How and when feedback works in psychotherapy: Is it the signal?

Objective: Monitoring of ongoing psychotherapy is of crucial importance in improving the quality of mental health care, and feedback (FB) about patients' progress has been established as a viable means. The essential feature of FB models is that patient progress is measured continuously through therapy. Aim: This study investigated the effect of receiving a warning signal when a patient is not achieving expected improvement (not-on-track), monitored with the Norwegian version of the patient FB system OQ (R)-Analyst. Method: Patients from six psychiatric clinics in Southern Norway (N=259) were randomized to FB or no feedback (NFB). Results: For the total sample, the FB effects appeared early (session three). Receiving a warning signal did not change the slope of patients' progress after the signal was given (FB versus NFB). FB seemed to be more effective with more severely distressed patients, although insignificant. Therapists indicated that the graphs imaging patient progress, and the accompanying discussion with the patient, were the most important aspects of FB. Conclusions: The use of OQ (R)-Analyst should be recommended in psychotherapeutic settings in Norway. Given the inconsistent results regarding the effect of warning signals, definitive conclusions about their effect may depend upon how and for whom it is used.