Outcome research has documented worsening among a minority of the patient population (5 to 10%). In this study a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure was reviewed through the use of meta-analytic, mega-analytic, and multilevel analytic techniques. A pooled dataset from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were re-analyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians to help them intervene before treatment failure occurred. Intent-to-treat and efficacy analyses of the effects of feedback interventions were conducted to obtain the estimates of effects expected from implementation of this quality assurance system as a policy as well as in clinical trials. Three forms of feedback interventions—integral elements of this quality assurance system—were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (Clinical Support Tools and the provision of patient progress feedback to therapists). The Clinical Support Tool intervention was effective not only in terms of the amount of outcome enhancing effect, but also in the rate of patient recovery. The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.



College and Department

Family, Home, and Social Sciences; Psychology



Date Submitted


Document Type





treatment outcomes, treatment failure, patient deterioration, feedback, psychotherapy quality assurance



Included in

Psychology Commons