CCCE: Measuring Effectiveness

You and your therapist track how things are going from session to session. We also track our overall effectiveness to address areas where we can improve as therapists.

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People come to psychotherapy and counseling for all sorts of reasons. During therapy, those reasons can evolve. So how can we know when psychotherapy has been effective?

We ask you to reflect on your recent well-being at the start of each session by asking a few simple questions about your distress.
We take your feedback about the process seriously.

Using your feedback can prevent a poor outcome.

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Why don't other therapists measure their effectiveness?

Well, a few do. The number of psychotherapists in private practice who systematically track their treatment outcomes (with valid methods) is still probably fewer than 1 in 1000. The Colorado Center is one of a handful of private practices in the world that openly publish their results at this level of detail and scientific accuracy.

Why is this?

It takes work. Effective therapy doesn't need technology, but quickly identifying ineffective therapy does. Keeping track of therapy quality only takes about 2 minutes and can be enormously helpful to you, but it is very difficult to get therapists to do it reliably--session after session, client after client. Without that kind of commitment, outcome data aren't valid and therapists resort to hand-picked testimonials, "years of experience," or the brand of training they've received. What good is 30 years of experience if it's 30 years of providing mediocre therapy? We are focused on you getting great therapy so we want to know if we're providing it, rather than just hoping for the best.

Fear of being judged ineffective. Most psychotherapies are "effective" (better than no treatment), but there is a wide range of effectiveness between therapists. Training, degrees, and experience have surprisingly little effect on how much clients improve from therapy! Research also shows that a therapist's overall effectiveness tends to be stable year after year. So how do you find a good therapist? By knowing how effective your therapist has been, you can know how good they are likely to be.

Paternalistic "expertise." Some clients report working with a previous therapist who wasn't very helpful, but who acted as if dissatisfaction with the therapy was the result of the client being "difficult" or "resistant." Perhaps the therapist was being too smug rather than recognizing the limits of their approach and taking in some feedback! Tracking effectiveness and being accountable requires some humility and more interest in the well-being of our clients than in our egos.

How does measuring effectiveness help you as a client?

Everyone is unique. Labeling you with diagnoses or scores on tests can't fully capture how you feel or who you are. Yet, as long as a measurement of change is valid (actually measures what it claims to measure), and is used with respect for your individuality, it can help us have a clearer sense of whether therapy is going in the right direction. In fact, some research shows that giving this simple feedback to us (about how well the sessions are going, and how you are feeling in your life from session to session) can be helpful in making therapy more effective.

The Rating of Outcome Scale ("RŌS"; Seidel et al., 2016) has only 3 questions. It is fast, easy to use, and was recently validated in a peer-reviewed study published in the top-tier journal Psychological Assessment with a much longer "gold standard" instrument (the OQ-45) and another ultra-brief instrument (the ORS). The RŌS reflects your point-of-view about things. You, the client, are the most accurate judge of how things are going in your life and in therapy. Outcome scales like the RŌS can be like "guardrails" to keep therapy on track and alert you and your therapist to ineffective or stagnant therapy.

We use a contextual model of treatment, not a medical model. And we use measures of real change outside of therapy.

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Here's the medical model as many psychotherapists learn it in graduate school and which will sound familiar (many people think of therapy as a kind of medical treatment):

Diagnose the condition.
Select a treatment based on the diagnosis.
Provide the treatment and wait for the expected outcome.
If no improvement is apparent, do more of it since it "should" work.
If still no improvement, add another treatment (like medication) based on the diagnosis.
If still no improvement, consider the client "treatment resistant."

We've met a lot of "treatment resistant" clients who later experience significant improvement. If the treatment isn't working, it isn't the client that's the problem! Here's the contextual model that we use because of the superior outcomes that it tends to produce:

Understand your specific concerns and what you want to change.
Use methods that we adjust based on your feedback along the way.
Measure whether there is improvement in well-being and satisfaction with the process over the course of several sessions.
If no improvement, work collaboratively with you to adjust what we are doing (change the treatment).
Measure again whether there is improvement over the course of several sessions.
If still no improvement, consider whether the therapist is ineffective for this particular client and try to find a better fit.

Doesn't that sound better? Well, it works better too! Everyone is different, so therapy can be brief or can take a long time. Regardless, we want to know as we are going forward whether what we are doing is helping. That's a lot more important than just focusing on a diagnosis and a treatment that "should" help.

We abide by core principles for analyzing and presenting our effectiveness data.

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We use widely accepted (or tougher statistics that are understandable and that make it possible to compare therapists.
We report sources of possible bias and use transparent, rigorous methodologies comparable to (or more stringent than) peer-reviewed research.
We adhere to strict ethical standards, total client confidentiality, and appropriate interpretations of our data.

Check out our results and learn more about how we track our effectiveness.