A study of outcome in a clinical psychology service and preliminary evaluation of cognitive-behavioural therapy in real practice

Abstract

This paper presents data collected as part of an ongoing audit and describes the clinical characteristics and progress in treatment of a subgroup of clients presenting to a direct referral clinical psychology service. Cases were selected retrospectively from data spanning a 40-month period on the following criteria: 1) clients presenting with anxiety and/or depression as the primary problem (identified by treating therapist); 2) audit data completed by client and therapist at both pre- and post-treatment time points; 3) clients attending at least two sessions of treatment. All clients were offered cognitive - behaviourally oriented therapy. Multiple measures of initial problem severity and outcome including standardised measures of symptomatology, therapist ratings of improvement and therapist and client ratings of achievement of individualised therapeutic goals were utilised. The degree of correspondence between the different measures of outcome was examined and possible predictors of outcome explored. Results tentatively suggest an encouraging level of improvement, with a high degree of correlation between outcome measures and two measures (self-reported duration of presenting problem and Global Assessment of Functioning (GAF; APA, 1987)) predicting outcome. The study represents a preliminary step towards assessing the impact in 'real-life' services of techniques proven to be effective in controlled trials and highlights some of the methodological difficulties inherent in this endeavour.