Making the case for using personalised outcome measures to track progress in psychotherapy

While highly effective, psychotherapy outcome studies suggest 5-14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically collect feedback from psychotherapy clients are discussed and two systems for monitoring treatment response, feeding back this information, and assisting in problem-solving with such cases are described. Within these systems, obtaining client ratings of their relationship appear to be highly important. We summarize meta-analyses of the effects of these feedback systems (The combined weighted random effect size for the Partners for Change Outcome Management System was r = .23, 95% CI [.15, .31], p < .001, k = 3, n = 558; the effect size for the Feedback condition of the Outcome Questionnaire (OQ) system among not-on-track patients was r = .25, 95% CI [.15, .34], p < .001, k = 4, n = 454; the effect size for the Patient/Therapist Feedback condition of the OQ system among not-on-track patients was r = .25, 95% CI [.15, .34], p < .001, k = 3, n = 495; the effect size for the Clinical Support Tools feedback condition among not-on-track patients was r = .33, 95% CI [.25, .40], p < .001, k = 3, n = 535). The number of psychotherapy patients who deteriorate can be cut in half by use of these systems. We conclude with a series of practice implications, including that clinicians seriously consider making formal methods of collecting client feedback a routine part of their daily practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

The past 40 years have generated numerous insights regarding errors in human reasoning. Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial. We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective. We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy-naive realism, confirmation bias, illusory causation, and the illusion of control. We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories: (a) the perception of client change in its actual absence, (b) misinterpretations of actual client change stemming from extratherapeutic factors, and (c) misinterpretations of actual client change stemming from nonspecific treatment factors. These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective. We (a) examine how methodological safeguards help to control for different CSTEs, (b) delineate fruitful directions for research on CSTEs, and (c) consider the implications of CSTEs for everyday clinical practice. An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice.