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Setting up clinical audit in a psychodynamic psychotherapy service: a pilot study

Department of Psychiatry, Royal Free Hospital, Pond Street, London NW3 2QG

Anne Ward, Consultant Psychotherapist and Sue Davison, Consultant Psychotherapist

Maudsley Hospital (South London & Maudsley NHS Trust)

AIMS AND METHOD

Clinical governance implies a need to engage in a demonstrable form of clinical audit. We decided to pilot a pre-post-therapy questionnaire study, involving both therapists and patients, with the aim of assessing its feasibility as a routine measure of outcome in our service.

Questionnaires were chosen to reflect both the symptom profile Clinical Outcomes in Routine Evaluation (CORE) and the general level of functioning Global Assessment of Functioning Scale (GAF). The patients were also questioned about their satisfaction with the therapy.

RESULTS

Of 53 eligible patient-therapist pairs, 26 patients and 19 therapists responded pre-treatment (overall 51% response rate). The mean (s.d.) CORE score per item was 1.93 (0.78), whereas the GAF score was 55 (15.2), somewhat belying the idea that psychotherapists only treat the ‘worried well’. The post-therapy response rate was poorer, rendering statistical analysis of change difficult to perform. The trend, however, was towards an improvement in both symptoms and level of functioning over the course of therapy.

CLINICAL IMPLICATIONS

Our patient group presents with a considerable degree of impairment. Although the response rates in this pilot study were poor, the data trend suggests that patients do benefit from the treatment offered. The aims of the study were met in that implementation of a clinical audit process within our department is feasible and the data are obtainable. The main interest, however, lies in what we learned from the process. We offer a dynamic and practical assessment of the impediments encountered, with implications for how these might be confronted.

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