Validation of a model of Psychotherapy Rupture Repair using Feedback
Research type
Research Study
Full title
Validation of a model for using formal feedback to repair ruptures in the therapeutic alliance during psychotherapy using the task analytic method
IRAS ID
231420
Contact name
Alexander Harvey
Contact email
Sponsor organisation
University of Oxford
Clinicaltrials.gov Identifier
n/a, n/a
Duration of Study in the UK
0 years, 3 months, 4 days
Research summary
Summary of Research
Can a feedback questionnaire help to resolve difficulties in the therapeutic relationship during psychotherapy?
Psychotherapy has been shown to be effective in helping with different types of problems. However, the bond between psychotherapist and service users (SU) can become strained, difficult or even ‘break down’, potentially leading the SU to have a worse outcome or discontinue therapy if not resolved.
It has been suggested that using a questionnaire at the end of each session can help to resolve these events. The questions ask the SU to rate if they felt understood, if the right topics were discussed, if the approach used was appropriate, and if the session was right for the SU overall. If any difficulties are discovered they may then be discussed and resolved.
Therapists and SUs will use this questionnaire together at the end of each of their sessions. The sessions will be audio-recorded. They will separately complete a second short questionnaire after the session to report if there were difficulties. Sessions thought to have ruptures will be listened to, any ruptures will be identified and what was said will be written down. The final part of the session when the questionnaire is used will also be listened to and written down.
Raters will be asked to read the anonymous transcripts of the sessions and say if they agree there was a difficult moment, know as a rupture, and whether it was resolved using the questionnaire. They will also be asked if the therapist and SU went through certain steps identified in previous research as they tried to resolve the rupture.
We will compare sessions where a rupture was resolved with those that were not resolved to see if there is any difference in terms of how much the SU improved between the start and the end of their therapy.Summary of Results
: The study was conducted as part of the lead researcher’s doctoral training in Clinical Psychology and was sponsored by the University of Oxford. The researchers had no competing interests to declare and the funding was provided by the Oxford Institute of Clinical Psychology Training.
The participants were therapists and their clients who were receiving talking therapies (Cognitive Behavioural Therapy and Person-Centred Therapy). Seven therapists and seven clients participated in the study. The clients completed a short feedback questionnaire with the therapist at the end of each therapy session which asked the client to rate the session on four questions;
1. How much they felt the therapist heard, understood and respected them,
2. How much they had focused on the client’s goals and topics,
3. If the approach the therapist had taken felt right for them and,
4. Overall if the session was satisfactory or if they felt something had been missing
Therapists were given brief training in how to encourage clients to use the questionnaire to give feedback and how to follow-up on any issues the client reported. The therapist and client were asked to discuss the answers in the final minutes of each therapy session, and if any issues were identified the therapist and client could then try to address these issues. Clients also completed two questionnaires after the session which were used to help the researchers to identify sessions most likely to have discussion of an issue.
Previous research has suggested that this feedback process between therapist and client can help improve the outcomes of talking therapy for clients by identifying and potentially resolving any tensions or misunderstandings between them that might otherwise not be noticed and discussed. Previous research had identified steps that one therapist and their clients followed when using feedback to discuss and resolve issue. As this was based on sessions from only one therapist and their clients, we wanted to see if other therapists used the same steps.
This study showed that the therapists and clients went through a similar process when discussing issues. The completion of more of the model steps was linked to resolving issues whereas if fewer steps were completed, they were likely to remain unresolved.
Future research could examine whether therapists and clients respond differently depending on the type of difficulty in the session. These issues can be described as either the client withdrawing from therapy or confronting the therapist about an aspect of therapy. This study suggested that therapists might respond differently depending on which type of issue the client brings up. Future research could also investigate other types of talking therapy to explore if the same model steps are followed or if there are differences between them.
This model of using feedback to resolve issues could be used to help therapists understand steps that are helpful to follow when attempting to discuss and resolve issues that clients report. Improving therapists’ ability to identify any issues clients having in therapy and resolve them may be a helpful experience for clients and could help them to complete therapy and to make greater progress towards their goals.REC name
East of England - Cambridgeshire and Hertfordshire Research Ethics Committee
REC reference
18/EE/0188
Date of REC Opinion
26 Jul 2018
REC opinion
Further Information Favourable Opinion