Making Therapy Better

Measurement-Based Care (MBC): theory, practice, and research

Measurement-Based Care is increasingly recognized as an evidence-based practice in psychotherapy.
This page provides a practical overview of the research, along with selected references for readers who want to explore the literature in greater depth.
Bruce Wampold, PhD
Bruce Wampold, PhD
The literature on MBC is broad, but several themes appear consistently across research and implementation work. The summary below highlights the main conclusions in a clearer, more accessible format.

Key takeaways

  • MBC improves outcomes. Compared to treatment as usual, MBC is associated with better outcomes and, in some cases, shorter treatment.
  • The strongest effects may be in “not on track” cases. Patients at risk for poor outcomes appear to benefit most from systematic feedback and monitoring.
  • Implementation matters. The success of MBC depends heavily on how it is introduced, supported, and used within an agency or practice.
  • No single MBC system has been shown to be clearly superior. The evidence suggests that how a system is used matters more than which platform or framework is selected.
  • MBC supports collaboration. Feedback is most useful when it is shared and discussed openly between therapist and patient.

Frequently asked questions about MBC research

Does it work?
Compared to treatment as usual (no MBC), MBC improves outcomes and reduces length of treatment.
For which patients?
It appears that the primary effect of MBC is for patients who are at risk for poor outcomes (often called “not on track” cases).
How does MBC work?
Interestingly—and importantly—we do not know exactly what therapists do with the feedback they receive. We know that MBC generally does not make therapists more effective over time. That is, therapists using MBC do not automatically become more effective therapists. But clearly, in the right conditions, using MBC improves the quality of care.
Will an agency or system of care installing an MBC system achieve better outcomes?
The evidence is clear that implementation is absolutely critical to success. How the agency uses MBC, the organizational climate relative to MBC, and the training and effort required to use MBC meaningfully are critical factors.
Does it matter which MBC system is used?
There are several MBC systems, using different measures, procedures, and displays. There is no evidence that one system is better than another. It is more important how the system is used by the agency and by the therapist.
What should be measured?
There is still limited evidence about specific measures, but there seems to be agreement that different domains should be measured, including:
  • symptoms and distress,
  • general functioning, such as well-being, quality of life, or loneliness, and
  • therapeutic processes, especially the relationship with the therapist and confidence in treatment.
Does MBC provide prescriptive actions that are needed in therapy?
MBC provides important information to the therapist, but that information still needs to be interpreted in the context of the therapy and applied with clinical expertise and judgment.
Does MBC promote collaboration?
There is general agreement that MBC information should be available to both the therapist and the patient. This information should be discussed during the course of therapy, creating a climate of shared decision-making. Therapist expertise remains vital, but there should be a context where the successes and challenges of treatment are discussed openly and honestly.
Should MBC be adopted universally?
In many systems of care, MBC is mandated. Practice guidelines are forthcoming that will suggest that MBC be used as a standard of care. Given the evidence for MBC, it seems to be in the patient’s best interest to use it.
What are the challenges?
Therapists’ workload is challenging, and patients generally do not want added burden either. MBC systems must be designed to minimize burden for both therapists and patients. Their utility needs to be clear, and the usefulness of MBC should be readily apparent to everyone involved in care.

Bottom line

The research supports Measurement-Based Care. However, the benefits of MBC depend less on choosing a specific system and more on implementing it well, using it consistently, and discussing feedback in a clinically meaningful, collaborative way.

Selected references

The references below are grouped to make the literature easier to navigate.

Meta-analyses, reviews, and foundational perspectives

de Jong, K., Conijn, J. M., Gallagher, R. A. V., Reshetnikova, A. S., Heij, M., & Lutz, M. C. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review, 85. https://doi.org/10.1016/j.cpr.2021.102002
Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520–537. https://doi.org/10.1037/pst0000167
Lambert, M. J. (2010). Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice. American Psychological Association.
Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2013). The outcome of psychotherapy: Yesterday, today, and tomorrow. Psychotherapy, 50(1), 88–97. https://doi.org/10.1037/a0031097
Sapyta, J., Riemer, M., & Bickman, L. (2005). Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology, 61(2), 145–153. https://doi.org/10.1002/jclp.20107

Implementation, practice, and organizational use

Boswell, J. F., Kraus, D. R., Miller, S., & Lambert, M. J. (2015). Implementing routine outcome assessment in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25, 6–19. https://doi.org/10.1080/10503307.2013.817696
Connors, E. H., Douglas, S., Jensen-Doss, A., Landes, S. J., Lewis, C. C., McLeod, B. D., Stanick, C., & Lyon, A. R. (2021). What gets measured gets done: How mental health agencies can leverage measurement-based care for better patient care, clinician supports, and organizational goals. Administration and Policy in Mental Health, 48(2), 250–265. https://doi.org/10.1007/s10488-020-01063-w
Jensen-Doss, A., Haimes, E., Smith, A. M., Lyon, A. R., Lewis, C. C., Stanick, C. F., & Hawley, K. M. (2018). Monitoring treatment progress and providing feedback is viewed favorably but rarely used in practice. Administration and Policy in Mental Health, 45(1), 48–61. https://doi.org/10.1007/s10488-016-0763-0
Scott, K., & Lewis, C. C. (2015). Using measurement-based care to enhance any treatment. Cognitive and Behavioral Practice, 22(1), 49–59. https://doi.org/10.1016/j.cbpra.2014.01.010
Bickman, L., Lyon, A. R., & Wolpert, M. (2016). Achieving precision mental health through effective assessment, monitoring, and feedback processes. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 271–276. https://doi.org/10.1007/s10488-016-0718-5

Therapist feedback, outcomes, and related perspectives

Harmon, S. C., Lambert, M. J., Smart, D. M., Hawkins, E., Nielsen, S. L., Slade, K., & Lutz, W. (2007). Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools. Psychotherapy Research, 17(4), 379–392. https://doi.org/10.1080/10503300600702331
Brattland, H., Koksvik, J. M., Burkeland, O., Gråwe, R. W., Klöckner, C., Linaker, O. M., Ryum, T., Wampold, B., Lara-Cabrera, M. L., & Iversen, V. C. (2018). The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial. Journal of Counseling Psychology, 65(5), 641–652. https://doi.org/10.1037/cou0000286
Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11. https://doi.org/10.1037/cou0000131
Goldberg, S. B., Babins-Wagner, R., Rousmaniere, T., Berzins, S., Hoyt, W. T., Whipple, J. L., Miller, S. D., & Wampold, B. E. (2016). Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice. Psychotherapy, 53(3), 367–375. https://doi.org/10.1037/pst0000060
Boswell, J. F. (2020). Monitoring processes and outcomes in routine clinical practice: A promising approach to plugging the holes of the practice-based evidence. Psychotherapy Research, 30, 829–842. https://doi.org/10.1080/10503307.2019.1686192
Miller, S. D., Hubble, M. A., Chow, D., & Seidel, J. (2015). Beyond measures and monitoring: Realizing the potential of feedback-informed treatment. Psychotherapy, 52, 449–457. https://doi.org/10.1037/pst0000031
Muir, H., Coyne, A., Morrison, N., Boswell, J. F., & Constantino, M. J. (2019). Ethical implications of routine outcome monitoring for patients, psychotherapists, and mental health care systems. Psychotherapy, 56(4), 459–469. https://doi.org/10.1037/pst0000246
Boswell, J. F., Hepner, K. A., Lysell, K., Rothrock, N., Bott, N., Childs, A. W., Douglas, S., Owings-Fonner, N., Wright, C. V., Stephens, K. A., Bard, D. E., Aajmain, S., & Bottitt, B. L. (2022). The need for a measurement-based care professional practice guideline. Psychotherapy.