How A Measurement Based Care App Helps Make Therapy Better
Did you know tracking your progress during therapy is a proven way to get more out of therapy? It helps patients and therapists focus on what is most helpful. This approach is called Measurement Based Care or MBC. MBC is recommended by mental health experts and professional organizations.
How The App Works
We’ll ping you through the free Making Therapy Better app a few times a week and ask you rate your symptoms, wellbeing and relationship with your therapist.
Each assessment takes just a couple of minutes. You’ll get a graph and report you can review with your therapist. You’ll be pinged when it’s time to do the next rating.
Download the app and you can share the results with your therapist.
Collaboration with your therapist is critical to the success of your therapy. Collaboration depends on two aspects: Your relationship with the therapist and a focus on your progress. Numerous studies have shown discussing information on your progress during therapy and on your relationship with your therapist improves the outcome of therapy. The field has given this process a name: Measurement-based care (MBC) in mental health care.
Zac Imel, PhD is a professor and Director of clinical training in the counseling department at the University of Utah as well as co-founder and Chief Psychotherapy Science officer at Lyssn.io, an AI-powered assessment platform for behavioral health and human services. He has had over 50 papers published in academic journals, with a particular interest in assessing and improving the quality of mental health services in a variety of settings.
Daisy Singla, PhD is a clinical psychologist, associate professor in the Department of Psychiatry at the University of Toronto, and senior scientist with the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health. She has led some of the largest clinical psychotherapy trials in the world, exploring methods for increasing access to mental health services in diverse cultures and settings around the world. She has received awards from the American Psychological Association and the Society Psychotherapy Research, and in 2018 she became the youngest ever recipient of the Pragmatic Clinical Study Award.
Michael Garrett, MD is professor emeritus of Clinical Psychiatry at SUNY Downstate Medical Center in Brooklyn, and previously served as medical director of the Department of Psychiatry at North Central Bronx Hospital, and Deputy Director of Psychiatry at Bellevue Hospital Medical Center in Manhattan. He is the author of Psychotherapy for Psychosis: Integrating Cognitive-Behavioral and Psychodynamic Treatment, which won Second Place in the American Journal of Nursing Book of the Year Award, Psychiatric and Mental Health Nursing Category. His clinical and academic work has focused on better understanding the experience of psychosis and how it can be effectively treated with psychotherapy.
Jerome is a Professor of Social Work at New York University as well as a member of the American Academy of Social Work and Social Welfare, and has sat on editorial boards for the Clinical Social Work Journal and Evolutionary Psychology. He is the author of more than 300 publications appearing in journals in psychology, philosophy, psychiatry, psychoanalysis, and social work, and a number of books, including The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder, which was named Best Psychology Book of 2007 by the Association of American Publishers
Nancy McWilliams, PhD is emerita visiting professor of Psychology at Rutgers University and a former president of the American Psychological Association’s Division of Psychoanalysis. She is the author of several books including Psychoanalytic Diagnosis, and Psychoanalytic Psychotherapy: a Practitioner’s Guide. She is the recipient of numerous awards, including the Rosalee Weiss Award, the Laughlin Distinguished Teacher award, and awards for Leadership, Scholarship, and International Academic Excellence from the APA Division of Psychoanalysis. She also maintains a private practice in Lambertville, New Jersey.
Dr. Raison is a professor of psychiatry and human ecology at University of Wisconsin-Madison, director of Clinical and Translational Research for Usona Institute, and Director of Research on Spiritual Health for Emory Healthcare. In addition, Dr Raison founded the Center for Compassion Studies at the University of Arizona. His research has focused on novel mechanisms involved in the development and treatment of major depression and on the physical and behavioral effects of compassion training. Recently, Dr. Raison has taken a leadership role in the development of psychedelic medicine, particularly as a treatment for depression. He has received numerous awards, including the Raymond Pearl Award from the Human Biology Association, and being named one of the most influential researchers in the world by Web of Science. His most recent book is The New Mind-Body Science of Depression.
Steven is a professor of psychology at Vanderbilt University. He has over 300 publications to his name and is the recipient of numerous awards, including, in 2020, the American Psychological Association’s Distinguished Scientific Award for the Applications of Psychology. He has served as Editor of the journal Cognitive Therapy and Research, and president of the Association for Behavioral and Cognitive Therapies. His research focuses on the treatment and prevention of depression, with a particular emphasis on cognitive therapy in comparison to antidepressant medications.
Ed received his doctorate in anthropology from UC Santa Barbara, after which he worked at the Institute for Theoretical Biology in Berlin. He is currently a professor of evolutionary anthropology and director of the Bioanthropology Lab at Washington State University Vancouver. His research focuses on evolutionary medicine and finding evolutionary explanations for the origins of substance use and other mental health issues. His work challenges the notion that depression is caused by a dysfunction of the brain and argues that it is likely an adaptive response passed down through natural selection.
Research evidence has shown clearly that therapists are more effective when they use standard measures to track patient progress in therapy. This approach is called Measurement Based Care (MBC).
By Bruce Wampold, PhD
by Barrett Griffith, Maureen Hart, PhD and Geoff Gray, PhD
Barrett Griffith is CEO of CarePaths, where he has served for over five years, previously as a developer and then as CTO. He has two decades of experience in the tech industry, with much of that time in healthcare IT.
By Barrett Griffith, Maureen Hart, PhD and Geoff Gray, PhD
Catherine Eubanks, PhD is co-director of the Center for Alliance-Focused Training, and professor of clinical psychology at Adelphi University. She is a fellow of the American Psychological Association and received the Outstanding Early Career Achievement Award from the Society for Psychotherapy Research in 2015. Dr. Eubanks helped to develop the Rupture Resolution Rating System and is coauthor of Therapist Performance under Pressure: Negotiating Emotion, Difference and Rupture. She also recently released Rupture and Repair in Psychotherapy as part of the APA Video Series.
Jonathan Shedler, Phd is a clinical professor of psychiatry at the University of California, San Francisco (UCSF) and faculty member at the San Francisco Center for Psychoanalysis. He is author of numerous scientific and scholarly articles, and his article The Efficacy of Psychodynamic Psychotherapy won worldwide acclaim for firmly establishing psychoanalytic therapy as an evidence-based treatment. He has more than 25 years’ experience teaching and supervising psychologists, psychiatrists, and psychoanalysts.
Edward R Jones, PhD is a clinical psychologist with years of executive leadership experience in the behavioral healthcare industry, including Vice President roles at Pacific Care Behavioral Health and Value Options. He has worked as a healthcare consultant in connection with both established and start-up companies. In recent years he has focused on health and wellness services, digital health services, and consultation to employers on the economic value of health and productivity.
Terri Moyers, PhD is a Professor in the Psychology Department at the University of New Mexico. Her research has focused on the active ingredients of empirically supported interventions for substance use treatments, particularly motivational interviewing. She also has an active line of research investigating therapist characteristics that support more favorable client outcomes. Dr. Moyers has more than 30 peer-reviewed papers in these areas, and has been a keynote speaker and workshop teacher in 11 countries.
As we have discussed, MBC provides information. In the last blog, I discussed how sharing the MBC information with the patient is beneficial to therapy. That discussion, although absolutely necessary in most cases, is a first step to improving therapy. The second step involves using the MBC information to make clinical decisions and to guide therapy. In this way, the information is integrated with your knowledge about the client to make effective clinical decisions about the course of treatment, the treatment delivered, how you relate to the patient, and the myriad other elements that compose the complexity of psychotherapy.
Helene Nissen-Lie is a professor of clinical psychology at the University of Oslo and a practicing psychologist. She participates in a number of research projects in Norway as well as internationally, including collaborations with the University of Sheffield and the University of Chicago. She has published over 50 papers and articles, and her research interests include therapist effects, the therapeutic alliance, mechanisms of change in psychotherapy, and outcomes research, among many others.
Robbie Babins-Wagner, PhD has contributed to the mental health field as a clinician, researcher, teacher, and manager. She is CEO of the Calgary Counseling Center, widely recognized as a leading institution in accessible, evidence-based, community mental health care. She is also an adjunct professor in the Faculty of Social Work at the University of Calgary, and serves on the board of directors for PolicyWise. She has conducted leading research on Counseling Outcomes, Social Finance, and Social Innovation, and has received several awards, including the University of Calgary Alumni Achievement Award and the 2017 Grant MacEwan Lifetime Achievement Award.
George Silberschatz, PhD is a licensed psychologist in San Francisco and has been practicing, teaching, and doing research on psychotherapy for over 40 years. He is a clinical professor in the department of psychiatry at University of California San Francisco School of Medicine, a past president of the North American chapter of the Society for Psychotherapy Research, and a past president of the International Society for Psychotherapy Research. He advocates for grounding practice in scientific evidence, as well as grounding research in clinical reality.
Dr. Jesse Owen is a Professor in the Counseling Psychology Department at The University of Denver. He is a licensed psychologist with clinical specializations including couple and family therapy and multicultural therapy. He holds various positions including lead psychologist at Lifelong, Inc; Research Director for CelestHealth; Senior Research Advisor for SonderMind; Editor for Psychotherapy. He has co-authored three books: Mindfulness-based practices in therapy: A cultural humility approach; Therapists’ cultural humility; and Research design in counseling. He also has over 180 publications/book chapters. His research focuses on the process and outcomes of psychotherapy with a focus on therapist expertise and multicultural orientation. His research has been supported by foundations, federal agencies, and private companies (e.g., John Templeton Foundation, NIMH, DHHS-ACF, and SonderMind).
Michael Barkham, Ph.D., is a Professor of Clinical Psychology at The University of Sheffield, UK. He has spent the past 35 years promoting the measurement of psychological therapies in routine practice and the paradigm of practice-based evidence as a complement to trials-based methodologies. His research has also focused on the contribution of therapists as well as securing evidence supporting various models of psychological therapy. Most recently, with Wolfgang Lutz and Louis Castonguay, he was editor of the 7th edition of Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (2021) and the recipient of the 2019 Society for Psychotherapy Research (SPR) Senior Distinguished Research Career Award.
As we have discussed previously, measurement-based care (MBC) involves assessing patient progress and the therapeutic process throughout the course of treatment to improve the quality of the service being delivered. Of course, the clinician will naturally gather many of their own insights from interacting with the patient. MBC supplements this information by providing the patient’s perspective on their symptoms, well-being, and their relationship with the clinician.
Scott D. Miller, PhD is the founder of the International Center for Clinical Excellence, a consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health. He conducts workshops and training in the United States and abroad, helping hundreds of agencies and organizations, both public and private, to achieve superior results. He has written numerous books and articles, including Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness.
This interview was conducted at the Request of Jordan Harris, Ph.D, LMFT, LPC who offers his own counseling services as well as resources for other counselors at www.jordanthecounselor.com.
John is a Distinguished Professor and chair of the psychology department at the University of Scranton and Clinical Professor of Psychiatry at SUNY Upstate Medical University. He is the author of over 400 publications and more than 23 books, including Changeology. He is the recipient of numerous awards and has served as president of the APA’s division of psychotherapy and society of clinical psychology. He also maintains a part-time clinical psychology practice in Scranton, Pennsylvania
Once a clinician or a system of care has made the commitment to implement MBC, we soon find that the devil is in the details. Like most initiatives, the pragmatics involved in MBC, particularly administering the assessment to patients and collecting responses, is critical to its success. The challenge is to collect useful and actionable information without burdening patients, clinicians or administrators. In this blog, I will discuss the major challenges to administering assessment to patients and touch upon the CarePaths solution. As with any systemic initiative, there are tradeoffs to consider, depending on the context and priorities.
Now that we have agreed (hopefully) that Measurement-Based Care (MBC) is a method that improves psychotherapy outcomes, we are faced with the logical next question: What should be measured?
Measurement-based care (MBC) involves assessing patient progress and therapy processes through
the course of therapy to improve the quality of the service being delivered. A number of different labels
have been used for this practice, including routine-outcome monitoring (ROM), practice-based evidence,
feedback informed treatment (FIT), among others. Whatever name is used, the research is clear:
Providing information about patient progress to the therapist improves outcomes, especially for cases
that are not on track to be successful. MBC is now considered an evidence-based practice and the
American Psychological Association is developing practice guidelines for its implementation.
