A recent study highlighted discrepancies between qualitative client self-reports of outcome and OQ-45 reports. Specifically, only 8.8% of clients who deteriorated during a course of therapy based on the OQ-45 perceived that they had deteriorated, while 50% of these clients perceived that they had improved in therapy (Top et al., 2018). This phenomenon, where different means of tracking outcomes yield divergent results, has been called “paradoxical outcome.” The trend suggests that the most advanced forms of tracking psychotherapy outcomes might not detect important facets of outcome from the perspective of psychotherapy clients. The current study is a qualitative investigation of the experience of psychotherapy clients who reported improvements in therapy despite meeting criteria for deterioration per the Outcome Questionnaire-45.2 (OQ-45; Lambert et al., 1996). We used a consensual qualitative research (CQR) protocol (Hill, 2012). CQR uses group consensus to detect themes in participant interviews. Common themes included attributing negative changes to factors outside of therapy, endorsing complicated circumstances, and reporting positive outcomes that were not well detected by the OQ-45. More results and their implications are discussed.
College and Department
Family, Home, and Social Sciences; Psychology
BYU ScholarsArchive Citation
Ghelfi, Eric Alexander, "When Clients Who Got Worse Believe They Got Better: A Qualitative Analysis of OQ-Deteriorators Reporting Improvement In Therapy" (2021). Theses and Dissertations. 9259.
psychotherapy, deterioration, OQ-45