Measurement Based Care


historical overview

In their introduction to the Handbook of Psychotherapy and Behavior Change, 5th edition, Michael Lambert, Allen Bergin and Sol Garfield introduce the problem of applying randomized clinical trials to actual care:

“A clear trend in psychotherapeutic interventions since the mid-1960s has been the proliferation not only of the types of practitioners, but also of the types and numbers of psychotherapies used alone and in combination in day-to-day practice. Garfield (1982) identified 60 forms of psychotherapy in use in the 1960s. in 1075, the Research Task Force of the National Institute of Mental Health estimated that there were 125 different forms. Herink (1980) listed over 200 separate approaches, while Kazdin (1986) noted 400 variants of psychotherapy. Research on the effectiveness of each and every emerging form of therapy was nonexistent, raising the issue of the degree to which many forms of treatment were merely experimental. Parloff (1982), for example, pointed out that ‘a systematic approach to dealing with a matrix of 250 psychosocial therapies and 150 classes of disorders would require 47 million comparisons’.


Given the large numbers of disorders, treatment research paradigms, and means of measuring treatment effects, [a practical goal] would be to inform both practitioners and the public of developments in the field based on current research. Lists of empirically supported treatments are static and seem to offer only a false guarantee of effectiveness. Although many practitioners and the public may be comforted by the notion that they are offering or receiving an empirically supported psychotherapy, the fact is that the success of treatment appears to be largely dependent on the client and the therapist, not on the use of “proven” empirically based treatments. Proof of effective treatment needs to be based on measurement of treatment response rather than provision of the “right” treatment.


In contrast to other research strategies, outcome management makes empiricism a viable part of routine practice rather than a distant abstraction that practitioners find difficult to incorporate into practice.”

-Michael Lambert, Allen Bergin, Sol Garfield, Handbook of Psychotherapy and Behavior Change, 5th edition

Measurement based care is also sometimes called Routine Outcome Measurement (ROM) or Feedback Informed Treatment (FIT).