Elisa Napoleone: Learning about feedback with international colleagues

A few of us from the CORC team have recently had the great opportunity to take part in a two-day meeting organized by Dr Kim de Jong at the University of Leiden, in the Netherlands. The meeting brought together researchers, academics and practitioners from all over Europe, Israel and the United States, who all share a passion and drive to explore the role of feedback in psychotherapy.

The meeting was thought-provoking from the first session, which focused on implementation of feedback in clinical practice. Introduced by CORC Director, Prof Miranda Wolpert, and chaired by Dr Susan Douglas from Vanderbilt University in Tennessee, the discussion spanned from reflecting on the barriers and solutions to implementation to taking a step back and actually thinking about the many ways that feedback can be defined: Is it about measuring pre-post outcomes? Is it a clinical support tool for adapting interventions? Is it about capturing the daily fluctuations in symptoms, functioning, or any of the other aspects that clients and therapists are working together on? The broader context was also considered: Should feedback be a tool to help clients access and stay in therapy, and help practitioners and organizations think about the clients that they are not helping?

Dr Kim de Jong then took us through the most recent research about whether feedback works and if so, for whom, how and why. While there is some evidence that feedback may be more useful to identify and help clients who are not on track, particularly when they have high complexity (such as low socio-economic background), there is a lot we still don’t know, and a need to bring the field forward with further, more targeted research into the moderators and mediators of change.

The final session gave us a flavour of the statistical approaches that are being developed for better understanding feedback and helping therapists use it in practice. As Dr Jaime Delgadillo from the University of Sheffield eloquently described in a metaphor, if you have no instruments to explore the ocean, you focus on the land, but once you have those instruments, who knows how many discoveries await! From predicting an individual’s treatment response from their initial scores or those from individuals most similar to him/her (the so called ‘nearest neighbour’ approach), to viewing symptoms as interconnected networks, the session inspired us to challenge ourselves and try these approaches at home.

During this final session, Dr Marjolein Fokkema also introduced us to “trees” in a statistical sense (yes, they do exist!): these are methods of exploring treatment effectiveness and factors that have an influence on it, and they lend themselves to being turned into practical tools for clinical decision making. An example that Marjolein shared with us was that of a model for deciding between two treatments for depression (CBT and anti-depressants) based on educational level and comorbid anxiety.

Galvanised by the experience, the group agreed on forming an international network and co-producing materials based on the learning from the meeting. These will include a position paper on the current state of affairs of feedback research, one on the statistical methods that are used by researchers internationally, and one on implementing feedback in real-world settings, as well as resources more clinically useful in practice. So watch this space!

It was a real privilege to share the CORC learning with international colleagues, and find out the many different perspectives on feedback that experts in psychotherapy research take. We look forward to feeding the learning back into our work, and if you would like to know more about this international experience, don’t hesitate to get in touch.

Elisa Napoleone is a CORC Research Officer. To get in touch with her or anyone at CORC, please contact corc@annafreud.org.

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