When ‘good outcome’ does not correspond to ‘good therapy’: Reflections on discrepancies between outcome scores and patients’ therapy satisfaction

In the present paper we examine four cases in which the assumption that “good outcome” necessarily means “good therapy” did not hold. Cases were selected that reported good pre-post outcome (i.e., clinically reliable decrease in symptom severity) but a negative (disappointing) therapy experience, drawn from a randomized controlled trial (the Ghent Psychotherapy Study) and a naturalistic outcome study (the Stockholm Young Adults Psychotherapy Project). Analysis of these seemingly contrasting findings made it possible to identify three distinct patterns of client experience of outcome. Implications for research and practice are discussed.