Author Date


Degree Name





Family, Home, and Social Sciences

Defense Date


Publication Date


First Faculty Advisor

Benjamin Ogles

First Faculty Reader

Davey Erekson

Honors Coordinator

Bruce Brown


Psychotherapy, Discrepancy, Routine Outcome Monitoring (ROM), Retrospective Narrative Interviews, Consensual Qualitative Research, Therapeutic Alliance


This thesis is a qualitative case study which examines an observed discrepancy in psychotherapy outcomes between prospective routine outcome measurements (ROM) and narrative retrospective assessment by two clients. Although ROM has proven to be effective in improving therapy efficiency and effectiveness (De Jong et al., 2021; Lambert et al., 2018), recent research investigates discrepancies between ROM categorizations of improvement and deterioration and the lived experience of the client. Researchers have found that the narratives delivered through client structured interviews can provide additional and more nuanced insight into therapy outcomes, which can complement and enhance ROM (Roubal et al., 2018; De Smet et al., 2019; Desmet et al., 2021). A recent case study used qualitative analysis of a post-treatment interview to examine the client’s perspective of discordant outcome when ROM indicated that the client deteriorated during treatment and the client reported retrospective improvement (Ogles, Goates-Jones, & Erekson, 2022). This thesis builds upon this research. A retrospective survey was sent to 67 former clients at a university counseling center who’s prospective OQ-45 results showed reliable improvement. 25 completed the survey and 7 indicated they felt “about the same” after treatment, presenting a discrepancy with the prospective ROM. Two of these participants were interviewed and interview transcripts were analyzed using the Consensual Qualitative Research (CQR) method (Hill & Knox, 2021). Qualitative themes include motivation, social support, life events and context, therapeutic alliance, and the client’s own view on the observed discrepancy. Findings are discussed with implications for researchers and practitioners.