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The Difficult Task of Assessing and Interpreting Treatment Deterioration: An Evidence-Based Case Study
Sarah Bloch-Elkouby1,2, Catherine F Eubanks2,3, Lauren Knopf1,2
1Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, United States.
Frontiers in Psychology
|July 24, 2019
Summary
This case study explores why some patients worsen during therapy. It found that skillful treatment delivery and a strong therapeutic alliance did not prevent patient deterioration, suggesting other factors may be involved.
Area of Science:
- Psychology
- Clinical Psychology
- Psychotherapy Research
Background:
- A significant percentage of patients do not improve or worsen during psychotherapy.
- Understanding factors contributing to treatment non-response or deterioration is crucial for improving therapeutic outcomes.
Observation:
- A single case study examined a patient undergoing cognitive-behavioral therapy within a non-randomized trial.
- The patient, L., showed deterioration based on the Reliable Change Index for the Inventory of Interpersonal Problems (IIP) and Symptom Checklist-90 (SCL-90).
- Therapeutic process and outcomes were assessed using mixed quantitative and qualitative methods.
Findings:
- The cognitive-behavioral therapy was delivered skillfully, and a strong patient-therapist alliance developed.
- Despite positive process indicators, the patient's outcome was classified as deterioration.
- The patient reported high satisfaction and attributed his deterioration to treatment termination.
Implications:
- Deterioration during therapy may not solely be due to flawed therapeutic process or delivery.
- Further research is needed to explore multifaceted explanations for patient deterioration in clinical settings.
- Findings highlight the complexity of psychotherapy outcomes and the need for nuanced assessment.
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