Making the case for using personalised outcome measures to track progress in psychotherapy

Abstract

The practice-based evidence movement has become increasingly influential in the practice of counselling. One element of this approach is the recommendation that therapists regularly administer standardised or nomothetic measures to track the progress made by their clients. When this feedback indicates that therapy is off course (i.e. out of kilter with the projected course of effective treatment) therapists are alerted to the risks of potential dropout and encouraged to take some form of corrective action. Despite an expanding evidence base supporting this strategy for improving psychotherapeutic outcomes, there are also concerns that the generic measures adopted do not always possess the specificity and sensitivity required to capture the unique experiences of individual clients. The paper argues that personalised or idiographic assessments can be designed to match the language and priorities of individual clients and so provide a more nuanced measure with which to track the course of therapy and promote informed reflective conversations between client and clinician on when and whether a change in direction is needed. However the idiographic alternative is not an easy option and practical as well as theoretical challenges in adopting this approach to monitoring treatment outcomes are acknowledged and discussed. Finally the virtue of using a strategy that combines nomothetic and idiographic measures is considered.