Do therapists know when their clients deteriorate? An investigation of therapists’ ability to estimate and predict client change during and after psychotherapy

In routine outcome monitoring, psychotherapists receive feedback from their clients about their self-reported progress during therapy. This practice is based on research indicating that therapists overestimate their effectiveness and cannot detect and predict negative client change. However, this assumption is based on only a few studies. This study aimed to investigate whether trainee therapists could estimate client deterioration after each session and after therapy and whether they, from session to session, could predict client post-therapy outcomes. Fifty-three postgraduate trainee therapists at a university clinic treated 105 clients, with an average of 13.1 sessions. A questionnaire was developed to measure the therapists' estimation of client change at each session and their session-by-session prediction of client post-therapy outcomes. The 10-item version of the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) was used to measure clients' self-reported change at each session. The data included 96 (91.5%) therapist estimations of client post-therapy outcomes, 1015 (87.8%) estimations of client change from the second to the penultimate session, and 1140 predictions of post-therapy outcomes. The study found that at post-therapy, the therapists were only able to identify one out of eight clients who showed deterioration on the CORE-10. Additionally, during therapy, they could accurately estimate only six out of 83 sessions in which clients had experienced deterioration on the CORE-10, and they failed to predict any of the eight clients who ended therapy with deterioration. In conclusion, therapists cannot rely on their clinical judgement alone to assess client progress and outcomes and will depend on routine outcome monitoring to detect client deterioration.