You and your therapist will track how things are going from session to session. Keeping your data anonymous and private, we also track our overall effectiveness to address areas where we can improve as therapists.

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People come to psychotherapy and counseling for an wide range of reasons. During therapy, those reasons can evolve. So how can we know when psychotherapy has been effective?

• We ask you to reflect on your well-being at the start of each session.
• We ask a few simple questions about your distress.
• We take your feedback about how therapy is going seriously.

There is a big range of effectiveness among therapists. Controlled studies of different treatments won't predict how good your therapist will be. Studies have consistently shown that measuring clients' well-being and satisfaction with therapy leads to better treatment and more change.

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Why don't other therapists measure their effectiveness?

Well, a few do. The number of psychotherapists in private practice who systematically track their treatment outcomes (with consistency and valid methods) is still probably fewer than 1 in 1000. The Colorado Center is one of a handful of private practices in the world that openly publish their results at this level of detail and scientific accuracy.

Why is this?

It takes work. Effective therapy doesn't need technology, but quickly identifying ineffective therapy does. Keeping track of therapy quality only takes about 2 minutes and can be enormously helpful to you, but it is very difficult to get therapists to do it reliably--session after session, client after client. Without that kind of commitment, outcome data aren't valid and therapists resort to testimonials, years of experience, or the brand of training they've received. What good is 30 years of experience if it's 30 years of providing mediocre therapy? We are focused on you getting great therapy so we want to know if we're providing it, rather than just hoping for the best.

Fear of being judged ineffective. Most psychotherapies are "effective" in general (better than no treatment), but there is a big range in the effectiveness of each therapist. Training, degrees, and experience have surprisingly little effect on how much change clients report experiencing from therapy! Research also shows that a therapist's overall effectiveness tends to be stable year after year. So how do you find a good therapist? By knowing how effective your therapist has been, you can know how good they are likely to be.

Paternalistic "expertise." Some clients report working with a previous therapist who wasn't very helpful, but who acted as if dissatisfaction with the therapy was the result of the client being "difficult" or "resistant." Perhaps the therapist was being too smug rather than recognizing the limits of their approach and taking in some feedback! Tracking effectiveness and being accountable requires some humility and more interest in the well-being of our clients than in our egos.

How does measuring effectiveness help you as a client?

Everyone is unique. Labeling you with diagnoses or scores on tests can't fully capture how you feel or who you are. Yet, as long as a measurement of change is valid (actually measures what it claims to measure), and is used with respect for your individuality, it can help us have a clearer sense of whether therapy is going in the right direction. In fact, some research shows that giving this simple feedback to us (about how well the sessions are going, and how you are feeling in your life from session to session) can be enormously helpful in making therapy more effective.

The Outcome Rating Scale ("ORS"; Miller et al., 2003) is a measure for clinical practice with only 4 questions. It is fast, easy to use, validated with a much longer "gold standard" instrument (the OQ-45), and reflects your point-of-view about things. You, the client, are the most accurate judge of how things are going in your life and in therapy. The ORS is a "guardrail" to keep therapy on track and alert you and your therapist to ineffective therapy and a lack of change.

We use methods that are more effective because we use a contextual model of treatment rather than a medical model. And beyond just "satisfaction" with therapy, we use measures of real change outside of therapy.

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Here's the medical model as many psychotherapists learn it in graduate school and which will sound familiar (many people think of therapy as a kind of medical treatment):

• Diagnose the condition.
• Select a treatment based on the diagnosis.
• Wait for the expected outcome.
• If no improvement is apparent, apply more of the treatment since it "should" work.
• If still no improvement, apply different treatment (e.g., medication) based on the diagnosis.
• If still no improvement, consider the client "treatment resistant."

We have met a lot of "treatment resistant" clients who later experience real and significant improvement, so we think that it is more helpful to focus on the fit between therapist and client when there is a problem.

Here is the contextual model, as we use it and as an increasing number of training programs are adopting it given the superior outcomes that it tends to produce:

• Understand your specific concerns and what you want to change.
• Use methods that we adjust based on your feedback.
• Measure whether there is an improvement in well-being and satisfaction with the process session-by-session.
• If no improvement, work collaboratively with you to adjust what we are doing (change the treatment).
• Measure again whether there is improvement from session-to-session.
• If still no improvement, consider the therapist to be ineffective for this particular client and try to find a better fit.

Sometimes people feel relief when they get a diagnosis for a psychological problem. And most of us were trained to think in these terms, borrowing the medical model from our physician colleagues. However, we also know that diagnoses can cause providers (whether physicians or therapists) to develop a narrow or fixed view that can actually get in the way of effective treatment. We want to know as we are going forward whether what we are doing is working. That's more important than focusing on a diagnosis.

We abide by core principles for analyzing and presenting our effectiveness data.

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• We use widely accepted statistics that are understandable and that make it possible to compare therapists.
• We report sources of possible bias and use transparent and rigorous methodologies comparable to (or more stringent than) peer-reviewed research.
• We adhere to strict ethical standards, total client confidentiality, and appropriate interpretations of our data.

You can view our results and learn more about how we track our effectiveness.