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Dissertation

Early prediction of psychotherapeutic failure in a community clinic setting: Using in-place assessment instruments

1 April 2006

Abstract

This study was intended to be a program development focusing on designing a reliable and valid predictive instrument of therapeutic risk factors that would allow student clinicians to assess for potential therapeutic failure. The planned predictive instrument was to be designed for use with the community mental health client population receiving psychotherapeutic services at the Psychological Services Center in Portland, Oregon. Using the archival data generated from in-place outcome assessment instruments such as the Outcome Questionnaire 45 (OQ-45) and the Working Alliance Inventory - Short Form (WAI -SF), as well as demographic and accounting data it was hypothesized that there would be enough data variability to statistically reveal key predictive factors for this population: an OQ-45 Reliable Index of Change (RCI) of less than 14, a WAI-SF client report of 28 or less, sliding scale fee for services impact, payment schedule effect, disrupted attendance patterns, and gender differences. The results of data analysis did not support the hypotheses assumptions of predictive powers for therapeutic failure with this population. The discussion focuses on possible areas of improvement for future program development efforts looking to capture early warning signs of potential therapeutic failure and subsequent rupture and early termination.


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