Discrepancies between outcome scores and patients’ therapy satisfaction

What is it about?

When “good outcome” does not correspond to “good therapy” in patients’ experiences, this can be due to several reasons, which ideally should be examined on a case-specific level in order to make sense of the discrepancies. In the examined cases in our study, this analysis pointed at patients’ level of agency in the process, the patient-therapist alliance and the need to evaluate the effects of therapy from a broader angle beyond symptomatic outcome scores. Our cases in particular showed how good outcome in scores and symptom relief can occur while more fundamental changes remain lacking, ultimately resulting in patients’ feeling better yet unable to cope with future challenges. To grasp whether therapy had a helpful effect, it seems necessary that different measures are used and including more perspectives could be a fruitful avenue. Moreover, we support the endeavor that disentangles the study of change from the evaluation of therapeutic effects and advocate for more clear and careful use and formulations of these definition. The interchanging use namely suggests synonymity and as such installs the risk of creating the illusion of mental health as a consequence of therapy, yet clinical reality is more complex, and the general causal effect assumption does not do justice to the variation found within and between those patients included in outcome research.

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