on:
The most prevalent mental health disorders are depression and anxiety. Most mental health disorders are characterized by elevated levels of depression and anxiety. It is essential therefore to assess symptoms of anxiety and depression. We have chosen the two most widely used and accepted measures:
Well-being and Loneliness
Most patients come to therapy seeking much more than a decreased symptomatology. Generally, patients desire greater well-being and decreased loneliness. It is established that perceived loneliness increases risk for mental as well as physical illness and places individuals at as much or more risk for death than smoking, obesity, lack of exercise, and excessive drinking. This has led us to include the following two instruments:
Alliance, relationship, and perceived belief in treatment
There is strong evidence that humans have evolved to make judgments of others along two dimensions: warmth and competence. These two dimensions are critical in medicine and psychotherapy. Basically, does the patient perceive the clinician (a) to be trustworthy, caring, genuine, and willing to work in the patient’s best interest, and (b) is the therapist competent to perform the treatment, meaning that the patient perceives that the treatment, as administered by the clinician, will be effective. We use two scales here:
These three sets of measures, albeit brief, provide critical information that will be helpful to the therapist and to the patient to assess the process and outcome of therapy. Integrated into therapy and combined with the clinical judgment of the therapist, this information will be useful for understanding progress, modifying treatment, strengthening the relationship, and planning termination and referral.
In my next two entries, I will discuss some of the procedural details of this particular MBC protocol, as well as exercising clinical judgment in interpreting and acting on the data collected.
Article provided by makingtherapybetter.com
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