Treatment success or failure? Using a narrative interview to supplement ROM.

Although routine outcome monitoring (ROM) has been demonstrated to improve therapy efficiency and effectiveness, categorizations of improvement or deterioration using ROM measures (typically global symptoms) may not always be consistent with the lived experience of the client. A recent line of investigation examines these discrepancies and recommends supplementing ROM with additional measures or narrative interviews. In this case study, we use qualitative analysis of a posttreatment interview to specifically examine the client's perspective of discordant outcome when ROM indicated that the client deteriorated during treatment and the client reported retrospective improvement. We find that the interview provides a unique and helpful narrative perspective that supplements ROM. Findings suggest it may be useful to supplement ROM with approaches that extend beyond global symptom measurement and that outcomes from aggregated patient-focused research may be more complex than anticipated.

Common Factors in Biofeedback Administered by Psychotherapists.

Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82-96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors-including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring-may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors.

Therapist training, feedback, and practice for dream work: a pilot study.

Thirteen therapists (8 women, 5 men; M age = 29.1 yr., SD = 6.3; M counseling experience 2.7 yr., SD = 6.3, range = 1 semester to 8 yr.) received training in the cognitive-experiential model of dream work through a didactic-experiential workshop, individual feedback, and practice. All participants but one were enrolled in masters' or doctoral level counseling training programs. An examination of effect sizes indicated that (a) therapists' self-efficacy about using the dream model increased substantially and positive attitudes toward dreams increased slightly after the didactic-experiential workshop; (b) the process and outcome of the second dream session were better for therapists who received individual feedback after the first session than for therapists who did not receive feedback after the first session; and (c) for the subgroup of six therapists who conducted five sessions, therapists' attitudes toward using the dream model improved, and their self-efficacy for working with dreams and perceived self-competence in dream work increased.