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Deference in Psychotherapy Influences How Clients Complete Outcome Measures

23 July 2018


Psychotherapy feedback instruments, commonly called “outcome measures,” have been implemented pervasively in mental health clinics and agencies across the country. Clients’ response strategies on these instruments could be influenced by dynamics inherent in the therapeutic relationship, particularly deference factors (Rennie, 1994b), which include concern about meeting therapist expectations, concern that responses/scores will be perceived as criticism or reflect badly on therapist, concern that responses/scores will cause therapist to feel badly about themselves, and feelings of indebtedness toward therapist. Additionally, a client’s attitude toward the frequent administration of these instruments could affect the client’s feelings toward therapy or the therapist. The existence and effects of bidirectional influences between the measurement experience and therapeutic relationship dynamics were the subject of this study. Adult, individual psychotherapy clients were surveyed to ascertain whether they are aware of deference factors while completing outcome measures and whether that awareness influences how they complete the questionnaires. Other information of interest was also collected, including who they believe reads their responses/scores, whether they believe their responses/scores are used to evaluate their therapist’s work performance, and whether their therapist discusses responses/scores with them in session. Results indicated that clients are aware of deference factors while completing outcome measures and that this awareness sometimes affects how they complete measures. As the quality of the therapeutic alliance increases, the influence of deference factors on outcome measure completion appears to decrease slightly. Significantly higher overall deference was reported among participants who identified as Asian, participants who identified themselves and their therapist in the same ethnicity category, participants who reported having attended more than 30 sessions with their therapist, participants who reported attending therapy at least weekly, participants who reported completing outcome measures at every therapy session, and participants who reported believing their responses/scores are used to evaluate their therapist’s work performance. This exploratory study has raised many questions that warrant further consideration and investigation.


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