Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational, School, and Counseling Psychology

First Advisor

Dr. Robert J. Reese


A review of the adult psychotherapy outcome literature reveals decades of empirical studies that support the efficacy of group treatment for mental health concerns (Burlingame, Fuhriman, & Mosier, 2003; Horne & Rosenthal, 1997). Although research demonstrates positive results for the utilization of group therapy, between 33-50% of clients drop out before treatment is completed (Baekeland & Lundwall, 1975; Wierzbicki & Pekarik, 1993). Methods for improving psychotherapy retention have been addressed through the application of a client feedback model (i.e., monitoring treatment outcome routinely). Although using client feedback has been found to be beneficial for improving retention and even enhancing client outcome in both individual (Lambert et al., 2001a; Lambert et al., 2002; Miller, Duncan, Brown, Sorrell, & Chalk, 2006; Reese, Norsworthy, & Rowlands, 2009; Whipple et al., 2003) and couples psychotherapy (Anker, Duncan, & Sparks, 2009; Reese, Toland, Slone, & Norsworthy, 2010), evidence of client feedback efficacy in a group format is limited but worthy of investigation given the positive individual and couples therapy findings. In the current study, I evaluated the effects of client feedback in group psychotherapy using a randomized clinical trial design. Participants (N = 85) attended psychotherapy groups that were randomly assigned to a client feedback (Feedback) or treatment as usual (TAU) condition. Clients in the Feedback condition were predicted to experience a statistically significantly higher pre-post gain on the ORS compared to group clients in the TAU when controlling for their initial functioning. The effect size (ES) for Feedback between treatment conditions was found to be d = 0.35 on the Outcome Rating Scale when initial treatment functioning was controlled, which is a medium ES (Cohen, 1988). Additionally, statistically significantly more clients in the Feedback condition experienced reliable and clinically significant change, attended statistically significantly more sessions, and dropped out at a lower rate than clients in the TAU condition. Results of this study were similar to those generated by other studies that evaluated the efficacy of client feedback with individuals (Reese et al., 2009) and couples (Anker et al., 2009; Reese et al., 2010). Study limitations and implications for future work are provided.