PPRNet Clinical summary: Therapist Review of Client Symptoms Measures Before Each Session

Routine outcome monitoring (ROM ), also known as feedback-informed treatment or measurement-based care, involves systematically tracking patient progress during treatment using standardized measures and using this information to inform therapy. ROM is an effective approach in a variety of therapeutic orientations, settings, and clinical populations. ROM might focus therapists’ attention, provide new information, and enhance therapist-patient communication. But there have been challenges with implementing ROM in real-world practices, with therapists sometimes feeling micromanaged and patients sometimes feeling the process is intrusive. Nevertheless, the research shows that ROM has positive effects on reducing patient symptoms. Why and how ROM works remains somewhat unknown. In this study, Li and colleagues asked why and how ROM works and examined three possibilities: a session-to-session effect (i.e., across therapists and patients, does a therapist getting feedback before a session affect the patient's outcome in the very next session?), a patient effect (i.e., regardless of the therapist, do clients have better outcomes if their therapist uses ROM when treating them?), or a therapist effect (i.e., across all their patients, do those therapists who consistently use ROM generally have patients with better outcomes?). Knowing this might help to improve the process and direct training efforts. Li and colleagues studied 26 therapist trainees who saw 456 clients, with each client completing outcome measures before each session, for an average of about 13 sessions. The researchers noted whether therapists accessed the feedback patient questionnaires before a session, after a session, or not at all. The researchers were able to separate out session, patient, and therapist effects. Despite being trained to use and interpret outcome feedback with ROM, only about 50.5% of therapists reviewed patient outcome data before a session, 27.4% reviewed it after a session, and 22.2% did not review it at all. The researchers found that therapists monitoring outcomes and receiving feedback before each session had a positive effect on patients’ symptoms from one session to the next (a session -to-session effect). Second, if a patient’s therapist reviewed all of that patient’s outcome scores before each session, that patient’s symptoms decreased significantly (a patient effect). Third, if the therapist across all their patients viewed 100% of the outcome scores before each session, that therapist’s patients, on average, had better outcomes (a therapist effect).

Practice Implications 

ROM improved outcomes at multiple levels. Reviewing outcome data improves symptoms from one session to the next across patients and therapists. A patient whose therapist regularly reviewed their outcomes had fewer symptoms. And therapists who used ROM regularly had patients who, on average, had better outcomes. These findings underscore the importance of closely monitoring and reviewing patients’ symptom changes before each session.

Li, X., Carney, J. J., Rousmaniere, T., Fineman, B., & Vaz, A. (2025). The “magic” of looking at that score: A multilevel investigation of therapist review of client symptom measures and client clinical outcome. Journal of Counseling Psychology. Advance online publication. https://dx.doi.org/10.1037/cou0000781