Abstract

Routine outcome monitoring (ROM), the practice of tracking client progress in therapy by administering regular questionnaires to assess functioning, has demonstrated a significant positive effect on psychotherapy outcomes, especially for clients are who not improving as expected. However, some researchers argue the symptom-based measures and outcome classification criteria commonly used in ROM may not represent a complete picture of client change. A recent body of mixed-methods research has investigated these ROM-determined outcome categories to gain insight into client experiences and whether the category and client perception of therapy outcome align. In this investigation, researchers have found significant variety within outcome categories, often to the extent that the client perspective seems to conflict with their ROM-determined outcome. Using mixed-methods methodology, we investigated the therapy experiences and outcomes of clients in the "œno change"group, an under-researched ROM-determined outcome group. We specifically focused on the subgroup of clients who demonstrate "œno change" according to symptom-based ROM but who report that they "œfeel better" after finishing therapy. We recruited 15 clients who met these criteria after completing short-term psychotherapy at a university counseling center. Following consensual qualitative methodology (CQR) we interviewed and then analyzed responses of these students. Results indicated substantial heterogeneity between these "œno change" clients. Despite unchanged symptom scores, clients reported outcomes including improved thoughts and emotions, increased insight, better relational functioning, and greater capability to handle distress. Participants also described factors they perceived as contributing to their discrepant results, including failure of the symptom-based measure to capture their areas of change, shifts in their response style over time, the emergence of new stressors during their course of therapy, and delayed recognition or impact of the changes they made while in therapy. These findings support concerns that symptom-based ROM may not fully represent client change, especially in the early stages. Building on current ROM practices to include additional domains of change, as well as account for issues of response shift and new external stressors, could increase its validity and clinical utility.

Degree

PhD

College and Department

Family, Home, and Social Sciences; Psychology

Rights

https://lib.byu.edu/about/copyright/

Date Submitted

2026-08-11

Document Type

Dissertation

Keywords

routine outcome monitoring, paradoxical outcome, client perspective, psychotherapy, OQ-45

Language

english

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