Feedback informed treatment

Feedback informed treatment
SpecialtyBehavioral health
UsesAssessing and improving the therapeutic relationship and progress of care

Feedback Informed Treatment (FIT) is an empirically supported, pantheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services, originally developed by psychologist Scott D. Miller.[1][2] It involves routinely and formally soliciting feedback from clients regarding the therapeutic relationship and progress of care and using the resulting information to inform and tailor service delivery.[1]

FIT utilizes empirically validated, client-rated measurement tools at each session. Although any validated measures could be used, due to their brevity, the Outcome Rating Scale (ORS)[3] and Session Rating Scale (SRS) are commonly employed by FIT Practitioners. The ORS measures the client’s therapeutic progress while asking about their level of distress and functioning. The SRS measures the quality of the therapeutic relationship.[1]

A number of studies and meta-analyses have demonstrated the benefit of routinely monitoring and using client outcome data and feedback to inform care.[4] Studies using the ORS and SRS document:

  • Improved client outcomes (27%)[5]
  • Increased client retention
  • Reduction of deterioration rates (50%)[5]
  • Shortening the length of time spent in care

Relationship to therapist development and deliberate practice

A central question in psychotherapy research is whether therapists improve in effectiveness over the course of their careers.[2] A large longitudinal study analyzing outcomes from over 6,500 patients treated by 170 therapists found that patient outcomes did not improve with accumulated therapist experience and showed a small but statistically significant decline over time.[6] However, a companion study at a different agency that had integrated routine outcome monitoring into supervision and deliberate practice of therapeutic skills found small but statistically significant improvements in therapist effectiveness over time.[7] A subsequent randomized clinical trial also found that the positive effects of routine outcome monitoring increased as training and supervisory support for its use increased.[8]

These findings contributed to growing interest in integrating client outcome data into clinical supervision and training. Researchers have described strategies for using outcome monitoring in supervision, including training students to obtain and use objective client feedback and identifying patterns across clients to guide supervisee development.[9] Broader frameworks have proposed using FIT data as the basis for a cyclical process of therapist development, in which outcome and alliance measures identify areas for improvement that then become the focus of structured skill practice.[10] In this approach, tools such as the ORS and SRS serve not only as clinical decision aids but also as a performance measurement system for ongoing professional development. Some graduate training programs integrate FIT and deliberate practice into their curricula.[11]

Further reading

  • Prescott, D. Maeschalck, C & Miller, S.D. (eds.) (2017). Feedback Informed Treatment in Clinical Practice. Washington, D.C.: American Psychological Association Press. ISBN 978-1-4338-2774-7.
  • Miller, S.D., Hubble, M.A. & Chow, D. (2021). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. Washington, D.C.: American Psychological Association Press. ISBN 978-1-4338-3344-1.

References

  1. ^ a b c Prescott, D., Maeschalck C., and Miller, S. (2017). Feedback Informed Treatment in Clinical Practice: Reaching for Excellence. Washington, D.C.: American Psychological Association. ISBN 978-1-4338-2774-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
  2. ^ a b Miller, Scott (2013). "The outcome of psychotherapy: Yesterday, Today, and Tomorrow". Psychotherapy. 50 (1): 88–97. doi:10.1037/a0031097. PMID 23505984.
  3. ^ Seidel, J. A., Andrews, W. P., Owen, J., Miller, S. D., & Buccino, D. L. (2016). "Preliminary Validation of the Rating of Outcome Scale and Equivalence of Ultra-Brief Measures of Well-Being". Psychological Assessment. 29 (1): 65–75. doi:10.1037/pas0000311. PMID 27099979. S2CID 5857225.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Dulark & Dupre as cited in the Brattland, H., Koksvik, J.M., Burkeland, O., Gråwe, R. W., Klöckner, C., Linaker, O. M., Ryum, T., Wampold, B., Lara-Cabrera, M. L., & Iverson, V. C. (2018). "The effects of Routine Outcome Monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial". Journal of Counseling Psychology. (65)5: 641–652.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ a b Miller, S.D., Duncan, B.L., Brown, G.S., Sorrell, R., & Chalk, M.B. (2006). "Using formal client feedback to improve retention and outcome: Making ongoing, real-time assessment feasible". Journal of Brief Therapy. 5 (1): 5–22.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Goldberg, Simon B.; Rousmaniere, Tony; Miller, Scott D.; Whipple, Jason; Nielsen, Stevan Lars; Hoyt, William T.; Wampold, Bruce E. (2016). "Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting". Journal of Counseling Psychology. 63 (1): 1–11. doi:10.1037/cou0000131. ISSN 1939-2168.
  7. ^ Goldberg, Simon B.; Babins-Wagner, Robbie; Rousmaniere, Tony; Berzins, Sandy; Hoyt, William T.; Whipple, Jason L.; Miller, Scott D.; Wampold, Bruce E. (2016). "Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice". Psychotherapy. 53 (3): 367–375. doi:10.1037/pst0000060. ISSN 1939-1536.
  8. ^ Brattland, Heidi; Koksvik, John Morten; Burkeland, Olav; Gråwe, Rolf Wilhelm; Klöckner, Christian; Linaker, Olav Morten; Ryum, Truls; Wampold, Bruce; Lara-Cabrera, Mariela Loreto; Iversen, Valentina Cabral (2018). "The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial". Journal of Counseling Psychology. 65 (5): 641–652. doi:10.1037/cou0000286. ISSN 1939-2168.
  9. ^ Swift, Joshua K.; Callahan, Jennifer L.; Rousmaniere, Tony G.; Whipple, Jason L.; Dexter, Kyle; Wrape, Elizabeth R. (2015). "Using client outcome monitoring as a tool for supervision". Psychotherapy. 52 (2): 180–184. doi:10.1037/a0037659. ISSN 1939-1536.
  10. ^ Miller, Scott D.; Hubble, Mark A.; Chow, Daryl (2020). Better results: using deliberate practice to improve therapeutic effectiveness. American Psychological Association. Washington, DC: American Psychological Association. ISBN 978-1-4338-3190-4.
  11. ^ "Deliberate Practice Training for Therapists — Sentio Marriage and Family Therapy Program in California". Sentio University. Retrieved 2026-03-22.
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