Improving the effects of psychotherapy has been accomplished through a variety of methods. One infrequently used method involves profiling patient outcomes within therapist in order to find the empirically supported psychotherapist. This study examined data collected on 1841 clients seen by 91 therapists over a 2.5‐year period in a University Counseling Center. Clients were given the Outcome Questionnaire‐45 (OQ‐45) on a weekly basis. After analysing data to see if general therapist traits (i.e. theoretical orientation, type of training) accounted for differences in clients' rate of improvement, data were then analysed again using Hierarchical Linear Modeling (HLM), to compare individual therapists to see if there were significant differences in the overall outcome and speed of client improvement. There was a significant amount of variation among therapists' clients' rates of improvement. The therapists whose clients showed the fastest rate of improvement had an average rate of change 10 times greater than the mean for the sample. The therapists whose clients showed the slowest rate of improvement actually showed an average increase in symptoms among their clients. Use of this information for improving quality of patient outcomes is discussed. Copyright © 2003 John Wiley & Sons, Ltd.

This study examined data collected on over 5,000 clients seen by 71 therapists over a 6-year period in a University Counseling Center. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis to track their treatment response. Data were also collected on therapists' theoretical orientation, years of experience, gender, and type of training. Data were analyzed using hierarchical linear modeling (HLM) to see if general therapist traits (i.e., theoretical orientation, type of training) accounted for differences in clients' rate of improvement. Data were then analyzed, again using HLM with therapists as a fixed effect, to compare individual therapists to see if there were significant differences in the efficiency of treatment. In addition, pre- minus posttest OQ-45 scores were examined to see if there were differences in the overall outcome of clients. There was a significant amount of variation among therapists' clients' rates of improvement. Therapist feedback reports were generated to summarize client outcome for individual providers in contrast to center averages and in an attempt to improve client outcome.

Brief Therapy CenterA method of assessing outcome after psychotherapy in private practice or clinics is described. Use of this system is illustrated by reference to the progress and rate of recovery of 27 patients seen by a private practice clinician in comparison with base rates from a prior study. The results suggested more rapid recovery in the patients treated by an experienced clinician committed to a brief, solutionfocused psychotherapy. The methodology reported, based on weekly assessment of patient progress and the use of clinical significance markers, has implications for routine clinical practice as well as for managed health care practices and social policy decisions.Clinicians have remained rather skeptical about the relevance and value of psychotherapy process and outcome research, looking elsewhere for guidance in directing their clinical practice (Talley, Strupp, & Butler, 1994). Although there is a rich database supporting the efficacy of many psychotherapies (summarized by Lambert & Bergin, 1994), health delivery providers in general, and psychotherapists in particular, are being challenged to document the outcome of the treatments they provide to given patients. Much of this documentation is focused on demonstrating that more expensive, time-intensive treatments produce better outcomes than less expensive interventions. Andrews (1995) has argued that the push for outcome research is a worldwide phenomenon independent of any specific payment system. It appears that psychotherapists will be involved in outcome assessment either by choice or by default. Professional psychologists are seemingly well suited to the task of being practitioner-scientists and using outcome assessment to the advantage of their patients.Outcome assessment has a long history, dating back to the 1930s (see Lambert, 1983, for a review). Early efforts at outcome assessment represented by small, well-controlled studies were driven by psychological theories and scientific considera-

Sensitivity to change of the Outcome Questionnaire (OQ; M. J. Lambert et al., 1996) items, subscales, and total score was evaluated for clients receiving personal counseling in university counseling center settings. OQ data collected for 248 university students who did not receive treatment and 5,553 students who received treatment from 527 therapists employed in 40 university counseling centers nationwide were included in the analyses. Comparisons between the treated and untreated groups indicated that the OQ total score, all of the subscales, and 34 of the 45 items met 2 preset criteria for change sensitivity, providing support for the OQ as an appropriate index of outcome in counseling center clients. The 11 OQ items that failed to demonstrate change sensitivity were aimed at assessing aspects of interpersonal functioning, related to specific physical symptoms, or were susceptible to floor effects. The possibility of using change sensitivity results in revising the OQ for optimal use in counseling center settings is addressed, and general implications for outcome test development are discussed.

The association between endorsement of emotional "toughness" (i.e., extreme self-reliance and the suppression of outward displays of emotional distress) and likelihood for screening positive for mental health conditions was examined in a male sample of 198 Iraq and Afghanistan veterans presenting for postdeployment Veteran Affairs health care. After accounting for relevant covariates, veterans endorsing higher levels of emotional toughness were more likely to screen positive for posttraumatic stress disorder and depression. There was also a nonsignificant trend {p = .08) associated with a positive relationship between toughness and likelihood of self-reported alcohol abuse. Results are discussed in terms of identifying and addressing toughness norms among returning veterans to promote effective use of mental health services.