Developing a Therapeutic Relationship Monitoring System for Group Treatment

The use of outcome monitoring systems to identify clients that are at-risk for treatment failure has now become part of daily clinical practice, shown in >25 empirical studies to improve client outcomes. These promising findings have led to outcome monitoring systems being recognized as evidence-based. Feedback systems based on client perception of therapeutic processes are recent additions to the monitoring literature, and the research suggests that these too lead to improved outcomes. Unfortunately. feedback systems and research have been primarily limited to individual therapy, creating a knowledge gap for multiperson treatment. This study reports on the development of a therapeutic relationship monitoring system for group treatment using results from 6 Group Questionnaire (GQ) studies conducted in 4 unique clinical populations: nonclinical process, counseling center, European inpatient, and seriously mentally ill inpatients. The GQ is a factor-analytically derived scale, which assesses a client's perception of 3 relationship quality constructs (positive bond, positive work, and negative relationship) across 3 structural domains (member-member, member-leader, and member-group). The first goal of the present study was to replicate the previously established factor structure across each clinical population. The second goal was to establish normative values and relevant feedback alerts for the GQ subscales in each population. Findings support the GQ factor structure across clinical populations, indicating that the constructs measured by the GQ bear similar relationships in each population. Further, findings support the implementation of unique norms and feedback alerts in each clinical population, reflecting the reality of meaningful differences between clinical populations.