Therapy isn’t always a linear journey. While some people may see steady progress until they’re finally feeling good at some point, many others see lots of ups and downs along the way. It can make it hard to really know if you’re actually getting better.

One important way to track progress is through measurement-based care, an evidence-based practice of checking in with the client’s symptoms and functioning throughout the course of treatment. By regularly completing short self-assessments, it allows your therapist to see patterns and make decisions about whether they should change their approach. It’s also a way for you and your therapist to work together using some clear data.

Two of the most popular assessments in measurement-based care are the Generalized Anxiety Disorder Scale (GAD-7), which gauges anxiety, and the Patient Health Questionnaire (PHQ-9), which measures depression. Both are widely accepted healthcare tools, and you may have even received these assessments at your primary care doctor’s office. 

In addition to these standard measures, Octave has designed an extra assessment that checks in on the strength of your relationship with your therapist. We believe that relationship — called the therapeutic alliance — is key to your success in therapy, so we track that throughout your journey. 

Why Measurement-Based Care?

You may know people who have been in therapy for years, without any clear goals or sense if they’re getting results. They may feel like it’s helping, but without measurement-based care, it’s a subjective feeling from week to week. One study showed that 85% of therapists believed their clients were improving, when the actual rate of improvement was 40-60%.

If the goal of therapy is to reach a point where you’re equipped with the tools to manage your own well-being, then you need data to know when you’ve reached that point.

Think of it like this: When you go to the doctor, and they take your blood pressure, they’re using that measurement to make informed suggestions about your care. It doesn’t tell your doctor everything about what ails you, but it’s an important indicator of your health over time. If it’s too high, they can try different treatments, such as diet modifications or medication, and adjust when necessary. Once your health is stabilized and you’re managing it well, you shouldn’t have to go back to the doctor’s office until something comes up again.
Measurement-based care in therapy is the same idea – measure, if it’s not working, adjust, then measure again, and adjust again until you find a decline in the symptoms. Extensive research has shown that measurement-based care is more effective at reducing symptoms and preventing deterioration than non-measurement-based care. It also is shown to build trust between you and your therapist because it offers a structured way for you both to check in on how treatment is working for you.

Q: The monthly assessments feel repetitive. Are they worth it?

Dr. Mani: They really are. They only take a few minutes once a month, and they’re a great way to regularly pause, reflect, and really tune into yourself. The way you answer the questions may reveal something about your current mental state that wouldn’t otherwise come up in conversation with your therapist. These assessments ensure that you and your therapist are working towards goals and intentions that you set together at the beginning of your therapeutic journey.

Q: If I see no improvement month after month, does that mean therapy won’t ever work for me? 

Dr. Mani: If your assessments aren’t showing any improvement over time and your symptoms aren’t improving, that’s an opportunity to discuss with your therapist what’s working and not working. They will explore adjusting their approach until they find something that helps. That’s exactly what these assessments are designed to do — make sure your therapist’s treatments are actually working.  

For example, if you have high anxiety levels, and you’ve been in therapy for three months and you’ve seen no improvement in symptoms, you and your therapist might decide to use Dialectical Behavior Therapy instead of Mindfulness-Based Cognitive Therapy. 

Q: Does measurement-based care mean I have to feel better in a certain amount of time?

Dr. Mani: Absolutely not! Outcome-driven therapy doesn’t entail getting better on a specific timeline. You and your therapist have the ultimate goal of improved mental well-being, and this is a tool to ensure that whatever treatments are being applied are actually getting you there. 

Q: Do the assessments dictate when therapy should end? 

Dr. Mani: It’s not that straightforward. If your PHQ-9 and GAD-7 scores have decreased, and you’ve achieved the goals you and your therapist set at the beginning of your journey, then yes, that’s a good sign that therapy can end. But graduating from therapy is a mutual decision between you and your therapist, one that should be discussed over time once you feel ready to manage your own mental well-being.

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Measurement-based care also helps you feel more in-the-know of what’s going on in your therapeutic journey. When tracking the assessments month over month, they create an actual picture of the progress, most times shown as a simple line graph.