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Psychology patients with unmet preferences report poorer outcomes

Psychological therapy may yield greater benefits if providers can meet patients' preferences, a UK study suggests.
Most of the nearly 15,000 study participants had treatment preferences – and those whose preferences weren't met were less likely to say the treatments helped with their problems, the researchers report in BMC Psychiatry.
"When it comes to psychological therapies, it’s critical that people are invested in them and they engage in them fully," said senior author Dr. Mike Crawford, of Imperial College London. "When people don’t engage in them fully, they’re less likely to benefit from them."
Crawford told Reuters Health the UK has made a large investment to ensure psychological therapy for people with anxiety and depression. His team helped assess the effects of that increase in services.
"We (wanted) to see if people's experience of having preferences and having their preferences met increased their enjoyability of their services," he said.
The research team surveyed 14,587 people at 184 doctor's offices within the National Health Service in England and Wales. They were receiving psychological treatments like talk therapy or cognitive behavioral therapy.
Overall, 86 percent had a preference for some aspect of their treatment, such as choice of venue, appointment time, therapist gender, language or treatment type. About 37 percent had at least one preference that was not met.
Preferences about time, venue and type of treatment were most likely to be met, the researchers found. Preferences for a therapist to be a specific gender were only met for about 41 percent of people. About 37 percent said their preferences for language had not been met.
Some offices are limited in what they can offer patients in terms of the gender of therapists and their spoken languages, Crawford said. Those factors may be important, however.
Indeed, patients who had unmet preferences were more likely to report poorer outcomes than those who got what preferred.
For example, compared to those whose preferences were met, those who were not given their treatment choice were six times less likely to agree that they had been helped. And those who didn't get what they wanted in terms of venue, time, therapist gender or language were two to three times less likely to agree they had been helped.
The study can't prove meeting preferences causes people to have better outcomes, though. Crawford said people who had bad outcomes may have thought more intently during the survey about what their preferences were before treatments.
"This provides an indication that meeting people's preferences is important, but it doesn’t prove they benefit more when their preferences are met," he said.
But Crawford said it's important for people to think about what they want when looking for therapists.
"It’s not a passive process," he said. "It’s not like taking a pill or getting an operation. You have to be involved to benefit form it."

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