By Caitlin Hurley, MSW, LGSW,
2016-2018 Clinical Fellow at the MPSI Psychotherapy Center
The OQ-45 is an outcome questionnaire designed to evaluate a psychotherapy client’s progress initially and throughout treatment. At MPSI Psychotherapy Center (MPSI PC) the questionnaire is distributed with the initial intake paperwork and then at three month intervals throughout treatment. Ideally, there would be a final OQ distributed towards the end of treatment, whether a few weeks prior to the scheduled termination day or at the very last session.
Through client feedback I have developed a curiosity around the distribution, evaluation, and use of the OQ in psychotherapy sessions. I had one client struggling with interpersonal relationships with depressive and anxious symptoms. At our first session, they scored 10 points over 63, which indicates clinical significance. Our work together was spent exploring maladaptive relational patterns and this client’s subjective experience of others and the recognition, for the first time, of their own anxiety. Towards the end of treatment, this client actually reduced their overall score by exactly half, well below subclinical levels, and ready for a break from therapy.
What struck me as interesting were other client’s comments, the bulk of whom I ended up seeing in therapy at least once a week for two years. “Oh… you really don’t want me filling this out today…[laughing]” or simply, “it’s been a really rough week” indicating they don’t feel at baseline, and might skew higher than they ordinarily would. Some clients commented about how they can remember what they used to score themselves, specific questions, and how different their answers were from then until now. This made me curious about the effects on the OQ when given at their final treatment session, “will they try to appease me? Will they score themselves lower just so they can tell me I’ve done a good job as a therapist?” I know many of the clients I had felt guilt that we had what they identified as “a one-sided relationship”. Statements like these created a safe space to explore what I meant to each patient in a more in depth and authentic way. As a new clinician, I appreciated this opening in therapy.
The OQ allows a clinician to introduce a tool of measurement in therapy with a client. One client who was very bright, but neurotic benefited from our exploration of their progress over time. It was interesting to explore the client’s thoughts and feelings retrospectively around specific times that indicated either contentment and progress or complete destruction and disarray. I ended up giving the client a copy of their progress (in tables), which seemed to provide hope in the form of uncomplicated statistics. This client scored above well above clinical levels of distress, and would ebb and flow throughout their treatment with me. One of the most important markers of progress was in the middle of the year, the client reduced their score by over 63 points. Towards the end, the client was only one point above clinical significance. Perhaps this was anxiety about our therapeutic relationship ending, or the beginning of the next chapter of their life, both in and outside of therapy.
I felt positive seeing these results with patients I had been consistently working with for the past two years. Oftentimes, I was unsure of my skills and abilities as a therapist, the OQ provides a way to measure the treatment you are doing, while evaluating the client and easing anxiety to what is arguably one of the hardest things to begin to do, talk about the relationship. Although it should be noted that what works for one client does not always work for another, and it is reflective in their OQ scores. Patients who I evaluated to have thought disorders, scored themselves significantly lower in distress levels in comparison to patients who are relatively high functioning, but were experiencing more short-term or even transient symptoms of depression and anxiety varying session to session. Overall, my experience with the OQ has been positive as a beginning clinician. I appreciated MPSI Psychotherapy Center’s willingness to gather data on the clients being seen by the fellows and interns as well as the positive reinforcement it provided me, as a clinician, that I was doing good work.