Enhancing Outcomes with Progress Monitoring

The Globe & Mail published an article highlighting the use of routine progress monitoring to improve the effectiveness of psychotherapy. Given the time and money clients invest in psychotherapy, it is important that clients receive feedback-informed psychotherapy to enhance the effectiveness of treatment. Routine progress monitoring is a practice that clinicians implement at Eastwood Psychologists.  I will be sharing my experience with progress monitoring as a Psychologist (Supervised Practice) at Eastwood Psychologists and how it has benefited my work with clients.

What is Progress Monitoring?

Progress monitoring is a self-report survey completed routinely by a client to assess his or her functioning each week on various areas of concern (e.g. mood and anxiety symptoms). The questionnaire can be completed as a hard copy or electronically prior to each session. This survey is scored immediately and reviewed by the treating psychotherapist at the beginning of each session.

The Globe and Mail published an article on April 7, 2018, titled: “Rethinking therapy: How 45 questions can revolutionize mental health care in Canada.” The benefits and drawbacks of regular progress monitoring were discussed.

Some of the downsides of progress monitoring noted in the article are that the surveys can be lengthy and may distract from the focus of therapy by asking irrelevant questions. Therefore, some clinicians would prefer to rely on a client’s words and presentation, than rely on a self-report measure.  Despite these opinions, the article goes on to identify many benefits of progress monitoring.

The article suggests that routine progress monitoring can enhance the effectiveness of psychotherapy and may transform the healthcare system. Progress monitoring is useful in identifying when a client is improving over the course of therapy, but it can also identify when a client is not progressing in treatment. This information can be used to improve therapy effectiveness and perhaps reduce the risk of early dropout. Other areas of medicine use clinical tests, such as blood tests, to inform and enhance treatment. Similarly, the use of progress monitoring could serve the same purpose in psychotherapy.

Progress Monitoring at Eastwood Psychologists

Eastwood Psychologists have regularly used progress monitoring with their clients since 2011. The tool used at Eastwood Psychologists is a measure called the Outcome Questionnaire-45 (OQ-45). The OQ-45, developed by Psychologist Dr. Michael Lambert, is a 45-item measure that produces an overall distress score and a distress score in three categories:

  1. Symptom Distress – examines mood and anxiety symptoms
  2. Interpersonal Relationships – examines relationship satisfaction
  3. Social Role – assesses difficulties in the workplace, school or at home

The OQ-45 also highlights Critical Items that capture a client’s risk in potentially high-risk areas, including suicide potential, substance abuse, and workplace violence potential. The questionnaire is completed online, takes approximately five minutes to complete, and is automatically scored and reviewed by the clinician prior to session.

My Experience with the OQ-45

 As expressed by many clinicians in the article, I also find that the use of routine progress monitoring augments and enhances the psychotherapy process.  Specifically, the OQ-45 presents a weekly snapshot of a client’s distress, can be a collaborative tool, and can be rewarding to reflect on.

The OQ-45 provides me with a window into a client’s functioning in the past week, even before he or she enters the office. The client’s OQ-45 overall and subcategory scores are compared to a growing database of other groups, such as the general population or an outpatient mental health center. This gives me a context for the severity of a client’s distress.  Moreover, I use this data in conjunction with client presentation, verbal reports, and my clinical judgment. Together, this informs my understanding of a client as whole, allows me to monitor client safety, and helps determine the best use of our time in session.

The OQ-45 is also useful as a collaborative tool with my clients. The completion of the OQ-45 offers another means by which clients can communicate their concerns to me weekly. A discussion of a clients’ OQ-45 score can help them feel heard and understood. I also point out when there is a discrepancy between a clients’ OQ-45 score and what they express in session in body language and their words. These discrepancies helps me and my clients further understand how they cope with their distress, and help us target underlying concerns that may have remained concealed, if not captured by the OQ-45. In addition, tracking OQ-45 scores provides an opportunity to reflect on and revise the treatment plan in consultation with my supervisor, colleagues, and/or my clients.

Reflecting on change over time on the OQ-45 with my client is also a rewarding experience. The OQ-45 plots clients’ weekly data on a graph over the course of psychotherapy. I share progress graphs with my clients at various points over the course of treatment, providing them with evidence of the change they have described. Clients often express surprise, pride and contentment at how much they have changed over the course of treatment. Impressed with their progress, many clients request to take the graph home.

In summary, routine progress monitoring is a valuable addition to psychotherapy. This feedback informed approach not only informs the clinician session-by-session but also informs the treatment plan as a whole for increased therapy effectiveness. As stated in the Globe & Mail article, a brief 5-minute survey can contribute to enhanced treatment outcomes and improve the quality of mental health care.

Telehealth & Telepsychology: Efficacy, Benefits and Patient Satisfaction

The health care field is rapidly adopting the use of technology, and this is especially true in the midst of the Covid-19 pandemic. Due to physical distancing guidelines, an increasing number of health care professionals are using technology to provide services remotely.

The use of technology for health care is unfamiliar to many people.  Exploring and embracing technology, however, will help individuals stay connected with health care providers and continue to receive services.

What is Telehealth & Telepsychology?

The World Health Organization describes telehealth as the delivery of health care services via telecommunications and virtual technology. Telehealth relies on technology to allow a patient to communicate and share information from their home with a health care professional. The delivery of mental health treatment via technology is known as telepsychology.

Telepsychology can be delivered in a variety of forms, including telephone, videoconferencing, web chats (i.e. internet text-based therapy), and apps. The common factor among all these modalities is the need for an Internet connection and an electronic device, such as a laptop or cell phone. These formats differ on whether the service is received in “real-time” or not.

Real-time telepsychology is most similar to traditional in-person treatment due to the live interaction between a health care provider and a patient. Asynchronous telepsychology refers to treatment delivery that does not provide real-time interaction between a provider and a patient. Examples of this include email and automated responses through an app. This article will focus on real-time telepsychology services, as this is the primary approach health care professionals have been using as an alternative to in-person services during the Covid-19 pandemic.

This blog post draws from recent research studies to identify the benefits of telehealth, as well as address concerns regarding its use, with a particular focus on psychotherapy. In turn, this may help promote the use of telehealth to access health care.

What are the Benefits of Telehealth?

Telehealth is a promising health care delivery method that increases access to services, including health care specialists. In addition, it overcomes several barriers to treatment including geographical distance and isolation (e.g. underserved areas), difficulty accessing transportation, travel costs, and time commitments due to travel and wait times to see a health care provider.

Patients can receive care without the need for in-person appointments. Telehealth also allows patients and health care providers to store and forward patient health information for rapid communication with patients or between health care providers.  Telepsychology is a convenient alternative that allows for access to treatment from the privacy of one’s home, while allowing optimal use of a patient’s time.

Is Telehealth Effective?

Despite the benefits, individuals may be reluctant to try telepsychology for a variety of reasons. One reason is the belief that the physical presence of a health care professional would be more effective than services received via technology. With the increasing use of, and reliance on, technology for health care delivery, research studies have taken a closer look at whether telehealth is as effective as in-person appointments.

Almathami and colleagues published a study in 2020 in which they investigated the efficacy of telehealth for the treatment of different health conditions and diseases. The authors conducted a qualitative analysis of 45 published research studies that examined treatment delivery via videoconferencing between a patient and a doctor. The patients in these studies ranged from 1 to 80 years of age, and received treatment within their home for either mental health (e.g. psychotherapy) or physical health conditions (e.g. cardiovascular disease). Treatment ranged in duration from 2 weeks to 12 months. Almathami and colleagues found that 98% of the articles reported that videoconferencing treatment delivery achieved the desired health outcomes. Specifically, videoconference was an effective method in assessing patients’ health conditions and improving patients’ overall health conditions.

What about telepsychology specifically? A study by Varker and colleagues published in 2019 investigated the efficacy of real-time telepsychology treatment of adults with mental health disorders. The authors critically evaluated 25 published studies that examined the efficacy of telephone, videoconferencing, or web chat based treatment for four mental health disorders: major depression, anxiety disorders, post traumatic stress disorder and adjustment disorder. This study found that there is strong and high-quality research examining the efficacy of telephone and videoconference treatment approaches, as opposed to studies examining the efficacy of web chat (i.e. internet text-based live chat). Furthermore, telephone and videoconferencing treatment were found to be as effective as standard in-person treatment on a range of outcomes (e.g. severity of symptoms). There was insufficient evidence to determine the benefits of web chat. The authors concluded that there is clear, consistent evidence of the benefits of telephone and video conferencing treatment delivery methods for psychotherapy, with no evidence suggesting negative effects of these methods.

Limitations of Telehealth

Though these studies highlighted the efficacy of telehealth and telepsychology, it is important to note that telehealth may be challenging with certain treatment populations. For example, young children or a geriatric population with hearing or vision loss and/or a cognitive impairment may have difficulty engaging in online treatment. Almathani and colleagues found mixed results for these populations, as some studies reported challenges, while others reported success and no additional difficulties. The authors concluded that further investigation is required to explore the use of telehealth with these populations.

Overall, research has found that telepsychology is an effective alternative to traditional in-person treatment.  In addition to examining the effectiveness of telehealth, researchers have also examined factors that can positively and negatively influence the use of telehealth.

Influencers and Barriers to Telehealth

Almathami and colleagues identified several factors that can either facilitate or serve as barriers to telehealth. These factors can be categorized as situational (e.g. access to technology) or personal factors (e.g. technology knowledge and skill). Together these factors can influence a patient’s satisfaction and convenient use of telehealth. These factors are summarized below along with suggestions to address barriers and enhance telehealth services.


Telepsychology services (particularly videoconferencing) require access to the Internet. Internet speed and quality can interfere with the ability to clearly see and hear the health care provider. Internet quality can be influenced by the network and wireless signal coverage in the area, as well as obstructions within or outside the home. Sitting close to the Internet source or connecting to the Internet directly using a cable may improve the Internet connection and speed.

Available Device

In addition to Internet access, telepsychology services require an electronic device that is equipped with video and/or microphone. This can be a desktop computer, laptop, cell phone or tablet. Some devices may allow for easier access to a comfortable and private location for a psychotherapy appointment. For example, using a cell phone or laptop may provide more privacy than the desktop computer in a common area of the home.

Security and Privacy

The storage, transfer and communication of personal health information are important to consider, as not all technology platforms provide the necessary security measures to protect patient privacy. There are telehealth video platforms available that comply with legislation for the use of, management and storage of health information and records for enhanced security.  Eastwood Psychologists uses a video platform called Virtualcare (https://www.thinkresearch.com/ca/products/virtualcare/) that has end-to-end encryption to protect the privacy of personal health information and communication.  Virtualcare also allows documents to be shared securely over the platform.

Patients can also take steps to protect their privacy within their own home.  It is important to hold appointments in a quiet, private space where personal information can be discussed openly. It may be helpful for patients to schedule appointments when other family members will be busy or out of the home. Patients can also ask their health care providers questions about privacy and security.  Health care providers can help clarify any security concerns about the systems used, and help address concerns about privacy within the home.


Telehealth can allow for flexibility in scheduling. Patients may be able to schedule an appointment time that is suitable and convenient. This convenience may help patients be more willing to engage in, and comply with treatment, which in turn may help improve effectiveness. Health care providers may have availability that is suitable to patients’ schedules and at a time for increased privacy and reduced distraction during appointments.


Familiarity with technology and the online system can ease a patient’s transition to telehealth and promote openness to this approach.   Health care providers or their office staff may be able to provide a test call or tutorial to help patients become more acquainted with the system.  The use of technology for health care can be frustrating and anxiety provoking at first, but with repeated use, it can hopefully become a familiar and comfortable tool.

Telephone or Video Conferencing?

Patients may be offered a choice of videoconferencing or telephone sessions for health care appointments. As mentioned above, both approaches have been found to be effective.  The choice of video or phone may be made based on patient preference, quality of the available Internet connection, and ease of use.  Video conferencing may allow for more nonverbal communication (i.e. gestures, eye contact and body language) between patient and psychotherapist.  On the other hand, telephone sessions may be more familiar and comfortable for some people.


Based on these studies, telepsychology is a promising treatment delivery method due to its benefits, efficacy and similarity to standard in-person treatment. Telepsychology can overcome barriers to treatment, including recommended physical distancing due to Covid-19. Considering factors that can improve the quality of the telehealth experience may improve patient satisfaction with the experience. The adoption of telepsychology will allow patients to benefit from continued psychological services for effective and remote treatment from the comfort of one’s home.



Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services, 16(4), 621-635.

Almathami HKY, Win KT, Vlahu-Gjorgievska E (2020). Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review. J Med Internet Res 2020;22(2):e16407.

Addressing Privacy When You Do Therapy From Home

Taking care of your mental health is paramount during these times of social isolation, but can be difficult when you are stuck at home with your partner, siblings, parents, children or roommates. Telepsychology can be a great way to help you handle the unpredictability and uncertainty that so many of us are currently struggling with. However, it brings the added burden of seeking privacy while accessing the care you need. This blog post will address how you can obtain the privacy you need to be truly vulnerable when you are at home with others.
Asking family member(s) or other member(s) of your household to leave the home
If your family member(s) are aware that you are seeking psychological care and are supportive of your therapy, you can ask them to leave the home for the duration of your session. If you are not comfortable letting a member of your household know you are in therapy, you can let them know in advance that you would need privacy for an hour at the specific day and time. This will allow you to have privacy without divulging too much information.
You may ask your family member(s) or member(s) of your household to do the following while you have your therapy session:

  • Go for a walk
  • Go for a drive
  • Do groceries
  • Run an important errand

If family member(s) or member(s) of your household cannot leave the home
If the people you are living with are unable to leave the home, you can request them to:

  • Watch a movie or a TV show with headphones on in another room
  • Listen to music with headphones on while doing household chores
  • Take an extended bath or shower

In this option, make sure you inform them when your session is over or when you no longer require that level of privacy!
Therapy outside the home
Alternatively, if  the first two options are not suggestions that can work for your situation, you can choose to leave the home to have your therapy session. The virtual platforms used at Eastwood Psychologists allow clients to have video sessions on their phones, tablets and laptops. Some possible places outside the home where you can have your session include:
 Have the session in your parked car
Prior to the start of your session, drive your car in an isolated parking lot where you can use your device to connect with your therapist for the duration of the session. You can leave the windows down for some air!
 Have the session at a nearby park
You can walk to a nearby park and find a corner that is isolated where you can speak to your therapist through the video platform.
 Have the session in your backyard
If you feel comfortable and have access to privacy in your backyard, you can find a shaded area to have your therapy session.
Have the session in your garage
If you feel comfortable and have access to privacy, you can grab a comfortable chair and have your therapy session in your garage.
Have the session at the Eastwood Psychologists’ Office
You can let our office manager know that you are unable to do any of the listed suggestions and require privacy for your therapy sessions. Our office manager can arrange for you to come to the office and have your video session in a private space while your therapist connects with you from their remote office.
If any of the above do not work for you, you can request the therapist that your session be at a time when your children are sleeping or when your parents are at work. Your therapist will try to do their best to accommodate you as much as possible, but we cannot guarantee that they will be working very early or very late during the day.
Lack of privacy does not need to be a barrier to receiving psychological care. In this blog post, we have listed just some ways you can address privacy issues while starting or continuing therapy. If you would like to discuss this further, please contact our office or your therapist to brainstorm other ideas that can work for your unique situation.

In-person services at Eastwood Psychologists during the coronavirus pandemic

On May 26, 2020, the Ministry of Health amended Directive #2 to support the gradual restart of all deferred and non-essential and elective services carried out by Health Care Providers.  This includes the work of psychologists, who are regulated health professionals. For Directive # 2 http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/directives/RHPA_professionals.pdf

At Eastwood Psychologists, we are gradually resuming in-person services where indicated .  We are following the Ministry of Health’s Covid-19 Operational Requirements: Health Sector Restart document, also published on May 26, 2020. For COVID-19 Operational Requirements: Health Sector Restart: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/operational_requirements_health_sector.pdf

Specifically, we are applying a hierarchy of hazard control methods, as recommended by the government.

1.         Elimination and Substitution

The most effective way to contain health hazards is to eliminate in-person health care visits, and substitute them with telehealth.  By offering services virtually, we are able to prevent possible exposure to the coronavirus.   We continue to recommend that clients see their psychologist virtually wherever possible, to ensure everyone’s safety.  Research to date (with adolescents and adults) suggests that virtual therapy is just as effective as in-person therapy.  Thus we expect that it will make sense to continue to offer telehealth services to most of our clients.  For more information about virtual therapy, please see Dr. Naomi Carpenter’s blog post. At Eastwood Psychologists we have two general options for clients to participate in telehealth.

From your home:    This option works well when you have a private space in your home where you can go to meet with your psychologist.  This option also works best when you have a strong Internet connection, particularly when you want to meet with your psychologist using videoconferencing.  Meeting with your psychologist from your home is often more convenient, because it eliminates the need to travel to our office.

From our office:      Now that we have begun to re-open our physical office, you have the option to use one of our offices in order to meet with your psychologist virtually.  Your psychologist will join you virtually from their remote office.  This option works well when you have few options for a private meeting space in your home.

Although we continue to recommend virtual therapy wherever possible, there are some circumstances where virtual therapy is not advisable, possible, practical, or effective.  Before deciding to see a client in-person, we will discuss the need for in-person services and whether it makes sense to proceed.  For clients who will be attending sessions in-person, the following health hazard control measures will apply.

2.         Engineering and Systems Control Measures

These include the use of equipment/barriers to keep people apart and to increase ventilation, in order to reduce opportunities for transmission.  At Eastwood Psychologists, we have installed plexiglass screens that physically separate clinicians and staff from clients.  When the weather allows, windows will be opened to increase ventilation.  When the windows are closed, we will run HEPA filters to assist in removing potential pathogens from the air.

3.         Administrative Control Measures

These measures include the implementation of policies, procedures, training and education with respect to infection prevention and control.    Our policies include the following (subject to regular review and revision as needed):

Education and training:

  • Informed consent process for clients.
  • Passive screening (i.e. signs posted) reminding everyone of symptoms to watch out for and where to get help.


  • Active screening when appointments are booked and the day before the appointment.
  • Clients and clinicians must be symptom free in order to proceed with in-person sessions.

Physical Distancing:

  • All staff, clinicians and clients will wear masks at all times while at the office.
  • The waiting room will not be used.
  • Clients will wait outside (on the porch or in their vehicle) until they are cued to come in for their appointment (via text message).
  • Client appointments will be scheduled such there will be at least 15 minutes between sessions to minimize the overlap of clients coming to the office.
  • When appropriate, individuals accompanying clients but not participating in the session, such as those providing transportation, will be asked to wait elsewhere and return to meet the client after the appointment.
  • Office rooms are furnished to allow physical distancing between clinicians and clients.
  • Our office manager will continue to work from home most of the time, but she is able to assist as needed via phone.


  • All staff/clinicians and clients will wash hands upon arrival at the office.
  • Staff/clinicians wash hands after every client interaction.
  • Signage throughout the office will direct clients regarding where to go and how/when to sanitize their hands.
  • Common areas and other high-touch surfaces and objects handled by clients/patients (e.g., reception counters, chairs and seating areas, door handles, handrails, credit card machines, washroom fixtures, etc.) will be cleaned and disinfected after each use with a hard surface area cleaner approved by Health Canada.
  • Assessment materials or other equipment or items handled by multiple clients/patients will be cleaned and disinfected after each use as above.
  • Sufficient supplies will be available for proper hand hygiene, including hand sanitizer, soap, warm running water and paper towels. Non-touch, lined waste disposal receptacles for use by both staff and clients are provided throughout the office.

An important note about your privacy:

Your privacy is important to us.  It is important for you to be informed that we may be required to share some information about you with public health.  We will be keeping a daily log of everyone coming to the office, staff and visitors alike, in order to provide contact tracing should a case of COVID-19 be associated with our office.   The log will include arrival and departure times of each individual.  The log will be shared with public health if needed/requested.