# Evaluating the UE‐ATR Checklist: Nuanced Attribution in Unsuccessful Therapeutic Outcomes

## TL;DR

This study examines whether a checklist helps clinicians better understand treatment failures by considering multiple factors, but finds it doesn't significantly change their perspective.

## Contribution

The study evaluates the UE-ATR checklist's effectiveness in promoting balanced attribution of treatment difficulties in psychotherapy.

## Key findings

- Use of the UE-ATR checklist did not lead to more balanced attribution of treatment difficulties.
- Most users found the checklist clinically useful, but this did not translate into a more multicausal view of treatment outcomes.
- Additional training is needed to maximize the checklist's effectiveness in clinical practice.

## Abstract

Unwanted events in psychotherapy can hinder treatment, yet clinicians overlook them and tend to attribute treatment stagnation mainly to patient‐related factors. The unwanted events–adverse treatment reaction (UE‐ATR) checklist was developed to encourage a more balanced reflection on treatment difficulties, but its effectiveness remains unclear. This study investigated whether the UE‐ATR checklist enables clinicians to allocate treatment difficulties in a more nuanced way across various contributing factors. Clinicians and psychology students (N = 104) were randomly assigned to either use the UE‐ATR (n = 59) or not (n = 45) while reviewing a case vignette of a patient who experienced unwanted events during therapy and treatment stagnation. They allocated responsibility for suboptimal treatment outcome across five factors: the patient, the therapist, the treatment method, the patient's pathology or other circumstances. Attribution was analysed using the Herfindahl–Hirschman index (HHI), where higher scores indicate a monocausal and lower scores reflect a multicausal view. No significant differences were found between the conditions. Although most users found the checklist clinically useful, this positive perception did not lead to a more balanced perspective on the causes of unwanted events. Although the UE‐ATR checklist can support clinical reflection, additional training is necessary to maximize its effectiveness.