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Psychotherapy outcomes: The best therapy or the best therapist?

Posted by Tony Rousmaniere, PsyD on 2/20/11 - 2:56 PM
I’m often asked, “What’s the best therapy for anxiety/depression/trauma/etc?”  CBT, EMDR, ISTDP, ACT, DBT – the alphabet soup of therapies – how do we (and our clients) choose?  Research shows that psychotherapy outcomes often vary more between therapists than therapies, suggesting that picking the right therapy may actually be the wrong approach. In other words, choosing the most effective psychotherapist is more important than choosing the most effective therapy.   

How can our clients pick the most effective therapist? They can’t. There is no industry standard for tracking and reporting psychotherapy outcomes. This won’t last. Regulators and consumers are going to demand public accounting of treatment effectiveness. If I have the right to ask my surgeon for their success rate, then why can’t my clients ask for mine?

In a recent panel, the eminent psychotherapy researcher David Barlow noted the “inexorable trend” toward outcomes measurement. He believes it will bring “enormous benefit for all of us,” by improving the connection between clinical research and the effectiveness of actual clinical practice.

Many therapists, however, dread the movement towards measuring outcomes. They raise important concerns about the ability of outcome measures to assess subtle nuances of psychotherapy in long-term treatment. Other concerns include paperwork hassles, and the danger of “therapist profiling” by outcome. (You can join a lively discussion of these concerns in the forums here.)

However, the benefits of embracing outcomes far outweigh the concerns. I’d like to suggest four major benefits to tracking psychotherapy outcome:
  1. Measuring outcomes will help us become better therapists. How else can we know if all the workshops, trainings and supervision we do are actually helping?
  2. If we get out in front of this movement then we will have a stronger hand in designing it. If we resist the push towards accountability, it will be forced upon us. (For example, the Los Angeles Times recently published a report outcomes of public school teachers in Los Angeles county, by teacher name.)
  3. Online therapist-review websites (such as yelp.com or healthgrades.com) lets one or two disgruntled clients hurt your reputation. A public system for reporting outcomes gives a fair perspective of your work.
  4. Most importantly, our clients deserve to know about the treatment they are getting. Research consistently shows that most therapy is very successful. Dodging accountability can foster the impression that our failures are more common than our successes.
One good example of a therapist who has embraced outcome measurement is Allan Abbass. He tracked and reported his therapy outcomes for his first six years in private practice, and then published the results.

How can a therapist start tracking their outcomes?  I use the Outcome Rating Scale, which takes about one minute at the beginning of each therapy session. The free scale and instructions can be downloaded here  and here. There are also three online services that help therapists track their outcomes: myoutcomes, oqmeasures, and core-net.

[This blog is dedicated to exploring training tools and techniques that help us become better therapists. Please email me at trousmaniere@yahoo.com if you have any feedback or new psychotherapy training techniques you would like to share.] 
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