Routine outcome monitoring [ROM] with collaborative client feedback helps improve outcomes and reduce drops outs in psychotherapy. ROM with feedback involves session by session monitoring of client progress using standardized measures, and may include measurement of the therapeutic alliance. Results are shared with the client and yield moderate improvement with clients whose progress is not on track. ROM is used in many countries but has not, as yet, impacted U.S. social work practice. ROM with feedback is best implemented with strong administrative support and takes some learning and adjustment for practitioners. This article examines two models of ROM with feedback in detail, notes how they differ from earlier efforts to link research with practice, identifies several implementation issues, and practice implications.
Aafjes-van DoornK.De JongK. (2022). How to make the most of routine outcome monitoring (ROM): A multitude of clinical decisions and nuances to consider. Journal of Clinical Psychology, 78, 1963–1972. https://doi.org/10.1080/09515070.2022.2110451
2.
AmbleI.GudeT.StubdalS.OktedalenT.SkjortenA.AndersenB.SolbakkeneO. A.BrorsonH.ArnevikE.LambertM.WampoldB. (2014). Psychometric properties of the Outcome Questionnaire-4.5.2: The Norwegian version in an international context. Psychotherapy Research, 24(4), 504–513.
3.
AnkerM. G.OwenJ.DuncanB. L.SparksJ. A. (2010). The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample. Journal of Consulting and Clinical Psychology, 78(5), 635–645. https://doi.org/10.1037/a0020051
4.
BarberJ.ResnickS. G. (2023). Collect, share, act: A transtheoretical clinical model for doing measurement-based care in mental health treatment. Psychological Services, 20(S2), 150–157.
5.
BarkhamM.de JongK.DelgadilloJ.LutzW. (2023). Routine outcome monitoring (ROM) and feedback: Research review and recommendations. Psychotherapy Research, 33(7), 841–855. https://doi.org/10.1080/10503307.2023.2181114
6.
BarkhamM.LambertM. J. (2021). The efficacy and effectiveness of psychological therapies. In BarkhamM.LutzW.CastonguayL. G. (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (7th ed., pp. 135–189). Wiley.
7.
BergmanH.KornørH.NikolakopoulouA.Hanssen-BauerK.Soares-WeiserK.TollefsenT. K.BjørndalA. (2018). Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database of Systematic Reviews, 8, CD011729. https://doi.org/10.1002/14651858.CD011729.pub2
8.
BoneC.DelgadilloJ.BarkhamM. (2021). A systematic review and meta-analysis of the good-enough level (GEL) literature. Journal of Counseling Psychology, 68(2), 219–231.
9.
BoswellD.WhiteJ.SimsW.HarristR.RomansJ. (2013). Reliability and validity of the Outcome Questionnaire-45.2. Psychological Reports, 112(3), 689–693. https://doi.org/10.2466/02.08.PR0.112.3.689-693
10.
BoswellJ. F.KrausD. R.MillerS. D.LambertM. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6–19.
11.
BrattlandH.KoksvikJ. M.BurkelandO.GråweR. W.KlöcknerC.LinakerO. M.RyumT.WampoldB.Lara-CabreraM. L.IversenV. 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
12.
CastonguayL.Barkham LutzW.McAleaveyA. A. (2013). Practice oriented research: Approaches and applications. In LambertM. (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 85–133). Wiley.
13.
CordonyI.MillsL.MammenK.LintzerisN. (2023). A systematic review on the effect of routine outcome monitoring and feedback on client outcomes in alcohol and other drug treatment. Drug and Alcohol Review, 42(7), 1701–1722.
14.
de JongK.ConijnJ.GallagherR.ReshetnikovaA.HeijM.LutzM. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review, 85, 102002.
15.
de JongK.van SluisP.NugterM.HeiserW.SpinhovenP. (2012). Understanding the differential impact of outcome monitoring: Therapist variables that moderate feedback effects in a randomized clinical trial. Psychotherapy Research, 22(4), 464–474.
16.
DemirS.SchwarzF.KaiserT. (2022). Therapy from my point of view: A case illustration of routine outcome monitoring and feedback in psychotherapeutic interventions. Journal of Clinical Psychology, 78, 2029–2040.
17.
DriskoJ.GradyM. (2019). Evidence based practice in clinical social work (2nd ed.). Springer.
18.
DuncanB. (2012). The Partners for Change Outcome Management System (PCOMS): The heart and soul of change project. Canadian Psychology/Psychologie Canadienne, 53(2), 93–104.
DuncanB.MillerS. (2000a). The client’s theory of change: Consulting the client in the integrative process. Journal of Psychotherapy Integration, 10, 169–187.
DuncanB.ReeseR. (2015). The Partners for Change Outcome Management System (PCOMS): Revisiting the client’s frame of reference. Psychotherapy, 52(4), 391–401.
23.
DuncanB.ReeseR. (2024). The evolution of feedback: Toward a multicultural orientation. Psychotherapy, 61(2), 101–109.
24.
DuncanB.SparksJ. (2015). Systematic feedback through the partners for change outcome management system (PCOMS). In CooperM.DrydenW. (Eds.), The handbook of pluralistic counselling and psychotherapy (pp. 55–67). Sage.
25.
GelkopfM.MazorY.RoeD. (2022). A systematic review of patient-reported outcome measurement (PROM) and provider assessment in mental health: Goals, implementation, setting, measurement characteristics and barriers. International Journal for Quality in Health Care, 34(Supplement 1), ii13–ii27.
26.
GillaspyJ. A.MurphyJ. J. (2011). The use of ultra-brief client feedback tools in SFBT. In FranklinC.TrepperT.McCollumE.GingerichW. (Eds.), Solution-focused Brief Therapy (pp. 73–94). Oxford University Press.
27.
GomezB.Fernández-ÁlvarezJ.GarcíaF. (2022). Implementing routine outcome monitoring in the treatment of a patient with obsessive-compulsive disorder. Journal of Clinical Psychology, 78(10), 2002–2015.
28.
HersenM. (1976). Single-case experimental designs. In BellakA.HersenM.KazdinA. (Eds.), International handbook of behavior modification and therapy (2nd ed., pp. 175–210). Springer.
29.
HookeG. R.SavaniP.StewartB.AraujoS.PageA. (2022). Illustrating routine outcomes monitoring at different points in a patient’s journey: Inpatient then day patient treatment of a patient with depressive and borderline symptoms. Journal of Clinical Psychology, 78(10), 2041–2053.
30.
HorvathA.GreenbergL. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233.
31.
HowardK. I.MorasK.BrillP. L.MartinovichZ.LutzW. (1996). Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51(10), 1059.
32.
KaiserT.SchmutzhartL.LaireiterA. R. (2018). Attitudes of Austrian psychotherapists towards process and outcome monitoring. Administration and Policy in Mental Health and Mental Health Services Research, 45, 765–779.
33.
KazdinA. E. (2011). Single-case research designs. Oxford University Press.
34.
KendrickT.El-GoharyM.StuartB.GilbodyS.ChurchillR.AikenL.BhattacharyaA.GimsonA.BrüttA. L.de JongK.MooreM. (2016). Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. Cochrane Database of Systematic Reviews, 7, CD011119. https://doi.org/10.1002/14651858.CD011119.pub2
35.
KlatteR.StraussB.FlückigerC.RosendahlJ. (2023). Adverse events in psychotherapy randomized controlled trials: A systematic review. Psychotherapy Research, 35(1), 84–99. https://doi.org/10.1080/10503307.2023.2286992
36.
LambertM. J.BurlingameG. M.UmphressV.HansenN. B.VermeerschD. A.ClouseG. C.YancharS. C. (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy, 3(4), 249–258.
37.
LambertM. J.MortonJ. J.HatfieldD. R.HarmonC.HamiltonS.ReidR. C.BurlingameG. M. (2004). Administration and scoring manual for the OQ-45.2. American Professional Credentialing Services.
38.
LambertM. J.WhippleJ. L.KleinstäuberM. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520–537. https://doi.org/10.1037/pst0000167
39.
LandmanW.BogaertsS.SpreenM. (2023). How to evaluate a tailor-made social work intervention? Some practice-based solutions with single-case designs. Journal of Evidence-Based Social Work, 20(5), 595–622.
40.
LangkaasT.WampoldB.HoffartA. (2018). Five types of clinical difference to monitor in practice. Psychotherapy, 55(3), 241–254.
41.
LåverJ.McAleaveyA.ValakerI.CastonguayL. G.MoltuC. (2024). Therapists’ and patients’ experiences of using patients’ self-reported data in ongoing psychotherapy processes: A systematic review and meta-analysis of qualitative studies. Psychotherapy Research, 34(3), 293–310.
42.
LongC. G.HollinC. R. (1995). Single case design: A critique of methodology and analysis of recent trends. Clinical Psychology & Psychotherapy, 2(3), 177–191.
43.
McAleaveyA. A.de JongK.Nissen-LieH.BoswellJ.MoltuC.LutzW. (2024). Routine outcome monitoring and clinical feedback in psychotherapy: Recent advances and future directions. Administration and Policy in Mental Health and Mental Health Services Research, 51, 291–305.
44.
MillerS. D.DuncanB. L.SorrellR.BrownG. S. (2005). The partners for change outcome management system. Journal of Clinical Psychology, 61(2), 199–208.
45.
OglesB. M.Goates-JonesM. K.EreksonD. M. (2022). Treatment success or failure? Using a narrative interview to supplement ROM. Journal of Clinical Psychology, 78(10), 1986–2001.
46.
ØstergårdO. K.RandaH.HougaardE. (2020). The effect of using the Partners for Change Outcome Management System as feedback tool in psychotherapy—A systematic review and meta-analysis. Psychotherapy Research, 30(2), 195–212.
47.
ReeseR. J.DuncanB. L.Clements-HickmanA. (2024). Do practice-generated data improve psychotherapy effectiveness (Routine outcome monitoring)? In LeongF.CallahanJ.ZimmermanJ.ConstantinoM.EubanksC. (Eds.), APA handbook of psychotherapy: Evidence-based practice, practice-based evidence, and contextual participant-driven practice (Vol. 2, pp. 193–211). American Psychological Association.
48.
ReeseR. J.GillaspyJ.Jr.OwenJ.FloraK.CunninghamL.ArchieD.MarsdenT. (2013). The influence of demand characteristics and social desirability on clients’ ratings of the therapeutic alliance. Journal of Clinical Psychology, 69(7), 696–709.
49.
ReeseR. J.NorsworthyL. A.RowlandsS. R. (2009). Does a continuous feedback system improve psychotherapy outcome?Psychotherapy: Theory, Research, Practice, Training, 46(4), 418–431.
50.
ReidW. J. (1994). The empirical practice movement. Social Service Review, 68(2), 165–184.
51.
SackettD.RichardsonW.RosenbergW.HaynesR. (1997). Evidence-based medicine: How to practice and teach EBM. Churchill Livingston.
52.
SackettD.RosenbergW.Muir GrayJ. A.HaynesR. B.RichardsonW. S. (1996). Editorial: Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.
53.
ShimokawaK.LambertM. J.SmartD. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78(3), 298–311.
54.
SiegelD. (1984). Defining empirically based practice. Social Work, 29(4), 325–331.
55.
SloneN. C.ReeseR. J.Mathews-DuvallS.KodetJ. (2015). Evaluating the efficacy of client feedback in group psychotherapy. Group Dynamics: Theory, Research, and Practice, 19(2), 122–136.
56.
SolstadS. M.CooperM.SundetR.MoltuC. (2025). Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature. Psychotherapy Research, 35(1), 125–138.
57.
SuttonR.PincockD.BaumgartD.SadowskiD.FedorakR.KroekerK. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. npj Digital Medicine, 3, 17. https://doi.org/10.1038/s41746-020-0221-y
58.
TerjeT.WhittakerJ. W. (2022). Using ROM in family therapy. Journal of Clinical Psychology, 78(10), 1973–1985.
59.
ThyerB.WodarskiJ. (1998). First principles of empirically based practice. In ThyerB.WodarskiJ. (Eds.), Handbook of empirical social work practice (Vol. 1, pp. 1–19). Wiley.
60.
TildenT.WampoldB. (Eds.). (2017). Routine outcome monitoring in couple and family therapy: The empirically informed therapist. Springer.
61.
Valdiviezo-OñaJ.Unda-LópezA.MontesanoA.EvansC.PazC. (2025). Routine outcome monitoring from psychotherapists’ perspectives: A framework analysis study of expected benefits and difficulties. Administration and Policy in Mental Health and Mental Health Services Research, 52(1), 194–209. https://doi.org/10.1007/s10488-024-01350-w
