Randomized Controlled Trial Evaluating Feedback to Community-Based Therapists Based on Patient Reports of Trust and Respect

Objective: Patient trust/respect toward their therapists may be an important component of patient-therapist relationships. This randomized controlled trial evaluated the impact of providing weekly feedback to therapists regarding patient ratings of trust/respect toward their therapist. Method: Adult patients seeking mental health treatment at four community clinics (two community mental health centers and two community-based intensive treatment programs) were randomized to either having their primary therapist receive weekly symptom feedback-only or symptoms plus trust/respect feedback. Data were collected both prior to and during COVID-19. The primary outcome measure was a measure of functioning obtained weekly at baseline and the subsequent 11 weeks, with the primary analysis focusing on patients who received any treatment. Secondary outcomes included measures of symptoms and trust/respect. Results: Among 233 consented patients, 185 had a postbaseline assessment and were analyzed for the primary and secondary outcomes (median age of 30 years; 5.4% Asian, 12.4% Hispanic, 17.8% Black, 67.0% White, 4.3% more than 1 race, and 5.4% unknown; 64.4% female). On the Patient-Reported Outcomes Measurement Information System Social Roles and Activities scale (primary outcome), the trust/respect plus symptom feedback group had significantly greater improvements over time than the symptom alone feedback group (p = .0006, effect size d = .22). Secondary outcome measures of symptoms and trust/respect also showed statistically significant greater improvement for the trust/respect feedback group. Conclusions: In this trial, trust/respect feedback to therapists was associated with significantly greater improvements in treatment outcomes. Evaluation of the mechanisms of such improvements is needed. What is the public health significance of this article? The role of trust and respect in health care has seen increasing attention and is likely an important part of retaining patients in treatment and improving outcomes; however, previous research has only examined progress feedback to therapists based on patient symptoms and/or the alliance, but no studies have examined the impact of feedback reports that contain information about patient trust/respect toward their therapist. The results of the present study suggest that clinicians should consider monitoring trust/respect to enhance the evidence-based practice of receiving clinically relevant feedback as treatment progresses.