Ongoing monitoring of changes in psychotherapy, known as Routine Outcome Monitoring (ROM), has been gaining increasing attention in both research and practice in recent years. It is an approach that allows therapists to continuously monitor how clients are doing in therapy, how their symptom levels are changing, and how satisfied they are with the therapeutic relationship. Based on this data, the therapist can then adjust the course of treatment. Research shows that ROM can improve treatment outcomes, strengthen the therapeutic relationship, or help detect a worsening of the client’s condition in a timely manner. Nevertheless, it is used only rarely in routine practice. One reason may be that incorporating ROM into therapists’ daily work faces various obstacles. A new study from the Center for Psychotherapy Research, led by Klára Jonášová, focuses precisely on these factors. The study aims to systematically summarize what facilitates the implementation of ROM for therapists and what, conversely, complicates it.
Researchers from the Centre for Psychotherapy Research – Klára Jonášová, Michal Čevelíček, Petr Doležal, and Tomáš Řiháček – collaborated on the study with Benjamin Aas from Germany. The team reviewed 58 previously published studies in which therapists described how they use ROM in their practice. From these studies, they selected the most important findings and categorized them into groups based on their subject matter. This resulted in an overview of how therapists integrate ROM into their practice, what makes implementing ROM easier for them, and what, conversely, makes it more difficult.
How Therapists View Tracking Therapy Outcomes
One of the most striking findings is that it is absolutely crucial for therapists to perceive ROM as something useful and to feel that it fits into their way of working. If tracking outcomes provides them with new information about the client – perhaps something they wouldn’t otherwise learn – and if it can be easily integrated into their routine practice, ROM becomes an integral part of therapy and effectively complements their work. However, if a therapist feels that the questionnaires are just more “paperwork” that tells them nothing new, or that they oversimplify what actually happens in therapy, they tend to be skeptical of ROM and will easily reject it. Furthermore, some fear that regularly filling out questionnaires will disrupt the relationship with the client and make therapy feel less personal and more bureaucratic. However, this fear cannot materialize if ROM is properly integrated into therapy, since ROM becomes part of the therapeutic relationship, not a disruption to it.
The second important finding concerns how therapists cope with the emotions that feedback from ROM evokes in them. Positive feedback on their work usually encourages them and reassures them that they are doing a good job. Negative feedback, however, is more problematic – at first glance, it can come across as criticism or a questioning of just how good a therapist they actually are. For some, accepting negative feedback can be so challenging that they would rather distrust the entire tool and stop using it than admit that it could help them reflect on their own weaknesses. However, the study shows that therapists who manage to accept even unpleasant feedback as an opportunity for growth – ideally with the support of colleagues or a supervisor – can ultimately benefit greatly from ROM.
Organizational support is just as important as the therapist’s motivation
In addition to the therapists’ own attitudes, the conditions under which they work also matter. Many report that a lack of time, administrative duties, or technical complications make it difficult for them to use ROM. Conversely, where they have organizational support – for example, in the form of training, technical assistance, or the opportunity to participate in implementing the system – the use of ROM tends to be significantly easier and more effective.
The study thus shows that the successful implementation of ROM is not just a matter of having the right questionnaire or software. It is equally important for therapists to understand how the data they collect can help them in their daily work and to have sufficient support from their organization. The authors therefore recommend focusing not only on the technical aspects of implementing ROM, but also on high-quality training for therapists, open discussion of their concerns, and creating an environment in which feedback is viewed as an opportunity for growth rather than a form of control. If the needs of therapists, clients, and organizations can be successfully aligned, ROM can become a common and useful part of psychotherapeutic practice.
Recommended citation:
Jonášová, K., Čevelíček, M., Doležal, P., Aas, B., & Řiháček, T. (2026). Barriers and facilitators in the implementation of routine outcome monitoring from the clinicians’ perspective: A qualitative meta-analysis. Psychotherapy, 63(1), 33–47. https://doi.org/10.1037/pst0000605
