Do clinicians really use feedback-monitoring systems? A qualitative analysis of 16 group leaders.

The use of feedback based on outcome and process measures to inform treatment is gaining ground as one form of evidence-based treatment. However, little is known regarding how therapists actually use feedback, particularly from process measures, to affect treatment. This two-part qualitative study used session-by-session and treatment-episode narratives from group therapists to define how they acted on process feedback from a member-completed measure of the therapeutic relationship: the Group Questionnaire (GQ). Therapists' responses in the first wave of data were also used to develop a therapist-completed measure to quantify how feedback affected treatment. Sixteen group leaders received weekly session feedback reports on group members' responses to the GQ from the preceding group session. Leaders explained how they used that feedback in two ways: (a) with session-by-session written descriptions of feedback use and (b) with end-of-semester debrief interviews in which leaders described their experience with the feedback over the course of an entire group treatment episode. A content analysis of leader descriptions was undertaken by two independent pairs of raters to determine whether common patterns of use could be uncovered. Thirteen common use categories emerged across the two rater pairs. A 7-item questionnaire reflecting the most frequently used categories of use completed at the end of group treatment was shown to be highly correlated with session-by-session leader narrative. Implications of the common use patterns across therapists, variability between therapists, and the potential of the 7-item questionnaire are discussed. (PsycINFO Database Record