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Outcome and Session Evaluation in Psychotherapy Thesis


Human beings have been experiencing numerous challenges in the course of life for a considerably long period of time now. Different intervention strategies have been employed in order to counter the problems with an attempt to solve them amicably.

Many psychological researchers have made attempts to explore the possibility of enhancing the effectiveness of handling the challenges experienced in life. Psychotherapy is one of the most focused upon field by the scientists in the recent past. It is a process employed by a psychotherapist when attending to the clients.

Psychotherapy involves interpersonal counseling sessions where the psychotherapist and the client interact closely with an aim of aiding the patient overcome the problems associated with life. The primary focus of most intervention measures is to help the client enhance the feeling of self-worth and hence promote their well-being for a better living.

Psychotherapy can be defined as a process geared towards the relief of distressing or a challenge in an individual by someone else, using a predetermined approach from a given theory or paradigm, and the psychotherapist must have some professional training as far as offering the services is concerned (Plante, 1998).

A ray of techniques are employed by the psychotherapists depending on the relationship built from experience, dialogue, and continued interaction.

Other strategies including promoting communication and the emphasis on the need for a behavior change with an aim of improving the client’s psychological health as well as the need to improve relationships among groups, for instance among members of family.

Psychotherapy is such a broad field that it can be practiced by different professionals and practitioners with varying qualifications.

For instance, it can be performed by psychiatrists, clinical psychologists, counseling psychologists, rehabilitation counselors, music therapists, mental health counselors, clinical social workers, marriage and family therapists, occupational therapists, psychiatric nurses, and psychoanalysts (Plante, 1998).

Given the broadness of psychotherapy, it has the capacity to assert itself as a profession on its own. There are several forms of psychotherapy but most of them use spoken means for exchanging information.

Other forms of communication include; the written word, drama, narratives, music, story telling, and the use of art. Psychotherapy is normally conducted in a structured environment between a trained psychotherapist and the client(s).

Over a long period of time now, psychotherapy has always been conducted in response to either different clinically diagnosable problems or non-specified mental expressions in human beings resulting from crises in life. Some therapeutic involvements are modeled to attend to clients in the symptom-based approach.

However, most interventions by psychotherapists do not employ the medical model when attending to their client(s). Clients, therefore, respond differently to all the various approaches and greatly determine whether they are satisfied by the services offered or not. The need to find out client satisfaction after a session in psychotherapy has been at the center of many researches for the past two decades.

Virtually all therapeutic encounters involve the discussion of very sensitive as well as strictly personal issues with the client. As a result, psychotherapists are often bound legally to observe confidentiality as far as sharing client’s information is concerned.

The techniques employed in measuring client’s satisfaction have not been as effective as they should be. This paper seeks to focus on the outcomes and session evaluation in psychotherapy. It will discuss and review existing research, the contributing factors, and propose direction towards achieving better treatment in psychotherapy in order to ensure client satisfaction.

Although there exists a number of research findings concerning client satisfaction in psychotherapy, advanced and thorough research in session evaluation in psychotherapeutic satisfaction as well as proposals for enhancing the effectiveness of therapeutic interventions need to be conducted.

Literature Review

Researchers have made significant progress in an attempt to enhance the quality of services offered to the client by psychotherapists. Analyses of outcome and evaluation of client satisfaction from psychotherapeutic sessions by researchers have been done with an aim of drawing meaningful conclusions for improving the various intervention approaches.

As much as there are a number of research findings and conclusions, so are the numbers of unaddressed deficiencies in enhancing the effectiveness of psychotherapeutic interventions. This section seeks to focus on the works done by six researchers that will highlight the need for conducting a project for my stated thesis.

In a journal article by Laszloffy (2000), research findings to investigate the implications of client satisfaction feedback for fresh family therapists are discussed.

In the study, the researcher integrated the client’s perspective on session satisfaction as opposed to the traditional pattern by researchers to ignore this aspect and relying only on therapist’s perspective. Client-satisfaction ratings of therapy sessions were solely used to assess outcome and to select sample.

The rating scale was designed such that the client rated the outcome of a given therapy as either “extremely satisfying” or “extremely dissatisfying”. The client sample was collected from a degree-granting marital and family therapy (MFT) training program in the United States.

It involved separate phone interviews with the therapists and clients within 1-2 months following the termination of the case. All the participants were informed about the project and they participated voluntarily by signing a consent form. Audio-taped interviews were conducted by 8 MFT master’s students.

The researcher investigated two closed-ended questions: “Were there any changes in presenting problem (yes or no)?” and “Please rate how satisfied/dissatisfied you are with the therapy you received/provided (on a 7-point Likert scale).”

The following open-ended questions were also asked: “What was particularly good about the therapeutic experience?” “What was particularly not good about the therapeutic experience?” and “How would you describe your relationship with your therapist/clients?”

The results from the sample were analyzed in terms of what was regarded as good and not good about therapy experience as well as the perception associated with the client-therapist relationship (Laszloffy, 2000).

The research question that the analyst used to find out the themes linked to the divergent outcomes was: What specific factors/themes appear to be linked to clients’ overall satisfaction or dissatisfaction with the therapy experience (i.e., therapeutic outcome)?”

This research question is in tandem with my thesis where deeper factors contributing to client satisfaction/dissatisfaction need to be investigated.

According to the research findings, a number of inherent themes were established. Most clients were positive with their relationship with their therapists. Those who were positive reported that they felt connected.

For the therapists, language barrier hindered their desire to develop positive relationship with their clients, but no hostility was implied by those who were extremely dissatisfied. Differences in the levels of client satisfaction were also found to originate from the varying definition of therapeutic goals.

The conclusion drawn indicated that clients and the therapists had remarkable congruent perceptions of the therapy experience (Laszloffy, 2000). This supports the thesis in that some important contributing factors were identified as determining client satisfaction in therapy sessions.

However, the sample used was very small and specific such that no generalizations can be made about the conclusions reached. The absence of a dialectical data-gathering method similar to qualitative research may have interfered with the results and hence validity of the conclusions.

Another research by Simmons and Doherty (1998) focused around the same topic of investigation. The author addressed the question of whether academic training backgrounds make any difference among practicing marriage and family therapists and the client’s satisfaction.

The study investigated members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy by comparing their performance on a wide range of clinical practice variables, and their clients were surveyed as far as their satisfaction and outcomes were concerned.

The findings showed highly similar practice patterns and client outcomes across all four disciplinary groups. Just like the findings by Laszloffy (2000), this research sought to explore the role that educational training background may have on client satisfaction. The research concluded that professional discipline does not make any meaningful difference in the outcomes of psychotherapy.

The findings of the study, however, cannot be generalized outside the members of the American Association for Marriage and Family Therapy although the 33% response rate raises even further doubts.

Also, the role of ethnicity and race was not properly taken into account since the therapists and the clients were 96.6% European American and the report identified this as a limitation (Simmons & Doherty, 1998). Hence, it is consistent with my thesis statement that further research into factors affecting client outcome in psychotherapy sessions is needed.

An earlier research by Howard, Moras, Brill, Martinovich, and Lutz (1996), investigated the comparative efficacy and effectiveness of clinical interventions, aggregated over groups of patients. They advocated the monitoring of a patient’s progress over the course of treatment.

The research concluded that despite the accumulation of evidence showing that psychotherapeutic interventions are efficacious and effective for mental health problems, the provision of such treatments is faced with major challenges. The concern raised here will be captured in the project that I intend to pursue in relation to the thesis statement.

In an attempt to predict the evaluation of psychotherapy sessions, just as is mentioned in the thesis above, Eugster and Wampold (1996) conducted a research using 114 therapists and 119 patients.

They used the Comparative Scale of Psychotherapy Session Constructs designed to measure 9 process variables and how they are related to the session evaluation from the therapists’ and patients’ perspectives. The findings revealed significant difference between the session evaluations for the two groups.

Therapist expertness predicted therapist session evaluation while therapist real relationship predicted the patient session evaluation (Eugster & Wampold, 1996).

The study findings also showed that there are both similarities and significant differences in how patients as well as therapists evaluate psychotherapy sessions. The research had its own limitations.

The participating therapists were from a small group of experts; hence, the findings could not be generalized. Furthermore, the research sought to explore the overall systematic differences between therapists and patients and not on individual basis. The project to be pursued will scale down its perspective to focus on the individual dyads.

A recent research which was conducted by Reese, Norsworthy, and Rowlands (2009) sought to explore and attempt to solve the question of whether continuous feedback system does improve psychotherapy outcome.

The authors hypothesized that the use of outcome data on a continuous basis to monitor treatment progress plays a role in enhancing psychotherapy outcome.

The research findings indicated that those patients who used the Partners for Change Outcome Management System (PCOMS) demonstrated significant treatment progress compared to those who did receive treatment usually (Reese et al., 2009).

Furthermore, the findings revealed that the clients who use PCOMS experienced reliable change and within fewer sessions. Also, it was established that fewer premature termination of treatment was reported by the clients who used PCOMS. The researchers assessed the result using statistical calculations.

The use of the system proved to be a major limitation in this study. Moreover, the study was not consistent since a significant number of clients had no data, meaning they did not participate fully in the study and thus the conclusions may be invalid, to some degree.

More appropriate techniques of collecting data and ensuring that there is full participation of the clients in the project to evaluate patient satisfaction will be prioritized in my project.

Hollon and Dimidjian (2010) conducted the latest research to find out if there were any harmful effects of psychotherapy. The researchers hypothesized that patients can be harmed by treatment or by decisions that are made about those treatments.

They were motivated by numerous cases of the harmful effects of psychotherapy which has been established through research that the scope could be broader than is thought. The article defines several ways in which treatment can cause harm to patients. The factors that hinder the detection of the harm have also been discussed.

The data was collected through randomized clinical trials. Their desire was to highlight the impact of psychotherapy itself (Hollon &Dimidjian, 2010). This could actually be a significant factor that affects session satisfaction in psychotherapy which the project seeks to investigate.


From the above research findings by various investigators, it is evident that quite a number of studies have been conducted around the field of psychotherapy and client satisfaction. Conducting a deeper research that will build on the challenges experienced by earlier researchers is therefore justified.

We can therefore conclude that despite the fact that there exists a number of research findings concerning client satisfaction in psychotherapy, advanced and thorough research in session evaluation in psychotherapeutic satisfaction as well as proposals for enhancing the effectiveness of therapeutic interventions need to be conducted.


Eugster, S. L. & Wampold, B. E. (1996). Systematic effects of participant role on evaluation of the psychotherapy session. Journal of Consulting and Clinical Psychology. 64 (5), 1020-1028

Hollon, S. D. & Dimidjian, S. (2010). How would we know if psychotherapy were harmful? Journal of American Psychological Association. 19-32.

Howard, K. I., Moras, K., Brill, P. L., Martinovich, & Z., Lutz, W. (1996). Evaluation of psychotherapy: efficacy, effectiveness, and patient progress. American Psychological Association. 51 (10), 1059-1064

Laszloffy, T. A. (2000). The implications of client satisfaction feedback for beginning family therapists: back to the basics. Journal of Marital and Family therapy. 26 (3), 391-397

Plante, T. G. (1998). Measuring treatment outcome and client satisfaction among children and families: A case report. [Peer Reviewed Journal Article]. Journal of Professional Psychology. 29 (1), 52-55

Reese, R. J., Norsworthy, L. A., & Rowlands, S. R. (2009). Does a continuous feedback system improve psychotherapy outcome? Journal of American Psychological Association. 46 (4), 418-431

Simmons, D. S. & Doherty, W. J. (1998). Does academic training background make a difference among practicing marriage and family therapists? Journal of Marital and Family Therapy. 24 (3), 321-336

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