Title : A new method for the synthesis of hydrophobic gold nanotapes

Several studies have been published on the effects of psychotherapy in routine practice. Complementing traditional views summarized as “dose-effect models”, Stiles et al. (2008) put forward data consistent with the responsive regulation model underlining the importance of the client’s active participant role in defining length of treatment. One may ask what level of change reached by a patient is considered to be the “good enough level” (GEL) and if it is related to the duration of psychotherapy. The main objective of the present feasibility trial is to monitor the patient’s session-by-session evolution using a self-report questionnaire in order to define the GEL, that is the number of sessions necessary for the patient to reach significant change. A total of N = 13 patients undergoing psychotherapy in routine practice participated in the study. They filled in the Outcome Questionnaire – 45.2 (OQ-45; Lambert et al., 2004), which assesses the symptom level, interpersonal relationships and social role after every psychotherapy session. The data was analysed using multi-level analyses (HLMs). High feasibility of fine-grained assessment of effects of psychotherapy in routine practice in Switzerland was shown; response rates being acceptable; however, detailed analysis of the GEL was not feasible within the short study time-frame. Finally, some reflections on the political context of monitoring in the specific case of routine psychiatric practice in Switzerland are discussed. Key-Words: Clinical Governance; Outcome; Psychotherapy Monitoring; Routine Practice Psychotherapy Monitoring in Routine Practice 3 MONITORING THE EFFECTS OF ADULT PSYCHOTHERAPY IN ROUTINE PRACTICE IN SWITZERLAND: A FEASIBILITY TRIAL In general, dose-effect models explain change across psychotherapy. These models are based on the pharmacological metaphor and imply that patients are passive receivers of psychotherapy, instead of active agents. Another way of interpreting dose-response relationships is the good-enough level (GEL) model. Indeed, it assumes different rates of change are to be seen with patients who come for different numbers of sessions (Barkham et al., 1996; Barkham et al., 2006; Stiles, Honos-Webb, & Surko, 1998; Stiles, Barkham, Connell, & Mellor-Clark, 2008). The GEL model puts forward the idea that patients will remain in therapy until they, in agreement with their therapist, determine that they have improved sufficiently, i.e. to the good-enough level. Therefore, treatment response is generally reflected in the dose of treatment which indicates the malleability of patients’ symptoms; this contrasts with the dose-effect model which sees the patients’ symptoms as the driving force of treatment response. Thus, the GEL model predicts that patients who receive low doses of treatment are those who change rapidly, whereas patients who receive high doses of treatment are those who change slowly. This process has been described as consistent with the responsiveness concept (Stiles et al., 1998). In the present context, Stiles et al. (2008) explain the GEL in case of negotiated terminations, as done so jointly by the therapist and the patient, as a responsive process on the part of the therapist toward the patient’s demand. Stiles et al.’s (2008) study on N = 9703 psychotherapy patients in the UK showed that the GEL model is valid and demonstrated convincingly that the effect of psychotherapy in public mental health services is stable whatever its length (between 1 and 20 sessions). For this reason, it can be concluded that patients, together with their therapists, “know” how to assess quite finely the GEL for themselves (also see Barkham et al., 2006). Finally, in order to maximise the data related to clinical outcome in routine clinical practice, some researchers Psychotherapy Monitoring in Routine Practice 4 have added alliance measures, such as the Agnew Alliance Measure (Miller et al., 2005; Whipple et al., 2003). However, whilst developing scientifically relevant models, none of these studies address the question of international generalizability to different political and economical contexts, outside the US or the UK. Such research may help to render explicit the context parameters, as well as their interaction with the quoted scientific models and ultimately, test their generalizability. The overall objective of this project is to assess feasibility of progress tracking in adult psychotherapy in a routine practice context in one of Switerland’s states or cantons with regard to the afore-mentioned change models. To do so, two goals have been set in the present feasibility study: (1) To create a directory of psychotherapy, as defined under Art. 2 and 3 of the Swiss Ordinance on Health Care Coverage conducted in the three sectors or geographic regions (North, West, and Centre) of the state Department of psychiatry; (2) To track the evolution of the patients’ problems, session-by-session, throughout the psychotherapy. METHOD Procedure Based on the internal billing statements, a research assistant contacted the psychotherapists having started a new psychotherapy (for the entire 9-month pilot phase (september 2010 – may 2011): N = 300 patients; for the procedure flowchart, see Figure 1). Once the therapists had confirmed they had started a new psychotherapy, the research assistant then personally saw every therapist who, in turn, presented and explained the project to their patients. The latter then accepted or refused to participate. If they accepted, theyfilled in the OQ-45 independently of the therapist. The questionnaire was put in a sealed envelope and sent back. The study received clearance by the Ethic Board.