Is Routine Outcome Feedback Informing Your Practice? | Part 1 of 2

Is Routine Outcome Feedback Informing Your Practice?

The OQ®-Analyst has the power to save lives. This is the true story of Grace, and how Dr. Tony Rousmaniere, noted psychologist, author, podcaster, and expert in patient feedback and routine outcome monitoring, came to the conclusion years ago that measuring mental health vital signs with the right instruments can often help prevent heartbreaking case outcomes.

First published in The Atlantic Monthly, “What Your Therapist Doesn’t Know,”went viral across the psychotherapy world. In the popular article, Dr. Rousmaniere attributes much of the groundwork laid in the outcome measurement research field to Dr. Michael Lambert.   Dr. Lambert, along with colleagues Dr. Gary Burlingame and OQ Measures’ CEO, Sue Jenkins, are at the forefront of routine outcome monitoring with OQ Measures’ OQ®-Analyst platform, widely known as the gold standard in big data psychology tech.

Dr. Rousmaniere was a young therapist in training and Grace was a heroin addict who had been clean for roughly six months. At the start of psychotherapy with Tony, Grace was in an uphill battle as an unemployed single mother addicted to drugs who had been in several violent relationships. Retaining custody of her son was her primary motive for bravely attempting to get clean and putting the pieces of her life back together.

Attending Narcotics Anonymous meetings and reducing anxiety were central to Grace’s therapy, since the anxiety had driven her to drug abuse. At first, progress seemed positive, and each week she reported her successes: attending NA meetings, obtaining employment, and enjoying a healthy relationship with her new boyfriend.

Both Tony and Grace refused to accept failure, because the risk she’d lose custody of her son in the event of relapse was high. Grace was often asked for feedback about her therapy, and assured Tony it was proving productive. He noticed though, that her restrained enthusiasm seemed desperate and forced.

Tony received weekly supervision at his community counseling training site from a perceptive and intelligent psychologist, with decades of experience helping addicts, and he valued her guidance enormously. Several months into treatment, Tony told his supervisor, “It’s remarkable how quickly she’s improving,” and proudly informed her Grace was doing so well that he had agreed to cut their sessions from weekly to biweekly.

But Tony’s supervisor cautiously reminded him, “Getting clean is hard, but staying clean is harder.”

Her concern became reality, soon thereafter, when Grace no-showed for three straight therapy appointments after a heroin relapse. Grace’s life unraveled over the next several months, losing her job, her boyfriend, and repeatedly turning back to drugs. But she was still committed to therapy, attending faithfully, while Tony grasped for every technique in therapy he could find, with no success. Grace was determined, insisting she could do it. She told him, “I’ve just got to stay positive.”

Grace died of a drug overdose a few months after her relapse, and her son was put in foster care. Tony was devastated, igniting an internal crisis in him. “What could I have done differently?” he asked himself. “How could I become a more effective therapist?”

Dr. Michael Lambert and Dr. Gary Burlingame and the OQ Measures team have been at the forefront of developing psychotherapy metrics – an uncharted territory for Tony early in his career, but the answer to his professional crisis at the time.

The two world class researchers from Brigham Young University are highly regarded around the world as the pioneers of routine outcome monitoring research, and Dr. Lambert was the first person to introduce the measurement of mental health vital signs to the world in the early 90’s.

Over the past few decades, Dr. Lambert and Dr. Burlingame developed a system in which therapy clients take a 45-item questionnaire, the OQ®-45.2, before each appointment, and OQ Measures’ web-based platform, the OQ®-Analyst, then utilizes the data to tabulate responses. The OQ®-45.2 results are then displayed immediately in a clinician report featuring a graph that represents the trajectory of each client’s symptoms, in relation to an expected recovery curve determined by the baseline score, allowing his or her therapist to track the progress being made.

Drawing on historical data from thousands of cases, Dr. Lambert and Dr. Burlingame created algorithms predicting when clients are at risk of deterioration. If clients appear to be at risk based on their answers to the OQ®-45.2, the OQ®-Analyst alerts therapists using color-coded early warning alerts: red for risk of dropout or deterioration, yellow for less-than-expected progress. In over 15 randomized clinical trials, the algorithms are able to predict—with 85 to 100 percent accuracy—which clients will deteriorate.

The OQ® system aids therapy in two primary ways:

First, it provides performance feedback that therapists too often lack because many clients would prefer to report worsening symptoms to a computer—even if they know that their therapist will see the results—rather than disappoint therapists face-to-face.

The second benefit comes from metrics: Risk alerts allow therapists to adjust treatment plans, and can help them compensate for natural overconfidence and clinical blind spots.

To understand the power of the OQ®-Analyst alert status, stay tuned for our next installment of “Is Routine Outcome Feedback Informing Your Practice?” and we will continue the story of Dr. Tony Rousmaniere, and how he overcame his disappointment over Grace’s case, changing the course of his career for the better through the practice of measuring mental health vital signs…..

We highly recommend a demo of the OQ®-Analyst, widely considered the world’s gold standard routine outcome monitoring web-based solution. OQ Measures not only offers adult outcome questionnaires, but youth/adolescent and group outcome questionnaires as well, in addition to clinical support tools designed to be used in conjunction with OQ instruments.

You can email us at, or select an available date and time here to have a demonstration:

You can access the full Atlantic Monthly article

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