Praxical.Psych
science

Routine outcome monitoring and feedback

The cheapest available intervention, and the ethical questions it raises.

Collecting brief outcome measures every session and feeding the results back to clinicians improves outcomes — principally by catching cases that are not on track, which clinicians reliably fail to detect without data. Effects are largest when a protocol exists for responding to an alert rather than merely receiving one.

How it works

  1. 1A brief measure is completed each session.
  2. 2Progress is compared against an expected trajectory derived from similar patients.
  3. 3Cases falling below the expected trajectory generate an alert.
  4. 4The clinician receives the alert and, ideally, a set of clinical support tools: check the alliance, check motivation, check social support, consider referral.
  5. 5The plan changes.

The ethical questions

  • Be explicit at consent about who sees the data and what it is used for.
  • Resist using session-by-session measures for individual performance management; they are not psychometrically adequate for it.
  • Discuss the data with the patient rather than collecting it about them.
  • Remember that not everything that matters is on the form.

Sources

  • 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

    meta-analysis

  • Muir, H. J., Coyne, A. E., Morrison, N. R., Boswell, J. F., & Constantino, M. J. (2019). Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems. Psychotherapy, 56(4), 459–469

    article

  • Constantino, M. J., Boswell, J. F., Coyne, A. E., Mehta, A. H. P., & Smith, A. E. (2026). Improving mental health care by leveraging therapists’ own practice-based evidence. In Practice-Based Evidence in the Psychological Therapies. Oxford University Press

    chapter

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Before you begin

What Praxical.Psych is, and is not

Praxical.Psych is an educational tool. It teaches the theory, evidence base and clinical method of psychotherapy at the level of an advanced survey course, and it lets you rehearse a complete session in a simulator.

It is not medical, clinical, psychological or legal advice. It cannot diagnose or treat anyone, and it does not state the law where you practise — requirements differ by jurisdiction and change. Nothing here creates a clinician–patient or solicitor–client relationship.

  • Every patient, transcript and case in this app is fictional — a composite written for teaching. None depicts a real person.
  • Praxical.Psych is not therapy, not a substitute for supervision, and not a credential. Competence to practise comes from training, supervised hours and licensure.
  • Scores from the instruments here are for learning how they behave. They are not a diagnosis and not a risk assessment, and must not inform a decision about a real person.
  • Do not enter real patient information. Everything you type stays in this browser, but that is not the same as a compliant clinical record system.
If you are in crisis

In the US and Canada, call or text 988. In the UK and Ireland, call 116 123 (Samaritans). Elsewhere, find a local line at findahelpline.com. In immediate danger, use your local emergency number.

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