Clients' experience of therapy and its outcomes in ‘good’ and ‘poor’ outcome psychological therapy in a primary care setting: An exploratory study

Abstract

Aim: The qualitative experience of clients judged by quantitative measures as having ‘good’ or ‘poor’ outcome is not often the focus of outcome research. This exploratory study investigates client experience of psychological therapy in an inner-city primary care centre across two client groups, differentiated on the basis of their outcome scores on quantitative measures. Method: Clients (N=11) were allocated to one of two research groups, (a) good outcome (n=5), or (b) poor outcome (n=6) on the basis of their pre- and post-therapy outcome scores on the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). They participated in a face-to-face semi-structured interview. Data were recorded and analysed using a descriptive and interpretive qualitative method. Results: Both groups had broadly similar experiences of their current therapy although some differences in emphasis emerged. Good outcome clients described a greater sense of empowerment in therapy, commenting on a feeling of equality with their therapist and exhibiting greater autonomy overall. Poor outcome clients valued therapist support and while reporting increased awareness of problematic functioning described a reluctance to engage fully in the therapeutic process. Conclusion: There was very little difference in the qualitative accounts of therapy and its impact by the clients deemed by quantitative pre-post therapy measurement as either ‘good outcome’ or ‘poor outcome’. There is further research warranted, examining whether clients that seem to benefit from therapy according to standard pre-post measurement, experience therapy and its impact differently to clients whose pre-post results suggest that therapy did not work.

Keywords:

• psychotherapy
• process
• outcome
• primary care

Acknowledgement

We would like to acknowledge the contribution of Sheila Hawkins, a Senior Counselling Psychologist, whose service hosted the study (South Inner City Partnership in Primary Care).

Additional information

Notes on contributors

James McElvaney

Biographies

James McElvaney is a counselling psychologist and PhD candidate at Trinity College Dublin. He is involved in clinical work at the Central Remedial Clinic, Dublin and in private practice.

Ladislav Timulak

Ladislav Timulak is a counselling psychologist and Course Director of the Doctoral Programme in Counselling Psychology at Trinity College Dublin. He is an active psychotherapy researcher and also involved in clinical work.