At this point in the history of psychotherapy, one of the most
needed and yet most overlooked areas in outpatient mental health
treatment is the measurement and documentation of treatment effectiveness
and efficacy. By extension, such research would allow the identification
of proven and reliable therapeutic approaches for various psychological
problems and complaints. However, psychotherapists – – whether
in private practice, group practice, on managed care provider
panels, or on staff at community mental health centers – – are
invariably overwhelmed with the business of actually providing
mental health services; there is little time or energy
left over to use standardized treatment planning approaches or
to evaluate the results of the treatments we provide.

From its opening chapters this book takes a refreshingly direct
and pragmatic approach. The first issue tackled is how to meaningfully
define successful outcome in psychotherapy. The authors provide
a succinct and useful discussion of these issues, contrasting
efficacy and effectiveness research and providing a brief history
of psychotherapy outcome research efforts going back as far as
Eysenck’s classic studies in the early 1950s.

Treatment success may be (and most often is) defined differently
by clients, therapists, and third-party payers such as insurers
and managed care operations. For example, a client may experience
significant relief of troubling psychological symptoms but show
no outward, measurable changes in daily functioning; in such cases,
client self-reports and satisfaction surveys may be the only proof
of successful therapy outcome. For third-party payers and managed
case companies, this may not be sufficient evidence of the value
of psychotherapy, however. For example, cost-containment (e.g.,
no further need or demand for costly inpatient or outpatient services)
may be a more relevant measure for these companies.

The practical nature of the book is evident throughout. For example,
in Chapter Three the authors point out that for the clinician,
large-scale empirical studies are unfeasible. Thus, questions
about the effectiveness and/or efficacy of interventions cannot
usually be answered at the clinic or individual clinician level.
Fortunately, it’s usually enough to simply show that ones’ clients
benefit by making progress toward acceptable treatment goals.
To assist with this, the authors provide a number of sample forms,
including assessment and history forms, individualized treatment
plan formats, progress note forms, behavioral observation forms
and objectives charts, treatment outcome summary formats, and
even a suggested narrative report format. The various chapters
sequentially walk the reader through this individualized approach
to treatment planning and the measurement of "clinically
significant change".

This book is quite readable and is highly recommended for those
clinicians and administrators who want or need a practical and
time-effective way to approach assessment, treatment planning
and outcome measurement.

© 2002 Keith Harris

Keith Harris, Ph.D. 
is a clinical psychologist and supervisor of Victor Valley Behavioral Health
Center in San Bernardino county, California. His interests include clinical
supervision, the empirical basis for psychotherapy research (and its design),
human decision-making processes, and the shaping of human nature by evolutionary
forces.

Also available from Barnes & Noble.com:


Tracking Mental Health Outcomes: A Therapist’s Guide to Measuring Client Progress, Analyzing Data, and Improving Your Practice