This survey investigated psychologists' use of outcome measures in clinical practice. Of the respondents, 37% indicated that they used some form of outcome assessment in practice. A wide variety of measures were used that were rated by the client or clinician. Clinicians who assess outcome in practice are more likely to be younger, have a cognitive-behavioral orientation, conduct more hours of therapy per week, provide services for children and adolescents, and work in institutional settings. Clinicians who do not use outcome measures endorse practical (e.g., cost, time) and philosophical (e.g., relevance) barriers to their use. Both users and nonusers of outcome measures were interested in similar types of information, including client progress since entering treatment, current strengths and weaknesses, and determining if there is a need to alter treatment. Implications for practicing clinicians are discussed. DEREK R. HATFIELD received his MS in clinical psychology from Ohio University, where he is currently a doctoral student. His primary areas of research are outcome assessment and clinical judgment and decision making. BENJAMIN M. OGLES received his PhD in clinical psychology from Brigham Young University. He is a professor in the Department of Psychology at Ohio University. His research is focused on the assessment of outcome for mental health services. WE THANK Michael J. Lambert for his suggestions concerning this survey and the preparation of this article.

Routine clinical judgment is often relied upon to detect client deterioration. How reliable are therapists' judgments of deterioration? Two related studies were conducted to investigate therapist detection of client deterioration and therapist treatment decisions in situations of deterioration. The first study examined therapists' ability to detect client deterioration through the review of therapy progress notes. Therapist treatment decisions in cases of client deterioration were also explored. Therapists had considerable difficulty recognizing client deterioration, challenging the assumption that routine clinical judgment is sufficient when attempting to detect client deterioration. A second study was a survey of therapists asking how they detect client deterioration and what treatment decisions they make in response. Symptom worsening was the most commonly stated cue of deterioration.

Due to their potential as helpful clinical tools, it is necessary to understand the reasons why certain practitioners are currently using outcome measures and certain others are not. This study investigated the reasons why clinicians use outcome measures based upon factors such as work setting, theoretical orientation and source of payment. Similar analyses were conducted for reasons that clinicians do not use outcome measures. Findings suggest that several practical barriers are the primary reasons for not using outcome measures, although a subset of clinicians have additional concerns. Results also emphasized the need for clinicians to be trained on how to maximize the clinical benefits of formalized outcome assessment.

This study investigated the influence that information in the form of outcome measures and client verbal reports can have on treatment decisions and clinician judgment of client change. A random national sample of psychologists (N=810, 45% response rate) were given clinical vignettes and asked questions regarding their view of client progress and subsequent treatment decisions. Despite clinicians reporting that verbal report is more influential in their actual clinical practice than outcome measure information, both sources of information had an equal impact on judgments of client change. Negative information (from either source) influenced clinicians more than positive information. Outcome measure information indicating client deterioration led more clinicians to choose to alter treatment than client verbal report of deterioration. Information indicating client improvement led some clinicians to continue treatment in the same manner as they had been. Insight-oriented therapists were more likely to continue treatment-as-usual than were cognitive-behavioral therapists.

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