Creating Space for Responsiveness: Patients' Experiences of Individual Contact Prompted by ROM in Structured Group Psychotherapy

Objective: Therapist responsiveness within standardised group psychotherapy may be supported by patient feedback from routine outcome monitoring (ROM). This study examined patients' experiences of therapists approaching them outside group sessions to discuss therapy progress when prompted by ROM. Design: This is a qualitative feasibility study as part of a naturalistic multiple-case intervention. Twenty-nine patients with depression entered group cognitive behavioural therapy (CBT) with ROM. We implemented a procedure for therapist responsiveness based on ROM data, in which therapists checked in with patients who were not making expected progress outside the group setting in what we termed a ‘What's at stake’ session (WASS). This session occurred before the next group session and was delivered by phone or in person. Method: We interviewed 13 patients and applied a thematic analysis to address the research question: ‘How do patients experience a strategy for therapist responsiveness in structured group therapies, where therapists make individual contact based on the lack of progress suggested by ROM?’. Findings: We generated three main themes: ‘An unexpected contact’, ‘An invitation for reflection’ and ‘The WASS actualized ROM’. Patients generally found ROM meaningful because they had experienced the feedback being applied in the WASS. Subthemes revealed variations in experiences, with some participants perceiving the intervention as caring, while others found it intrusive. Conclusion: Therapists' responses prompted by ROM in group CBT were experienced as a departure from the standardised approach and were perceived as either caring recognition or intrusive monitoring. These qualitative findings show how the WASS fostered a potential for therapist responsiveness, but the realisation of the potential depended on the relational context and repeated, transparent explanation of ROM and the rationale for contact.