J. Russell Ramsay, Ph.D.
Associate Professor of Clinical Psychology
University of Pennsylvania, Perelman School of Medicine
The HBO series, In Treatment (2008-2010) centered on the life and practice of a psychotherapist, Paul Weston (as portrayed by Gabriel Byrne). Each nightly episode focused on a session with a different patient, with the course of therapy with each patient followed week-by-week. In a scene from a Season 1 episode (with a patient named Alex, if you want to track it down), Dr. Weston jokingly retorted, “In my profession we say that the customer is always wrong.”
Although some may argue that there is some truth in that line, clinicians and researchers who treat and study adults with ADHD seek objective measures of treatment response and improvements in symptoms and functional outcomes. Blinded assessments and other objective measures are employed toward this end, as there may be many biases in patient self-report.
However, what about patients’ subjective sense of what works for them? What do the “customers” have to say?
This question was asked as part of a separate analysis of follow up impressions gathered during a randomized controlled multi-center trial that compared the results between a specialized group psychotherapy for adult ADHD and supportive community care while either on stimulant medication or placebo (Philipsen et al., 2015). The results of this original study indicated that there were no significant differences between the specialized group treatment and community care (in either medication or placebo conditions) on blinded ratings of ADHD symptoms.
However, the study also employed a participant-rated therapy evaluation form to get their perspectives on what was most effective in the treatments they received (Groß et al., 2017). Participants rated their psychosocial treatment experience on a 5-point Likert scale (“How do you judge the effectiveness of the whole treatment in respect to your ADHD symptoms?” [with the added phrase “…until today’s date” for 18-month post-treatment follow-up].
At the end of the one-year treatment study and at 18-month follow-up, significantly (though moderately) more participants in the specialized group psychotherapy found this treatment to be more helpful when compared with those in community care. At 18 months, this difference was only found among participants receiving psychological treatment in the placebo condition of the medication arm; there was no difference between specialized group therapy with placebo and community care with stimulant. The group therapist was rated as the most helpful component of psychosocial treatment for ADHD. The presence of other group members and the information provided in sessions were viewed as next most helpful to an equal degree. The correlations with observer and blind-ratings were strong enough to support the use of this additional self-report item.
The take away message from the article is that there is potentially fruitful additional source of outcome data on the benefit of psychosocial treatments for adult ADHD, namely, “customer” feedback.
Highlighted Article
Groß, V., …. Philipsen, A. (2017). Effectiveness of psychotherapy in adult ADHD: What do patients think? Results of the COMPAS study. Journal of Attention Disorders. online ahead of print. doi: 10.1177/1087054717720718
Other reference
Philipsen, A., et al. (2015). Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: A randomized clinical trial. JAMA Psychiatry, 72, 1199-1210.