Improving outcomes for poorly responding clients: the use of clinical support tools and feedback to clients.

We present two methods of enhancing outcome and preventing treatment failure in psychotherapy. The first involves providing therapists with a decision tree and several assessment measures for clients who are not having a positive response to psychotherapy. The organization of the decision tree and the selection of measures were based on results from psychotherapy outcome studies. The second method involves providing clients with feedback on their progress throughout the course of treatment. Both methods of providing feedback enhanced treatment outcomes and representative studies are reviewed. Use of these methods is recommended for application in routine practice.

A lab test and algorithms for identifying clients at risk for treatment failure.

Many branches of medicine rely heavily on lab tests to monitor client treatment response and use this information to modify their treatment. By contrast, those who offer psychological interventions seldom rely on formal assessments (lab tests) to monitor their clients' response to treatment. Data are presented that demonstrate that clinicians rarely accurately predict who will not benefit from psychotherapy. This finding is contrasted with the use of a questionnaire (lab test data) and decision rules on the basis of a client's expected progress. Results have indicated that formal methods of monitoring were able to identify 100% of the patients whose condition had deteriorated at termination, and 85% by the time they had attended three treatment sessions. Practitioners are encouraged to consider formal methods of identifying the deteriorating client.

Providing feedback to psychotherapists on their patients' progress: clinical results and practice suggestions.

We describe and illustrate our system to measure, monitor, and feed back information about patient treatment. This clinical innovation relies on research-based clinical decision tools that provide psychotherapists with timely warnings when a patient's deviation from an expected treatment response foretells possible treatment failure. We summarize the results of four controlled studies using this methodology; the collective results suggest that measuring, monitoring, and predicting treatment failure (feedback) enhance treatment outcomes for patients who have a negative response. Clinicians are encouraged to employ these methods in routine practice despite their confidence in their own ability to predict patient outcome.