Feedback in psychotherapy: A client, therapist, and contextual perspective on barriers, facilitators and outcomes

Systematic Client Feedback (SCF) is the regular monitoring of patients' progress during their psychological treatment. A patient completes a questionnaire at regular intervals, and then patient and therapist discuss the results together and adjust the course of treatment if necessary. SCF has the potential to lead to better treatment outcomes, more personalized care and improved patient participation.
The aim of this PhD study was to clarify whether, and under what conditions, SCF can be of added value. It emerged that adding SCF to regular mental healthcare led to an additional decrease in psychiatric symptoms and increase in well-being of at least 25%, and a significant decrease in dropout in forensic mental health care.
We further discovered that the higher the perceived added value of SCF, the more likely therapists are to use the instrument. However, increased workload can cause the perceived added value to decrease, and SCF to be used much less.
Patients may experience SCF as useful if a) there is an appropriate balance between effort and yield from SCF use, and b) SCF is an integral part of the treatment. If these conditions are met, SCF is likely to improve the working alliance, therapy outcome, and treatment satisfaction.
To add SCF to professional practice, it is necessary that therapists are structurally facilitated. Here, detected 'barriers with potential' and 'facilitators intended' may best be used as levers to optimize ongoing SCF implementation.