What Are the Benefits of Outcome Measurement in Psychotherapy?

In my 39+ years and more than 17,000 hours of client experience, I’ve thought a lot about assessments and results. Throughout the years, as I saw more clients, some of the same questions kept popping up in my mind. How do I really know if a client is benefiting from therapy? Is there a way to tell which clients are deteriorating and which are improving? Is there a way to know if a client will be dropping out in the future?

That last question is particularly important, because we cannot help clients who drop out of therapy. Research shows that dropout rates average at least 47% in the delivery of mental health and substance abuse services. In addition, studies show that not all clients benefit from therapy, with estimates varying from 35 to 67% in terms of improvement.

Early in my career, I began to ask myself if there was a way to develop mental or behavioral health measures that could help assess outcomes systematically. Back then, other feedback systems existed, such as the Outcome Questionnaire 45.2 (OQ), but I kept thinking that we needed a system for behavioral and mental health outcomes measurement that was both client centered and easy to administer in a clinical setting. These thoughts ultimately led to the development of the Partners for Change Outcome Management System (PCOMS).

The System

PCOMS is a light-touch, checking-in process that usually takes about five minutes to administer, score, and integrate into psychotherapy. It allows therapists to partner with clients, identify those who aren’t responding, and address lack of progress in a proactive way.

Most importantly, unlike other mental and behavioral health measures, PCOMS’ Outcome Rating Scale is not an extensive list of symptoms or problems to be checked by clients. Instead, it’s an instrument that’s individualized with each client to represent his or her idiosyncratic experience and reasons for service. It also keeps front and center the clients' perceptions of the effectiveness of each therapy session.

The Web Application

PCOMS employs a visual, analog scale consisting of four 10-cm lines, corresponding to four domains: individual, interpersonal, social, and overall. Using the web application called Better Outcomes Now (BON), clients can place a mouse click (or touch if using a tablet) on each line to represent the perception of their functioning in each domain. The maximum score is 40, with lower scores reflecting increased distress.

The Outcome Rating Scale ensures the client’s voice remains central and is used to track outcomes in every session. Scores that do not increase over time are indicative of a greater likelihood of client dropout and/or poor outcome. One of the most useful features of PCOMS is that it can be integrated into any treatment model and applies to all diagnostic categories. 

PCOMS’ Outcome Rating Scale has been evaluated against other existing measures and demonstrates good reliability and concurrent validity with longer measures. It has also been used in mental health, behavioral health, and substance abuse settings in more than 20 countries with more than 1.5 million administrations in its database.

The Evidence

Seven randomized clinical trials have also demonstrated that PCOMS dramatically improves outcomes while increasing efficiency. An independent meta-analysis revealed that individuals using PCOMS had a 3.5 times higher chance of achieving reliable change and 50% less likelihood of deterioration.

It’s been a long time since my very first therapy session. Nonetheless, my goal has always been the same: to help my clients. I encourage you to take a look at PCOMS and BON to see if they could be useful behavioral or mental health outcomes measurement tools to help your clients as well.