Lambert Michael

Brigham Young University - Provo Main Campus | BYU · Department of Psychology

Objective: Some psychotherapists are more effective than others, which means that patients’ treatment outcomes partly depend on therapist effects (TEs). This study investigated whether the use of progress feedback influences TE. Method: Data from N = 4,549 participants and 131 therapists across six clinical trials of progress feedback were analyzed...

Objective This study investigated symptom change trajectory for patients with persistent somatic symptoms (PSS) during psychotherapy and the association of these patterns with pre-treatment characteristics and long-term outcome. Methods Growth mixture modeling was used to identify trajectory curves in a sample of N = 210 outpatients diagnosed with...

Within the Routine Outcome Monitoring System “OQ-Analyst”, the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not-on-track trajectories. Factor analysis and a machine learning algorithm (LASSO with 10-fold cross-validation) were applied and potential predictors of not-on-track classification...

The original version of this article unfortunately contained a mistake. In Results section, under the heading the "Application", CI difference values were incorrect in one of the sentences. The corrected sentence is given below.

This paper aims to provide researchers with practical information on sample sizes for accurate estimations of therapist effects (TEs). The investigations are based on an integrated sample of 48,648 patients treated by 1800 therapists. Multilevel modeling and resampling were used to realize varying sample size conditions to generate empirical estima...

Background Early dramatic treatment response suggests a subset of patients who respond to treatment before most of it has been offered. These early responders tend to be over represented among those who are well at termination and at follow-up. Early response patterns in psychotherapy have been investigated only for a few of mental disorders so far...

Despite evidence that psychotherapy has a positive impact on psychological disorders, 30% of patients fail to respond during clinical trials, and as many as 65% of patients in routine care leave treatment without a measured benefit. In addition, therapists appear to overestimate positive outcomes in their patients relative to measured outcomes and...

Objectives: Differing methodologies that identify dramatic change in psychotherapy have been thought to be capturing similar phenomena. We compared three methods-percentage improvement-50% (PI-50), rapid response (RR), and sudden gains (SG)-to identify similarities and differences between these approaches. Methods: Using a large database (n = 11...

Only one randomized clinical trial (RCT) has examined feedback-assisted (Fb) treatment in an inpatient eating disordered population. Results from this study suggested that those who received Fb treatment were more likely to recover than participants in the treatment-as-usual condition; however, long-term effects of this treatment have not been inve...

Zusammenfassung Erkenntnisse diverser Studien legen nahe, dass Placebo-Kontrollgruppen mehr von Psychotherapie profitieren als Kontrollgruppen ohne jegliche Behandlung, jedoch weniger als Patienten, die eine theoriegeleitete Behand-lung erhalten. Die vorliegende Auswertung der Ergebnis-se von Vergleichsstudien legt nahe, dass den allgemei-nen Wirkf...

The present study examined the impact of therapist and client gender, and gender matching on therapy outcome and attendance variables. Analysis was based on a database of over 17,000 students treated in a university counseling center by over 200 therapists. Results indicated that gender of clients (but not the gender of therapist, or the match betw...

Empirical evidence supports the efficacy and effectiveness of psychological treatments for a wide variety of psychological disorders. It appears that about two-thirds of patients secure positive outcome even though the problems they are struggling with have been long-standing. The gains that are made can be achieved very rapidly in many cases (firs...

Objectives: The aim of this project was to conduct the cross-cultural factorial validation of the Outcome Questionnaire (OQ-45.2) using the Polish population. Methods: Data were obtained from day-patients (n = 211), inpatients (n = 234), outpatients (n = 137) and non-patients (n = 426). Statistical analyses included: parallel analysis, explorato...

A serious problem in routine clinical practice is clinician optimism about the benefit clients derive from the therapy that they offer compared to measured benefits. The consequence of seeing the silver lining is a failure to identify cases that, in the end, leave treatment worse-off than when they started or are simply unaffected. It has become cl...

Objectives: Within the clinical support tools (CST) of the OQ-Analyst, the “Assessment for Signal Cases” (ASC) evaluates the therapeutic alliance, social support, motivation, and life events. We investigated whether the ASC covers domains of importance in treatment weeks with extreme deviations from expected recovery curves (ERCs). Methods: Psychos...

The current review targets efforts to use outcome measures in routine care for the purpose of enhancing patient outcome, particularly for patients whose positive outcome is in doubt. The review first provides a brief historical context that justifies this particular form of outcome assessment, and its role in reducing negative treatment outcomes. T...

Objective: The dose-response relationship in psychotherapy has been examined extensively, but few studies have included session frequency as a component of psychotherapy "dose." Studies that have examined session frequency have indicated that it may affect both the speed and the amount of recovery. No studies were found examining the clinical sign...

Acknowledgement. We wish the thank Daniel B. Fishman, Editor of the PCSP journal, for his patient guidance and wisdom as we worked through various versions of our manuscripts and phases of publication. He is truly committed to editing in the best sense of this word—more of a partner than harsh critic. _______________________________________________...

We respond to issues raised in the commentaries on early response and the exceptional psychotherapist, noting that our findings are consistent with those suggested by Laska and Federman (2015) as well as by Pereira and Barkham (2015). We call for prospective study of exceptional therapists that employ the variables and constructs noted in the comme...

Objective: While there are several Japanese, qualitative, case studies examining psychotherapy outcome, there is a growing need for quantitative psychotherapy outcome research in Japan. This study adapted the Outcome Questionnaire-45 (OQ), one of the most common quantitative measures of clinical outcome, for use in Japan. Method: With the help o...

Background: Measuring the progress of mental health treatment aids in assessment and monitoring of psychotherapeutic outcomes. The OQ-45 is a widely accepted measure of such outcomes. The aim of this study was to validate the Hebrew and Arabic versions of the OQ-45. Method: Data were collected from three samples: non patient university students...

Objective: The Clinical Support Tools (CSTs) were developed to help therapists organize and target potential problems that might account for negative outcomes in psychotherapy. The core of CST feedback is the Assessment for Signal Clients. The purpose of this study was to describe and identify patterns of problems that typically characterize off-tr...

Developed in the 1940s by the American psychologist Carl Rogers (1902–87), client-centered psychotherapy is focused on the client taking responsibility for discoveries and decisions in psychotherapy while the therapist creates an optimal growth environment through genuineness, empathy, and unconditional positive regard. Client-centered theory posit...

Treatment feedback research is a relatively new field of study aimed at reducing treatment failure and nonresponse by measuring patient mental health functioning on a weekly basis and providing this information to clinicians and patients as they undergo psychological and psychopharmacological interventions. Substantial evidence has accumulated indi...

Laska, Gurman, and Wampold (2014, pp. 467-481) seek to expand the lens of evidence-based practice by incorporating the common factors perspective. We comment on Laska et al.'s arguments along with the methods used to reach their conclusions. Although we share their view that the common factors explanation for therapeutic equivalence across various...

Background: Somatoform disorders are characterised by chronic, medically unexplained physical symptoms (MUPS). Although different medications are part of treatment routines for people with somatoform disorders in clinics and private practices, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications....

In this special section, authors discussed the therapeutic relationship in their respective theoretical orientations. The invited authors defined their relational approaches and identified the most important facets (e.g., alliance, empathy, immediacy) in their particular approaches. In this closing commentary, we remark on the constituent articles,...

Background In previous studies of on-track patients (OT) involving therapists receiving only patient progress feedback without clinical support tools (CST) inconsistent results were found. Possible effects of combining patient progress feedback with CST on OT patients remain unclear. Methods At intake (t1), 252 patients of two in-patient psychosom...

While highly effective, psychotherapy outcome studies suggest 5?14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically track client mental health functioning over the course of treatment and adjust treatment through the use of problem-solving tools are descr...

Objective: Monitoring of ongoing psychotherapy is of crucial importance in improving the quality of mental health care by detecting therapies being off track, which requires that the instrument used is psychometrically sound. This study investigates the psychometric properties of the Norwegian version of the Outcome Questionnaire 45.2 (OQ-45) and...

Abstract This article reviews the benefits, obstacles, and challenges that can hinder (and have hindered) implementation of routine outcome monitoring in clinical practice. Recommendations for future routine outcome assessment efforts are also provided. Spanning three generations, as well as multiple developed tools and approaches, the four authors...

Abstract Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings (Shimokawa, Lambert, & Smart, 2010). Although these interventions work well in outpatient settings their effects so far have not been investigated with eating-disordered patients or in...

Fifty years after the 1963 debate between Strupp and Eysenck, as recorded in their articles in Psychotherapy, it is clear that Eysenck overstated the case against psychoanalysis and dynamic psychotherapy (Bergin, 1971), while inflating the magnitude of improvement in untreated individuals (Lambert, 1976). Eysenck was probably correct about the bene...

While highly effective, psychotherapy outcome studies suggest 5‒14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically track client mental health functioning over the course of treatment and adjust treatment through the use of problem-solving tools are descr...

Abstract The current study examined the effects of providing treatment progress information and problem-solving tools to both patients and therapists during the course of psychotherapy. Three hundred and seventy patients were randomly assigned to one of two treatment groups: treatment-as-usual, or an experimental condition based on the use of patie...

Evidence is presented that suggests routine clinical practice is limited by therapist optimism about their personal effects on patients. This optimistic view prevents them from recognizing which of their patients are headed for a negative treatment outcome and taking steps to prevent poor outcomes for such cases. A formal method of measuring and mo...

This commentary focuses on the case of “Grace” treated by Erica Pass (2012) through the use of Accelerated Experiential Dynamic Psychotherapy with writing assignments (the "AEDP-Writing" model) delivered over 40-sessions. Grace was experiencing some PTSD symptoms resulting from a single index trauma and was viewed as having a positive outcome by he...

Previous research has consistently found self-assessment bias (an overly positive assessment of personal performance) to be present in a wide variety of work situations. The present investigation extended this area of research with a multi-disciplinary sample of mental health professionals. Respondents were asked to: (a) compare their own overall c...

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means...

This article examines the research on patient-psychotherapist collaboration in ways that can inform and improve clinical practice. Clinical wisdom suggests and research supports the importance of goal consensus and collaboration; empirical support for this assertion is summarized and the implications for practice are provided. Then, we present a me...

Reviews the book, Transformation in Psychotherapy: Corrective Experiences Across Cognitive Behavioral, Humanistic, and Psychodynamic Approaches edited by Louis G. Castonguay and Clara E. Hill (see record 2011-30086-000 ). Change in psychotherapy can be partially understood to be a function of the degree to which the therapist is able to promote cor...

The purpose of this study was to examine the effects of feedback provided to counselors on the outcomes of patients treated at community-based substance abuse treatment programs. A version of the Outcome Questionnaire (OQ-45), adapted to include drug and alcohol use, was administered to patients (N = 304) in 3 substance abuse treatment clinics. Pha...

There is no consensus as to how to define response and remission for mental disorder treatments. The Reliable Change Index (RCI) is most commonly used in psychotherapy research, whereas psychopharmacologists prefer to calculate percentage of improvement (PI). We compared both methods using the Beck Depression Inventory in 395 depressive outpatients...

The problems noted by Krause (see record 2011-19228-002) with regards to interpreting evidence from randomized clinical trials are discussed. It is suggested that some of these problems have already been addressed and improvements made by some researchers, mainly examining the changes made by every patient in the treatment groups through the use of...

The examination of treatment failure has substantial value in advancing psychological practice as illustrated by the articles in this special issue. Treatment failure is not well defined and includes at least two independent phenomena: nonresponse and deterioration. After discussing the important distinction between nonresponse to treatment and cli...

It is surprising and even ironic that clinical supervision is frequently conducted in the absence of systematic monitoring of patient progress. The use of a monitoring system that provides feedback to trainees and focuses attention on potential treatment failures is described. Potential advantages of such a practice include continued session attend...

In 2009, the American Psychological Association Division of Psychotherapy along with the Division of Clinical Psychology commissioned a second task force on evidence-based therapy relationships to update the research base and clinical practices on the psychotherapist-patient relationship. This chapter begins by tracing the purpose and processes of...

This article introduces the special issue of Psychotherapy devoted to evidence-based therapy relationship elements and traces the work of the interdivisional task force that supported it. The dual aims of the task force are to identify elements of effective therapy relationships (what works in general) and to identify effective methods of adapting...

While highly effective, psychotherapy outcome studies suggest 5–14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically collect feedback from psychotherapy clients are discussed and two systems for monitoring treatment response, feeding back this information,...

It is impossible in a mere chapter to discuss all of the achievements of the thousands of studies and decades of psychotherapy research that are now part of our history. As a consequence, I shall focus on those achievements that exerted the greatest relevance to practice and training. This focus is consistent with the major goals of psychotherapy r...

The principle aim of this study was to estimate the number of sessions of psychotherapy needed for clients suffering from psychiatric illness to return to a normal state of functioning or reliably improve. This would be helpful for treatment planning and policy decisions regarding how much therapy is enough. The progress of 125 clients entering psy...

The aim of the OQ system is to provide measures and methods to enhance treatment outcomes for psychological disorders, especially for patients whose progress and eventual positive outcome is in doubt, by providing progress information directly to practitioners. This system is owned and distributed by OQ Measures (www.OQMeasures.com), and consists o...

In this chapter we summarize findings from practice-focused research conducted over the past 14 years at a large university counseling center. The most formal phase of our research involved gathering, archiving, and examining outcomes and was prompted by our adoption in 1995 of the 45-item Outcome Questionnaire (OQ-45) as the counseling center's pr...

Outcome research has documented worsening among a minority of the patient population (5% to 10%). In this study, we conducted a meta-analytic and mega-analytic review of a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure. Original data from six major studies conducted at a large university...

The current review targets efforts to use outcome measures in routine care for the purpose of enhancing psychotherapy outcome, particularly for patients who are predicted to have a negative treatment outcome. The place of outcome measures in solving the negative effects problem is emphasized, with a narrow focus on one set of measures that is relat...

IntroductionDeviations from a positive course of treatmentResearch on ongoing treatment monitoringPrediction of treatment failure and description of the warning systemDiscussion of the OQ System in application to treatment monitoringReferences

IntroductionTowards an inclusive research strategy for building an evidence baseTrials and tribulationsPractice-based studiesConclusions AcknowledgementsReferences

The effectiveness of psychotherapy has been the subject of study since the 1930s. The activities that characterize psychotherapy practice have evolved over time and today consist of hundreds of established procedures based on psychological theories aimed at reducing the symptoms of psychopathology. In this brief summary, some of the most notable fi...

Without timely feedback about client progress, practitioners grossly underestimate negative outcomes. Accordingly, they are less likely to make the adjustments necessary to forestall negative outcomes or, for that matter, improve positive outcomes. Owing to the extant research documenting the superiority of actuarial over clinical methods in making...

Empirical evidence shows that treatment failure is a significant problem and one that practitioners routinely overlook. A substantial minority of patients either fail to gain a benefit from the treatments offered to them, or they outright worsen by the time they leave treatment. Intervening in a timely fashion with such individuals cannot occur if...

The current review targets efforts to use outcome measures in routine care for the purpose of enhancing psychotherapy outcome, particularly for patients who are predicted to have a negative treatment outcome. The place of outcome measures in solving the negative effects problem is emphasized, with a narrow focus on one set of measures that is relat...

It is recommended that an estimate of clinical significance be included in all psychotherapy outcome studies and that this estimate be based on the work of Jacobson and Truax (1991). The concept of clinical significance is defined and put in the context of broadly accepted statistical methods along with its advantages and a rationale for using the...

Psychotherapy clients often experience intake therapist discontinuity: meeting first with an intake therapist, then entering therapy with a different treating therapist. The authors compared such discontinuity clients at a university’s counseling center (55.6% of 15,137 clients) with continuity clients, who continued therapy with their intake thera...

This study examined sources of therapist effects in a sample of 25 therapists who saw 1,141 clients at a university counseling center. Clients completed the Outcome Questionnaire-45 (OQ-45) at each session. Therapists' facilitative interpersonal skills (FIS) were assessed with a performance task that measures therapists' interpersonal skills by rat...

To determine whether the Social Role (SR) Scale of the Outcome Questionnaire (OQ) can predict work productivity. Employees at Utah State Hospital completed the OQ and the Work Productivity and Activity Impairment Scale (WPAI) once monthly for four months. The SR predicted the WPAI Presenteeism and Activity Impairment scales. The SR can be used to e...

Some practical problems are highlighted with regard to studying the outcomes of individual therapists, including the long and inconsistent success in finding therapist variables that explain differential client treatment response. Research on the individual therapist makes it clear that considerable variability in outcome exists at the extreme ends...

In this article, the authors study the factorial structure of the Italian translation of the Outcome Questionnaire 45 (OQ-45) in a sample of college students (n = 522) and psychiatric outpatients (n = 301). The relative goodness of fit of six competing models of the OQ-45 was examined using confirmatory factor analysis (CFA). Specifically, the stud...

Most college counseling centers have adopted session limits for their psychotherapy clients though little evidence exists to support such cutoff points. In the past eight years, a few studies have been published using survival analysis statistics for investigating the speed of recovery in psychotherapy. The outcome of clients at a university counse...

The benefits of psychotherapy have been well documented; however, 5-10% of clients worsen while in treatment and another minority shows no response. The effects of feedback timing (delayed or immediate) and type (progress feedback and Clinical Support Tool [CST] feedback), aimed at reducing deterioration and improving outcomes, were examined in a s...

Positive emotions are discussed within the context of experiential, client-centered, and related psychotherapies. An attempt is made to discuss the idea that the effects of such psychotherapies could be enhanced if positive emotions were viewed as a cause of positive psychotherapy outcomes rather than a consequence of focusing on painful and distur...

De auteurs van dit artikel presenteren ‘verwacht-herstelgrafieken’ (expected recovery curves) als maatstaf om de voortgang respectievelijk achteruitgang tijdens een psychotherapeutische behandeling van jongeren te ‘monitoren’. Kinderen (of hun ouders) en adolescenten die in psychotherapie waren, vulden daartoe regelmatig de Youth outcome questionna...

It is with sadness that we note the passing of Sol Garfield. Sol L. Garfield was born on January 8, 1918, in Chicago and passed away on August 14, 2004 at the age of 86. Sol Garfield's contributions have been recognized many times by awards committees, perhaps most notably in the "Distinguished Professional Contributions to Knowledge" award of the...

Zusammenfassung. Theoretischer Hintergrund: Studien zu Sudden Gains bestätigten in hoher Übereinstimmung die prädiktive Validität jener Gains für das Therapieergebnis. Diese Gains wurden bisher in erster Linie als isoliertes, veränderungsinduzierendes Strukturmerkmal eines Therapieverlaufes betrachtet. Unter Routine-Praxisbedingungen fanden sich se...

Enhancing treatment outcomes for clients who are predicted to deteriorate before leaving treatment has important implications for quality of client care. The effects of three interventions aimed at reducing client deterioration were examined in a sample of 1,374 clients whose outcome was contrasted across experimental groups and with a no-feedback/...

Zusammenfassung. Theoretischer Hintergrund: Im Rahmen einer patientenorientierten Psychotherapieforschung werden Patientenausgangsmerkmale und Veränderungsmuster in einer frühen Therapiephase genutzt, um Behandlungsergebnisse und Behandlungsdauer vorherzusagen. Fragestellung: Lassen sich in frühen Therapiephasen verschiedene Muster der Veränderung...

We argue in this paper that it is time for therapists and supervisors to incorporate outcome monitoring and brief client assessments into ongoing counseling supervision. Tracking client treatment response, comparing it to expected treatment response, and alerting counselors and supervisors when a client shows poor progress is described. It is sugge...