Improving the Quality of Children’s Mental Health Care with Progress Measures: A Mixed-Methods Study of PCIT Therapist Attitudes

Progress measures are an evidence-based technique for improving the quality of mental health care, however, clinicians rarely incorporate them into treatment. Research into how measure type impacts clinician preference has been recommended to help improve measure implementation. Parent–Child Interaction Therapy (PCIT) is an assessment-driven treatment that serves as an ideal intervention through which to investigate measure preferences given its routine use of two types of assessments, a behavioral observation (the Dyadic Parent–Child Interaction Coding System) and a parent-report measure (the Eyberg Child Behavior Inventory). This study investigated PCIT therapist attitudes towards progress measures used within PCIT and children’s mental health treatment generally. A mixed-method (QUAN + QUAL) study design examined PCIT therapist attitudes towards two types of progress measures and measures used in two contexts (PCIT and general practice). Multi-level modeling of a survey distributed to 324 PCIT therapists identified predictors of therapist attitudes towards measures, while qualitative interviews with 23 therapists expanded and clarified the rationale for differing perceptions. PCIT therapists reported more positive attitudes towards a behavioral observation measure, the DPICS, than a parent-report measure, the ECBI, and towards measures used in PCIT than in general practice. Clinician race/ethnicity was significantly related to measure-specific attitudes. Qualitative interviews highlighted how perceptions of measure reliability, type of data offered, ease of use, utility in guiding sessions and motivating clients, and embeddedness in treatment protocol impact therapist preferences. Efforts to implement progress monitoring should consider preferences for particular types of measures, as well as how therapists are trained to embed measures in treatment.

Empathy, Honesty, and Integrity in the Therapist

Empathy, honesty, and integrity are essential concepts to ensure the quality of the therapy relationship and the client’s trust in the therapist. This chapter situates these concepts in relation to the necessary and sufficient conditions for therapy proposed by Carl Rogers in the late 1950s, and particularly in relation to the therapist attitudes of empathic understanding, unconditional positive regard, and congruence. In person-centered therapy (PCT), empathy is a moral, not instrumental, practice that nondirectively protects the self-determination of the client. It exemplifies power with others, avoiding power over others, and facilitating power from within, by providing a conduit for non-possessive love, the active ingredient in PCT. Honesty in PCT involves the sincerity of the therapist’s unconditional empathy and the transparence to be a full person in relation to a client. Integrity refers not only to the disciplined moral practice of empathy, but an extensional, fully functioning maturation.