a Department of Psychiatry , Weill Cornell Medical College , New York , NY , USA.
b Department of Psychology , The Pennsylvania State University , State College , PA , USA.
Psychother Res. 2019 Feb;29(2):139-156. doi: 10.1080/10503307.2017.1395921. Epub 2017 Nov 2.
Though many studies have shown that psychotherapy can be effective, psychotherapy available in routine practice may not be adequate. Several methods have been proposed to evaluate routine psychological treatments. The aim of this paper is to demonstrate the combined utility of complementary methods, change-based benchmarking, and end-state normative comparisons, across a range of self-reported psychological symptoms.
Benchmarks derived from randomized controlled trials (RCTs) and normative comparisons were used to evaluate the effectiveness of psychotherapy in a large (N = 9895) sample of clients in university counseling centers (UCCs).
Overall, routine psychotherapy was associated with significant improvement across all symptoms examined. For clients whose initial severity was similar to RCT participants, the observed pre-post effect sizes were equivalent to those in RCTs. However, treatment tended to lead to normative end-state functioning only for those clients who were moderately, but not severely, distressed at the start of psychotherapy.
This suggests that although psychotherapy is associated with an effective magnitude of symptom improvement in routine practice, additional services for highly distressed individuals may be necessary. The methods described here comprise a comprehensive analysis of the quality of routine care, and we recommend using both methods in concert. Clinical or methodological significance of this article: This study examines the effectiveness of routine psychotherapy provided in a large network of counseling centers. By comparing multiple established methods to define outcomes in this sample we provide a detailed understanding of typical outcomes. The findings show that, across several different problem areas, routine psychotherapy provided substantial benefit, particularly to clients in the most distress. However, there is room to improve, especially by increasing the number of clients who return to normal functioning by the end of treatment. Using distinct methods provides complementary answers to the question: How effective is routine psychotherapy?
尽管许多研究表明心理治疗有效，但常规实践中的心理治疗可能并不充分。已经提出了几种方法来评估常规心理治疗。本文的目的是展示补充方法、基于变化的基准测试和终态规范比较在一系列自我报告的心理症状中的综合效用。
使用来自随机对照试验 (RCT) 的基准和规范比较来评估大学咨询中心 (UCC) 中大量 (N=9895) 客户的心理治疗效果。
总体而言，常规心理治疗与所有检查症状的显著改善相关。对于初始严重程度与 RCT 参与者相似的患者，观察到的预-后效应大小与 RCT 中的相当。然而，治疗仅倾向于导致规范的终态功能，仅对于那些在心理治疗开始时中度但不严重困扰的患者。
这表明，尽管心理治疗与常规实践中症状改善的有效幅度相关，但可能需要为高度困扰的个体提供额外的服务。这里描述的方法构成了对常规护理质量的综合分析，我们建议同时使用这两种方法。本文对临床或方法学的意义：本研究检查了在大型咨询中心网络中提供的常规心理治疗的效果。通过在该样本中比较多种已建立的方法来定义结果，我们提供了对典型结果的详细了解。研究结果表明，在几个不同的问题领域中，常规心理治疗提供了实质性的益处，特别是对最困扰的患者。然而，仍有改进的空间，特别是通过增加治疗结束时恢复正常功能的患者数量。使用不同的方法可以为常规心理治疗的有效性提供互补的答案。
