Psychotherapists’ experiences of client reported feedback in therapy: How do therapists engage with feedback?

In the last 10 years there has been extensive research focused on patient reported outcome measures and feedback in Psychotherapy. Overwhelmingly, these studies have reported that using feedback is associated with increased gains in therapy. However, little is known about the processes that underlie these gains. The present study used a Grounded Theory approach to explore therapist’s reflections and experiences of using feedback in their practice. Ten psychological therapists from two psychological therapy services were interviewed; five therapists from each service. One services was an Adult Psychological Therapy Service, the other service was a Student Counselling Service. All interview transcripts were analysed using Grounded Theory techniques, and secondary analysis comparing and contrasting the two treatment services. This analysis produced a theory of therapist engagement with and disengagement from feedback. This theory provides the context and experiences under which therapists are likely to engage or disengage from feedback. Furthermore, this study found that therapists across the services responded to feedback information in four ways: (1) they shared it directly with clients, (2) reflected on information outside of the session, (3) reject the specific information, or (4) rejected the feedback system as a tool of therapy. These findings are interpreted in light of the existing literature on feedback in psychotherapy, and theoretical underpinnings such as the theory of planned behaviour, self-efficacy and cognitive dissonance. This thesis also makes suggestions for further research on therapist engagement factors, their responses to feedback and therapeutic gain.