Predictors of good outcome in very brief versus longer therapy

Kelly Aine Quester (1999)

While about 30% to 50% of clients terminate within one to four sessions, little is known about treatment outcome for this group. The purpose of this study was to assess predictors (demographic, diagnostic/clinical, and symptom severity) of good and poor outcome for brief and longer treatment groups. This study examines four outpatient groups: (1) those who have had good outcome (improved) and terminated within one to four visits; (2) those who have had poor outcome (not improved or worsened) in one to four visits; (3) those who have had good outcome in eight or more visits; and (4) those who have had poor outcome in eight or more visits. Clients were 152 outpatient admissions from three urban community mental health centers in the Midwest. Each client completed the Brief Symptom Inventory (BSI, Derogatis & Spencer, 1982) and Client Problem Rating (Mintz & Kiesler, 1982) at intake, 10 weeks and 5 months. Jacobson and Truax's (1991) criteria for Reliable Change were used to establish good outcome and poor outcome for the outcome measures. Univariate statistical tests were used to identify variables related to good and poor adjustment within each visit group (1 to 4 visits and 8+). For the I to 4 visit group, the following variables were found significant with the BSI as the outcome measure - high number of client anticipated visits ( p <.003), not inpatient referred (p <.002), referral source other than self ( p <.04), pretreatment BSI ( p <.01), and borderline significant, marital status ( p <.09). Discriminant Function Analysis (DFA) using these variables was able to correctly classify 82.14% of the grouped cases. With the Client Problem Rating as the outcome measure the following variables were found significant: Pretreatment BSI ( p <.02) and borderline significant, Pretreatment Client Problem Rating ( p <.09). The DFA correctly classified 60.38%. For the 8+ visit group, pretreatment BSI ( p <.09) was borderline significant using the BSI as the outcome measure. Pretreatment Client Problem Rating ( p <.005) and Sex ( p <.03) were significant using the Client Problem Rating as the outcome measure. The DFA correctly classified 62.26%. This could have important humanitarian and financial implications in the delivery of mental health services.