Do we know when our clients get worse? an investigation of therapists' ability to detect negative client change
Abstract
Routine clinical judgment is often relied upon to detect client deterioration. How reliable are therapists' judgments of deterioration? Two related studies were conducted to investigate therapist detection of client deterioration and therapist treatment decisions in situations of deterioration. The first study examined therapists' ability to detect client deterioration through the review of therapy progress notes. Therapist treatment decisions in cases of client deterioration were also explored. Therapists had considerable difficulty recognizing client deterioration, challenging the assumption that routine clinical judgment is sufficient when attempting to detect client deterioration. A second study was a survey of therapists asking how they detect client deterioration and what treatment decisions they make in response. Symptom worsening was the most commonly stated cue of deterioration. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: • Clinicians may have a difficult time detecting when their client's symptoms are worsening. • Outcome assessment strategies do exist to help clinicians detect client deterioration.
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There is a tendency in clinicians to neglect negative effects.
“Since there is a tendency in clinicians to neglect negative effects (Hatfield, McCullough, Frantz, & Krieger, 2010;Sarkozy, 2010)”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Hatfield, McCullough, Frantz, & Krieger, 2010
These measurement-based care programs do not reach all patients with mental disorders, and most health care providers do not routinely apply measurement-based care.
“However, these programs do not reach all patients with mental disorders, and a majority of health care providers do not routinely apply measurement-based care 48,49 .”
From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [48]
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- Authors
- Hatfield, D., McCullough, L., Frantz, S. H. B., & Krieger, K.
- Affiliations
- Indiana University of Pennsylvania (US)
- Corresponding author
- Hatfield, Derek
- Venue
- Clinical Psychology & Psychotherapy
- Publisher
- Wiley
- Published
- 2009-11-13
- Volume
- 17
- Issue
- 1
- Pages
- 25-32
- ISSN
- 1063-3995 (ISSN-L)
- 1099-0879
- OpenAlex
- W2050524608
- Cited by
- 321
- References
- 12
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 39 · 2023: 22 · 2022: 29 · 2021: 24 · 2020: 24 · 2019: 16 · 2018: 27 · 2017: 20 · 2016: 13 · 2015: 29 · 2014: 18 · 2013: 10 · 2012: 14
- FWCI
- 9.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology & Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- clinical judgment, treatment decision-making, symptom worsening, outcome measurement
- MeSH terms
- Affect, Attitude of Health Personnel, Clinical Competence, Decision Making, Humans, Judgment, Professional-Patient Relations, Psychotherapy, Surveys and Questionnaires, Treatment Outcome
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