Psychotherapy outcomes are primarily measured by symptom reduction. Such a focus on symptoms is largely determined by researchers’ interests and their need for a quick, unidimensional assessment of the potential impact of psychotherapy. This focus has translated into treatments that emphasize diagnoses and symptoms (CBT for OCD, IPT for depression, DBT for borderline personality disorder). However, this focus on symptoms may oversimplify the complex nature of mental health and ignore the psychosocial factors that contribute to overall well-being. Also, this singular focus on symptoms may overlook outcomes that patients experience and value. To identify psychotherapy outcomes experienced by patients, Ladmanová and colleagues conducted a qualitative meta-analysis – that is, a meta-analysis of qualitative studies that asked patients what changes they noticed in themselves as a result of therapy. The meta-analysis included 177 studies representing over 2900 patients. The researchers found nine clusters of psychotherapy outcomes reported by patients. First were outcomes related to self-understanding, including deeper self-awareness, new perspectives on the self, and more adaptive thinking. Second, were outcomes related to attitudes toward the self, including greater self-confidence, self-esteem, self-compassion, less guilt and self-criticism, increased self-agency and autonomy, and personal growth. Third were outcomes related to social and relational functioning, including being more assertive, better understanding and empathy towards others, better social engagement, and improved relationship satisfaction. Fourth were outcomes related to better coping and self-care. Fifth were outcomes related to emotional functioning, including better emotion regulation and understanding of one’s own emotions, and greater openness to emotional experiences. Sixth were outcomes related to behavioural functioning, such as the development of new adaptive behaviours and the reduction of problematic behaviours. The seventh was a cluster of outcomes related to symptom reduction, such as reduced depression and anxiety. Eighth were outcomes related to more general wellbeing, including feeling calmer, and having a greater sense of vitality and happiness. Finally, were outcomes related to generally embracing life, such as living more mindfully.
Practice Implications
Symptom improvement represented a fraction of the types of outcomes patients described after completing treatment. Beyond symptom reduction were broad areas of relational, social, and emotional functioning, as well as self-awareness and self-understanding. Clinicians should listen carefully to what patients value regarding psychotherapy outcomes. Symptom reduction may bring patients to therapy initially, but they may be expecting and wanting more from therapy than a narrowly focused treatment of their symptoms. Emphasis should be on supporting patients’ well-being in a more general sense.
Ladmanová, M., Řiháček, T., Timulak, L., Jonášová, K., Kubantová, B., Mikoška, P., Polakovská, L., & Elliott, R. (2025). Client-identified outcomes of individual psychotherapy: A qualitative meta-analysis. The Lancet Psychiatry, 12(1), 18–31. https://doi.org/10.1016/S2215-0366(24)00356-0.
The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders.
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PPRNet Clinical summary: Client-Identified Outcomes of Individual Psychotherapy
Psychotherapy outcomes are primarily measured by symptom reduction. Such a focus on symptoms is largely determined by researchers’ interests and their need for a quick, unidimensional assessment of the potential impact of psychotherapy. This focus has translated into treatments that emphasize diagnoses and symptoms (CBT for OCD, IPT for depression, DBT for borderline personality disorder). However, this focus on symptoms may oversimplify the complex nature of mental health and ignore the psychosocial factors that contribute to overall well-being. Also, this singular focus on symptoms may overlook outcomes that patients experience and value. To identify psychotherapy outcomes experienced by patients, Ladmanová and colleagues conducted a qualitative meta-analysis – that is, a meta-analysis of qualitative studies that asked patients what changes they noticed in themselves as a result of therapy. The meta-analysis included 177 studies representing over 2900 patients. The researchers found nine clusters of psychotherapy outcomes reported by patients. First were outcomes related to self-understanding, including deeper self-awareness, new perspectives on the self, and more adaptive thinking. Second, were outcomes related to attitudes toward the self, including greater self-confidence, self-esteem, self-compassion, less guilt and self-criticism, increased self-agency and autonomy, and personal growth. Third were outcomes related to social and relational functioning, including being more assertive, better understanding and empathy towards others, better social engagement, and improved relationship satisfaction. Fourth were outcomes related to better coping and self-care. Fifth were outcomes related to emotional functioning, including better emotion regulation and understanding of one’s own emotions, and greater openness to emotional experiences. Sixth were outcomes related to behavioural functioning, such as the development of new adaptive behaviours and the reduction of problematic behaviours. The seventh was a cluster of outcomes related to symptom reduction, such as reduced depression and anxiety. Eighth were outcomes related to more general wellbeing, including feeling calmer, and having a greater sense of vitality and happiness. Finally, were outcomes related to generally embracing life, such as living more mindfully.
Practice ImplicationsSymptom improvement represented a fraction of the types of outcomes patients described after completing treatment. Beyond symptom reduction were broad areas of relational, social, and emotional functioning, as well as self-awareness and self-understanding. Clinicians should listen carefully to what patients value regarding psychotherapy outcomes. Symptom reduction may bring patients to therapy initially, but they may be expecting and wanting more from therapy than a narrowly focused treatment of their symptoms. Emphasis should be on supporting patients’ well-being in a more general sense.
By Dr. Giorgio Tasca
The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders.Also Read