Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. C. Richard Spates

Second Advisor

Dr. Scott Gaynor

Third Advisor

Dr. Amy Naugle

Fourth Advisor

Dr. Tara Cornelius


Treatment preference, quality of life


The current study investigates whether treatment preferences prior to beginning treatment are different from treatment preferences at later points in treatment, and whether preferences are related to treatment outcome. While research to date supports the notion that matching clients to treatment in line with their preferences can improve retention and outcomes, results have been equivocal. Further, this research is typically conducted by measuring preferences just one time, prior to starting treatment. It is conceivable that preferences for treatment change over time as patients become more knowledgeable about their presenting problems and about the therapy process. A total of 969 participants were recruited from a Midwestern university-based psychology clinic and online sources. During the first phase of the study, preferences for treatment and the strength of those preferences were assessed in addition to typical intake measures gathered prior to engaging in services at an outpatient psychology clinic. Participants also answered a quality of life questionnaire. Preferences and quality of life were assessed again after the participant’s fourth treatment session, and every four sessions until the participant discontinued services. At all follow up time points, participants were also asked to what degree they believe their treatment aligns with their preferences. Due to recruitment difficulties, the first phase of the study was discontinued, and the survey was adapted for online distribution. Participants currently receiving mental health treatment were recruited from a variety of online sources, and accessed the survey just one time. Participants were asked about their preferences including strength of preference and perceived match to preference prior to starting treatment and currently. Participants also answered a quality of life questionnaire. It was hypothesized that participants would report changes in preference over time, and that strength of preference and match to preference would be related to quality of life scores.

Results from the study show that a minority of participants did report a change in preference for a variety of treatment related variables, and those who report a change in preference also report a less-close match between the treatment they are receiving and their preference. Results also show that participant perception of match between preference and treatment received is related to measured quality of life. However, results varied depending on the recruitment source. This study lends support to the notion that some of the variability in treatment preference research may be at least partially related to changes in preferences for treatment over time.

Access Setting

Dissertation-Open Access