Client satisfaction with psychotherapy: What are clients really trying to tell us?

Jill Reed (2000)

In the current managed health care marketplace, client satisfaction has become a more important indicator of quality of care than either published outcomes studies or the use of clinical guidelines, and the trend to use satisfaction surveys as a standard quality-assurance practice is likely to continue. However, the utility of client satisfaction surveys is limited in assessing services, as existing measures tend to produce inflated ratings and fail to discriminate factors relating to client satisfaction and dissatisfaction with services. Some of the problems responsible for the limited usefulness of existing satisfaction measures could be related to inherent methodological difficulties, or differences between the perceptions of the researcher or provider and the client. This study examined whether a wider range of attributes could be identified that could further discriminate factors relating to client satisfaction and dissatisfaction with psychotherapy. In focus groups and individual interviews, clients identified factors which they associated with their psychotherapy experience. This client-derived data then became the source from which a new satisfaction survey was constructed, and subsequently administered to outpatient psychotherapy clients of a regional behavioral health care organization. The new scale is a more sensitive measure in detecting dissatisfaction, and yields more discriminating information than the most frequently used client satisfaction measure, the CSQ-8 (Larsen, Attkisson, Hargreaves, & Nguyen, 1979).