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.