Testing the Dose-Response Curve in a Training Clinic Setting: Use of Client Pretreatment Factors to Minimize Bias in Estimates

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Abstract

Patient-focused research has been empirically established to reduce drop-out (Lambert, Hansen, & Finch, 2001) and improve outcomes (Reese, Norsworthy, & Rowlands, 2009), particularly for those at risk for treatment failure (Shimokawa, Lambert, & Smart, 2010). An additional benefit associated with the use of patient-focused research systems is the facilitating the integration of clinical and research endeavors. In an archival study, the current work utilized patient-focused research data (N = 132) to explore outcomes. Analyses focused on the number of sessions required for clients to experience reliable improvement or clinically significant change, while controlling for relevant pretreatment characteristics. Results demonstrated that while a significant proportion of clients experienced positive effect from treatment (41.2%), an even larger proportion of the sample (48.9%) did not experience any reliable improvement. In addition, results demonstrated that the number of presenting problems significantly influenced the median treatment length for improvement, with more than 1 problem generally predicting faster improvement. Finally, the results also highlighted potential problems with treatment length, with a number of clients staying in treatment significantly longer than what would be predicted to generate reliable or clinically significant change. Overall, the results support conducting psychotherapy research in a training clinic environment, with the potential for research to inform clinical care as well as clinical care informing future research projects.

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