Psychologists\u27 approaches to evaluating client progress in psychotherapy practice

Evidence-based mental health practice has emerged as a major priority in the search for cost-effective mental health treatments. The evaluation of client outcomes in psychotherapy practice represents an important but understudied component of evidenced-based mental health practice. Despite the growing research demonstrating that client outcomes tend to be enhanced when clinicians receive feedback on outcome measures, the utilization rates of empirically-derived outcome assessment methods among master and doctoral level clinicians remain quite low. While the literature shows that social workers evaluate client outcomes using subjective/intuitive approaches to a much greater extent than quantitative methods, less is known about the approaches that psychologists use to evaluate client progress. The current study is the first to examine the construct validity of outcome evaluation approaches identified in the social work literature and to assess the degree to which these approaches are used by psychologists. A national sample of 301 licensed clinical psychologists completed a mail survey that assessed predictors of various outcome evaluation approaches (i.e., subjective/intuitive approaches, general evaluation skills, and quantitative methods). The predictors examined were theoretical orientation, research training, practice setting, and attitudinal and practical barriers. As hypothesized, a factor analysis revealed a three-factor structure representing subjective/intuitive approaches, general evaluation skills, and quantitative methods. Subjective/intuitive approaches were the most widely used approaches and did not differ by theoretical orientation or practice setting. The use of quantitative methods, which were low across all theoretical orientations, and general evaluation skills were both found to be lower among psychodynamic/insight-oriented psychologists compared to psychologists endorsing cognitive-behavioral, integrative, and other theoretical orientations. Training in outcome evaluation methods obtained during graduate school, via coursework and practical experience, predicted greater usage of quantitative outcome evaluation methods in post-doctoral psychotherapy practice. These findings suggest the need for advanced training and practical experience in the reliable conjoint use of quantitative outcome evaluation methods and subjective/intuitive approaches as a means to evaluate client progress. The integration of these approaches represents one of the most promising evidence-based practices available to clinicians from all mental health disciplines and theoretical orientations