Research has shown that consistent use of objective measures in therapy improves overall treatment outcomes. One study found that when patient progress was measured in treatment, twice as many patients improved, and at-risk patients stayed in therapy longer and were less likely to deteriorate (Lambert et al. 2001).
Studies have identified the following four items as some of the major benefits derived from measuring patient progress.
Displaying a patient’s progress results helps to create transparency and a sense of control for a patient over their treatment process. This has been shown to reinforce patients’ motivation and engagement in the therapy process. One study showed that administering an outcome measure reduces patient cancellations and no-show rates throughout treatment (Bohanske & Franczak, 2010).
Regular symptom tracking can allow therapists to detect changes in health status and intervene early if necessary. Studies have shown that assessment results in the first three sessions of therapy are highly predictive of a positive or negative treatment outcome. It is important for therapists to be able to identify patients who are at risk of deterioration with a particular treatment plan. For these patients, measurement provides the greatest benefit (Lambert, 2007).
Real-time measurement and monitoring will allow therapists to obtain a more accurate picture of their patients’ well-being and reduce the impact of recall bias on therapy. Measurement does not replace a therapist’s method for decision-making, but instead, supplements and supports the traditional process with additional objective information.
Research has demonstrated that measurement has a positive effect on communication (Carlier et al. 2012), which may improve clarity and alignment on treatment goals between the patient and therapist. Since patients are in the best position to assess how they are doing, measurement and display of progress may help patients identify and discuss information that is relevant to their treatment, which they otherwise may not have shared.
Therapeutic alliance represents the fit between a patient and therapist. Research studies have consistently shown that a high therapeutic alliance is the strongest predictor of treatment success. One study demonstrated that high alliance resulted in an average of 40% symptom reduction in comparison to 14% for the control group (Baldwin et al.).
Two particularly relevant research studies are outlined below to help illustrate the importance of matching patients to the right therapist:
This study focuses on the effect that a particular therapist can have on the treatment outcomes of patients that he or she is matched with. “There were significant, sometimes dramatic differences, between therapists in terms of the number of sessions they saw clients, the speed of client change, and the overall amount of change.” This study shows that the therapist is an important outcome variable, which is in line with a number of meta-analytic reviews that have demonstrated the therapist to have a far more significant impact than the type of therapy administered.
Baldwin, Wampold and Imel set up this research trial to monitor the impact of therapeutic alliance on outcomes and to understand what contributed to this correlation. The study supported the findings in other papers that there is a significant correlation between the patient-therapist relationship and treatment outcomes. Importantly, it also demonstrated that therapist-specific factors predicted outcome while patient-specific factors (such as being better able to form a collaborative relationship) did not predict outcomes.
Goodman, J.D., McKay, J.R., Dephilippis, D., (2013). Progress Monitoring in Mental Health and Addiction Treatment: A Means of Improving Care. Philadelphia: Professional Psychology: Research and Practice, 2013, Vol. 44, No. 4, 231–246.
Carlier, I. V. E., Meuldijk, D., Van Vliet, I. M., Van Fenema, E., Van der Wee, N. J. A., & Zitman, F. G. (2012) Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. Journal of Evaluation in Clinical Practice.
Reese, R. J., Toland, M. D., Slone, N. C., & Norsworthy, L. A. (2010) Effect of client feedback on couple psychotherapy outcomes. Psychotherapy: Theory, Research, Practice, Training.
Reese, R. J., Norsworthy, L. A., & Rowlands, S. R. (2009) Does a continuous feedback system improve psychotherapy outcome? Psychotherapy: Theory, Research, Practice, Training.
Slade, K., Lambert, M. J., Harmon, S. C., Smart, D. W., & Bailey, R. (2008). Improving psychotherapy outcome: The use of immediate electronic feedback and revised clinical support tools. Clinical Psychology & Psychotherapy, 15, 287–303.
Lambert, M.J., (2007). Progress Feedback and the OQ-System: The Past and the Future. Brigham Young University: APA Psychotherapy: 2015, Vol. 52, No. 4, 381–390.
Harmon, C., Lambert, M. J., Slade, K. L., & Smart, D. W. (2007). Enhancing outcome for potential treatment failures: Therapist/client feedback and clinical support tools. Psychotherapy Research, 17, 379– 392.
Azocar, F., Cuffel, B., McCulloch, J., McCabe, J. Tani, S. Brodey, B. (2007). Monitoring Patient Improvement and Treatment Outcomes in Managed Behavioral Health. Journal for Healthcare Quality, March/April 2007.
Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing Feedback to Psychotherapists on Their Patient’ Progress: Clinical Results and Practice Suggestions. Journal of Clinical Psychology, 61, 165‐174.
Whipple, J. L, Lambert, M. J., Vermeersch, D.A., Smart, D. W., Nielsen, S. L., Hawkins, E. J. (2003). Improving the Effects of Psychotherapy: The Use of Early Identification of Treatment Failure and Problem‐ Solving Strategies in Routine Practice. Journal of Counseling Psycholtogy, 50, 1, 59‐68.
Lambert, M.J. J., Whipple, E. J., Hawkins, D. A., Niewlsen, S. L., Smart, D. W. (2003). Is it Time for Clinicians to Routinely Track Patient Outcome? A Meta‐Analysis. Clinical Psychology: Science and Practice, 10, 3, 288‐301.
Lambert, M. J., Whipple, J. L., Bishop, M. J., Vermeersch, D. A., Gray, G. V., & Finch, A. E. (2002). Comparison of empirically derived and rationally derived methods for identifying clients at risk for treatment failure. Clinical Psychology & Psychotherapy, 9, 149–164.
Ogles, B. M., Lambert, M. J., Fields S.A. (2002). Essentials of Outcome Assessment. New York: John Wiley & Sons.
Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum Associates.
Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D.A., Nielsen, S. L. (2001). The Effects of Providing Therapists with Feedback on Patient Progress During Psychotherapy: Are Outcomes Enahanced? Psychotherapy Research, 11, 1, 49‐68.
Brown, J., Dreis, S., and Nace, D. K. (1999) What Really Makes a Difference in Psychotherapy Outcome? Why Does Managed Care Want to Know? In M. A. Hubble, B. L. Duncan, and S. D. Miller (eds.). The Heart and Soul of Change: What Works in Therapy. Washington, D.C.: American Psychological Association Press, 389‐406.
Baldwin et al. “Untangling the Alliance–Outcome Correlation: Exploring the Relative Importance of Therapist and Patient Variability in the Alliance” (2007), J Consult Clin Psychology.
Okiishi et al. “An analysis of therapist treatment effects: Toward providing feedback to individual therapists on their clients' psychotherapy outcome” (2006), J Clinical Psychology.
Flückiger et al. "How Central Is the Alliance in Psychotherapy? A Multilevel Longitudinal Meta-Analysis" (2012), J Counsel Psychology.
Arrow et al. "The Relationship Between the Therapeutic Alliance and Treatment Outcome in Two Distinct Psychotherapies for Chronic Depression" (2013), J Consult Clin Psychology.
Sharf et al. “Dropout and Therapeutic Alliance: A Meta-Analysis of Adult Individual Psychotherapy” (2010), Psychotherapy (Chic).