A meta-analysis led by Klára Jonášová, Michal Čevelíček, Petr Doležal, and Tomáš Řiháček from the Center for Psychotherapy Research provides the most comprehensive look to date at how therapists utilize Routine Outcome Monitoring (ROM) directly during sessions. While ROM is an effective tool for increasing the safety and efficacy of psychotherapy, practical experience shows that the way it is integrated into sessions varies greatly in form and effectiveness. An analysis of 47 qualitative studies demonstrates that the benefits of measurement are not automatic; they are the result of careful integration into the therapeutic process.
ROM captures what escapes the conversation
Therapists reported that regular measurement allows them to notice changes that might easily be overlooked in standard conversation – minor worsening of symptoms, stagnation, or topics that clients discuss hesitantly or indirectly. ROM thus functions as a supplementary source of information: it does not replace clinical judgment but rather refines it and provides a structured view of how the client is truly progressing in therapy.
Measurement provides rhythm – and encourages flexibility
The results of the meta-analysis reveal a seemingly paradoxical finding: ROM can maintain therapy within a clear structure while simultaneously encouraging the therapist to deviate from it when necessary. Regular measurement of change brings a certain rhythm to therapy and clarifies which goals the work in individual sessions is centered around. At the same time, it provides signals when it is time to adjust the procedure – to change the pace, focus on a new topic, or re-evaluate the current approach. Many therapists stated that, thanks to ROM, they detected important changes earlier than they would have noticed them on their own.
The questionnaire as an icebreaker for difficult topics
One of the most surprising effects of ROM is its role in the dialogue between therapists and clients. For some clients, it is easier to first record their fears, dissatisfaction, or deterioration in a questionnaire than to bring them up verbally. ROM can thus facilitate sensitive topics that might otherwise remain unaddressed in standard dialogue or that clients would only approach much later. Therapists described how measurement often initiates conversations that would otherwise not take place at all – for example, about relationship difficulties, risky behavior, or uncertainty regarding progress.
Measurement can drive change
The study shows that ROM does not only serve therapists as a tool for tracking progress; it is also significant for the clients themselves. For many clients, the visualization of change – such as a graph showing gradual progress – is a powerful moment that boosts motivation, a sense of competence, and an understanding of their own process of change. In this way, measurement can function as a simple but effective "micro-intervention": it makes visible the change that might otherwise get lost in daily life.
The therapist remains a key part of the process
The meta-analysis shows that there is no single "correct" way to work with ROM; its effectiveness depends on sensitive integration into the therapeutic process. Therapists differ significantly in how often and what specifically they measure, how they discuss results with clients, or which indicators they consider key. However, the common denominator of successful use is flexibility: measurement must correspond to the needs of the specific client and the therapist's style of work to represent a benefit rather than an additional burden.
At the same time, the study emphasizes that data alone do not drive therapy – the therapist remains the key agent of change. ROM can only enrich the process if it is interpreted sensitively, placed in context, and used within a dialogue. The results thus support the conclusion that modern tools are not autonomous "upgrades" to therapy; their real impact arises only when connected with the therapeutic relationship.
Recommended citation:
Jonášová, K., Čevelíček, M., Doležal, P., & Řiháček, T. (2024). Psychotherapists’ experience with in-session use of routine outcome monitoring: A qualitative meta-analysis. Administration and Policy in Mental Health and Mental Health Services Research, 52, 106–122. https://doi.org/10.1007/s10488-024-01348-4
