An Internet-based survey of the effectiveness of psychotherapy and mental health care

In 1995, Consumer Reports (CR) published the results of a survey they conducted on mental health care in the United States. This report and Seligman's (1995) subsequent exploration of the report's findings sparked debate in the field of therapy outcome research about the methods used to measure outcome in studies of therapy efficacy. A review of the outcome literature reveals that use of the client perspective, as was done in the CR study, has not been a popular approach to outcome research. At the present time, due to changes in managed health care, there is a need for therapy outcome research conducted from the clienfs perspective. The current study utilized the clienfs perspective in an attempt to replicate several of the findings from the CR study via an Internet-based survey of international respondents. Several methodological refinements were implemented to correct some of the drawbacks to the CR study. Overall, respondents were more satisfied with the help they received from individual therapy and individual therapy plus medications than other sources or combinations of sources of aid, including informal sources of aid. Respondents that worked with psychiatrists consistently reported more distress at the time they completed the survey, although there were no differences in ratings of satisfaction with treatment. Results from the survey also indicated that respondents were significantly less satisfied with the help they received from physicians, as compared to mental health professionals. In most cases, participants reported therapy alone to be more helpful than medication alone, or medication plus therapy. In this study, treatment duration did not predict levels of distress; however, it did predict satisfaction: those respondents who stayed in therapy longer reported greater satisfaction with treatment. Finally, insurance coverage limitations were related to both positive and negative outcomes, depending on the specific problem treated. Findings are discussed in relation to the CR study and other outcome studies.