Understanding Long-term Outcome from the Patients’ Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy

Melissa De Smet; Reitske Meganck

doi:10.5334/pb.432

Figures & Tables

Table 1

Treatment history of research sample.

Treatment history	Before inpatient treatment	After inpatient treatment	At five-year follow-up
Participants	n	n	n
Outpatient psychotherapy	17	13	8
Psychiatrist	18	9	10
Medication	16	6	7
Psychiatric hospitalization	7	4

[i] Note. n = 22; various treatments per patient. Outpatient psychotherapy: often long-term, many different therapists and forms of talking-therapy or alternative treatments were consulted before inpatient treatment; creative therapy was increasingly consulted after inpatient treatment. Medication (in order of occurrence): antidepressants, sleep medication, anxiolytic, antipsychotic. Psychiatrist: if not specified, psychiatrist provided counselling.

Table 2

The average, variation and meaning of outcome scores measured with the OQ-45 (total scores).

Average total score (OQ-45)	Research sample		Clinical population		Normal population
Average total score (OQ-45)	M	SD (range)	Meaning	Percentile	Meaning	Percentile
Start therapy	97	16.5 (60–144)	High	80–95	Very high	95–100
End therapy	67	22.2 (36–115)	Below average	20–40	High	80–95
One-year FU	73	22.7 (24–124)	Average (men) Below average (women)	40–60 20–40	Very high	95–100
Five-year FU	76.7	19.6 (30–116)	Average	40–60	Very high	95–100

[i] Note. Research sample: n varies across measuring points. Clinical population: 628 men and 896 women; Normal population: 296 men and 511 women (de Jong et al., 2008).

Table 3

Clinical significance of outcome scores measured with the OQ-45 (total scores).

OQ-45 total score	Start therapy	End therapy	One-year FU	Five-year FU
OQ-45 total score	n	n	n	n
Participants	43	27	29	22
Functional	0	9	6	3
Clinical range	43	18	23	19
Change from start treatment
CS		9	6	3
RC		12	15	11
No RC		5	5	6
Deterioration		1	3	2

[i] Note. n varies due to the varying response rate at each measurement.

Functional distribution: below clinical cut-off; clinical range: above the clinical cut-off; CS: reliable change and crossing the clinical cut-off; RC: reliable change only; No RC: criteria of statistical reliable change not met; Deterioration: reliable deterioration (reliable change in negative direction). The cut-off between clinical and non-clinical population for the OQ-45 = 55; reliable change on the OQ-45: difference in scores ≥ 14.

Conceptual model of long-term outcome comprising the taxonomy of experienced changes (I–V) and explanatory factors (A–D).

Table 4

Taxonomy of the experienced changes.

Core and subcategories

I. Reconnection to others and (the meaning of) life
- i. A feeling of belonging
- ii. A new perspective
II. A revelation
- i. Insight into self and difficulties
- ii. Alternative ways of expressing emotions and thoughts
III. An altered self
- i. A mollified self
- ii. An empowered self
IV. Life changes
- i. Concrete changes in dealing with or handling things in life
- ii. Life-altering changes
V. Altered expectations and ideas about recovery and treatment
- i. Recovery as on-going and fluctuating process
- ii. Resignation versus disappointment

Table 5

Examples of different positions in treatment.

Position in treatment	Example excerpt
Dependent-passive: high need of guidance, support and initiative from therapists	‘It was hard when the initiative had to come from me. Maybe it’s my personality; I often need a lead, as I often tend to lean on others. And maybe it was the plan of the therapists that I would take initiative and stand up for myself. But having to create things myself in therapy was hard.’
Assertive-active: highly engaged in treatment process, taking own initiative	‘Being here [in the inpatient therapy centre] was a unique opportunity I had to grasp with my both hands. I chose for myself, I wanted to become a happier person, so I engaged in everything they offered me. At a certain point, I even asked for an extra form of therapy.’
Over-active: preoccupied with “working hard” and time-efficiency of treatment	‘I had prepared myself for [the inpatient] treatment. I had made drawings with all my characteristics on it, I wanted to know all of it, I did not want to do nothing there [in the inpatient therapy centre]; I wanted to work on myself.’ ‘When I was drawing in therapy I thought: “I have to be at my department, I have to lead my team, my colleagues!”’
Independent-keeping a distance: avoiding participation or inhibited to fully engage	‘I’ve realized, I’m not very good at therapy… Personal conversations with people I don’t know so well are hard, it takes a while before I trust a person. I’m very secretive. I constantly censor myself and consider ‘what can I share and what not’ and “shouldn’t I be solving this on my own”.’