Client and Therapist Reports

Testing efficacy and effectiveness of psychological treatment requires valid and reliable methods for describing change. There are three main issues in rating outcome: First, from what perspective should the ratings be made (client, therapist, society)? Second, what level should the measurement target (concrete behavior or thought, syndrome, or global change)? Third, should outcome be described nomothetically (with standardized instruments) or ideographically? Despite many proposals over the years, there is still no consensus about instruments that make comparisons between studies comparable. Some scales have, however, become standard for specific disorders. Comparisons of ratings by clients and therapists show moderate agreement about presenting problems, perception of the process (e.g., alliance), and outcome. One reason for imperfect agreement may be different formulations and instruments for each participant. Another reason could be that clients and therapists have different perspectives on how to describe problems and therapy activities conceptually. It may be important to distinguish between clients’ and therapists’perceptionsof agreement, for instance about activities in therapy and goals, andactualagreement on specific behaviors and targets. Although agreement may be important, recent theories and studies have emphasized that a mutual therapeutic endeavor can be characterized as an ongoing negotiation between client and therapist. The negotiation in itself may be a potent therapeutic tool. Therapists are encouraged to follow the development of clients’ ratings of both symptoms and alliance continuously during treatment in order to modify the treatment in accordance with the current level of symptoms as well as the clients’ perspective on the therapeutic collaboration.