title: Service user satisfaction with cognitive behavioural therapy for psychosis: Associations with therapy outcomes and perceptions of the therapist.
abstract: OBJECTIVE
  Few studies have investigated service user satisfaction with cognitive behavioural therapy for psychosis (CBTp). This study explored its associations with clinical presentation and outcomes, retrospective expectations of progress, perceptions of the therapist, and demographic variables.
  
  
  METHODS
  One hundred and sixty-five service users completed self-report questionnaires pre- and post-CBTp in relation to the constructs of interest. Regression analyses explored associations with (1) overall satisfaction with therapy and (2) perceived progress, skills, and knowledge gained.
  
  
  RESULTS
  Ninety-six per cent of service users reported satisfaction with therapy. Higher levels of overall satisfaction with, and perceived benefit from, therapy were associated with positive therapy expectations, positive ratings of therapist's personal qualities, competence and trustworthiness, lower pre-therapy depression, and improvements in quality of life. Symptom improvements were not related to overall satisfaction with therapy; however, with the exception of voices, better clinical outcomes were associated with subjective ratings of having made more progress and gained more CBT skills and knowledge. Demographic factors were not associated with satisfaction or perceived progress. In multiple regression analyses, expectations of progress showed the strongest associations with both satisfaction and perceived benefits. Other remaining significant associations consisted of perceptions of the therapist for satisfaction, and both pre-therapy levels of, and changes in, depression for perceived benefits. Qualitative feedback emphasized the importance of the therapeutic relationship and developing new coping strategies.
  
  
  CONCLUSIONS
  The findings provide preliminary evidence that high levels of satisfaction with therapy are not contingent on good clinical outcomes and are instead associated with positive therapy expectations and perceptions of the therapist.
  
  
  CONCLUSIONS
  Therapy expectations represent a neglected area of research and may have implications for levels of satisfaction with therapy and perceived benefit. The findings reinforce the importance of cognitive behavioural therapy for psychosis (CBTp) therapists demonstrating that they are supportive, competent, and trustworthy. The findings suggest that positive experiences of therapy do not require changes in psychosis symptoms and are instead related to changes in quality of life. Depressive symptoms at the start of therapy may adversely influence the extent to which CBT skills and knowledge are gained and levels of perceived progress at the end of therapy. The present sample was restricted to service users who completed therapy. Satisfaction levels were high. Further research is needed to explore factors associated with dissatisfaction with therapy.
authors.affiliation: Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, UK.|Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lawlor
authors.affiliation: Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Bina
authors.initials: B
authors.lastname: Sharma
authors.affiliation: Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.|Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Mizanur
authors.initials: M
authors.lastname: Khondoker
authors.affiliation: Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, UK.|Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.|NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Peters
authors.affiliation: Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, UK.|Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.|NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.|Department of Psychiatry, University of Oxford, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Johns
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010465:Perception; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: cognitive behavioural therapy; psychosis; service-user satisfaction; therapeutic relationship