ABSTRACT
The effects of psychotherapy have been found to be generally positive across a variety of studies and over a substantial period of time dating back to the 1930s (Lambert & Ogles, 2004). In randomized clinical trials (RCTs), in which treatments are offered by carefully selected and closely supervised therapists to carefully screened patients with a specific disorder, about 35–40 percent of patients experience no benefit and a small group of patients, perhaps between 5 and 10 percent, deteriorate (Hansen, Lambert, & Forman, 2002). In our program of research, we have endeavored to improve psychotherapy outcome in routine care through monitoring patient progress and providing this information to clinicians in order to guide ongoing treatment, especially for the patient who is not having a favorable response to treatment (not-on-track [NOT] cases). This research is an extension of quality-assurance action research and represents one effort to bridge the gap between research and practice while enhancing patient outcome before treatment termination. It is also well suited to models of care in which clinicians attempt to step up or step down the intensity of treatments after assessing a patient’s treatment response (Otto, Pollack, & Maki, 2000). I have documented here our progress in enhancing patient outcome by describing how we have operationally defined outcome, treatment success and failure, and our experience with monitoring treatment response and feeding back this information to therapists and patients before treatment termination.
