Routine outcome monitoring (ROM) with clinical feedback to therapists is an important development in psychotherapy practice. ROM often involves weekly repeated assessment of a patient’s progress in therapy using a standardized questionnaire and then feeding the information back to therapists. The information contains not only the patient’s score (on a symptom scale, for example) but also whether their scores increased or decreased relative to their previous week’s score, and how the client is doing relative to the general population. This practice reduces the number of patients who might deteriorate or drop out of therapy. However, recent reviews suggest that the effects of ROM are not so obvious. A potential problem with ROM is that it relies on standardized scales whose questions may not be relevant to all patients. Another possible problem is that patients and therapists may experience mandatory standardized measurements as serving the agenda of an institution, agency, or third-party payer rather than serving a clinical need. This might negatively impact the therapeutic relationship. One partial solution might be to individualize or personalize the outcome monitoring (I-PROM) so that each patient’s outcomes or goals are specific to the patient and defined in collaboration with the therapist. In this study, Solstad and colleagues wanted to get a better sense of the experiences of patients' and therapists' use of I-PROM. They systematically reviewed the literature and found 13 papers on I-PROM. They then performed a qualitative analysis of 9 papers that reported interviews and written text of the experiences of patients and therapists to understand their experiences with I-PROM better. Three themes emerged from the qualitative analysis. The first theme, “Opportunities,” indicated that I-PROMs could facilitate patient self-reflection, help track therapy topics, and empower patients by giving them a greater sense of responsibility for the therapy. The second theme, “Challenges” indicated that formulating goals and problems can be challenging, that the procedure can be experienced as taking away from therapy time, and that indications of a lack of progress can be demotivating. The third theme, “Implications for Practice”, suggested that flexibility and therapists’ clinical skills facilitate using I-PROM effectively. In other words, sometimes items need to be changed to reflect new emerging goals, and using it in every session may not be necessary or helpful. The procedure could improve collaboration, which is a key element of the therapeutic alliance.
Practice Implications
Individualized versions of routine outcome monitoring (I-PROM) may represent a promising advancement in this practice to improve patient outcomes and engagement. It represents an opportunity to identify personalized therapeutic topics (goals and outcomes) and facilitate communication and collaboration between patient and therapist. I-PROMs should flexibly adapt to patients' needs within the context of a good therapeutic alliance.
Solstad, S.M., Cooper, M., Sundet, R., & Moltu, C. (2025). Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature. Psychotherapy Research, 35, 125-138. https://doi.org/10.1080/10503307.2023.2283528
-COLOUR.svg "Collabzium")
