The meta-analysis revealed a small overall effect of using the PCOMS, but no effect in psychiatric settings. The positive results in counseling settings might be biased due to researcher allegiance and use of the ORS as the only outcome measure.

The aim of this study is to investigate the effectiveness of student counseling in Denmark and to compare the symptomatic distress among student counseling clients with that of Danish outpatients. The pre-intervention level of self-reported symptomatic distress among 1256 students closely paralleled that of psychiatric outpatients. Participants in the intervention study were the 739 student clients with two or more counseling sessions. For the 530 (71.7%) participants with both pre-and post-measurements, the mean pre-post Cohen's d effect size was 0.76 on the Global Severity Index of the Symptom Check List-90-Revised (Derogatis, 1992). An intention-to-treat analysis of all 739 clients resulted in an effect size of 0.59. The number of recovered clients according to the Jacobson and Truax (1991) criteria was 295 (68.8%) of the 429 (80.9%) clients above the clinical cutoff at preintervention, while 66 (12.5%) of the 530 clients reliably deteriorated. The mean number of sessions was 5.0. Individual counseling, number of sessions, and ending counseling in agreement predicted better outcome. In line with results from other countries, this study may indicate that in Denmark student counseling is an effective intervention for a highly needy clientele, even though a high proportion of clients deteriorated (12.5%) or droppedout (31.7%).

The authors would like to express their thanks to the Danish Student Counseling Service and the counselors for their invaluable contributions to this study. There are no conflicts of interest to report for this article. The results presented in the paper has not been disseminated before. Some of the descriptive data from the treatment as usual group has previously been published in Østergård, Fenger and Hougaard (2017). However, there is no overlap in hypotheses.

Cannabis use disorder is a major public health concern where problems with treatment retention (attending sessions and dropout) challenge the effectiveness of treatments. The aim of the present study was to investigate the effectiveness of the Partners for Change Outcome Management System (PCOMS) in improving the retention rate and reducing drug use in a clinic for drug use treatment. One-hundred outpatients with cannabis use as the primary presenting problem were randomized to either the PCOMS (n =51) or treatment as usual (TAU; n = 49). Eight weekly psychotherapy sessions were planned in both conditions. The primary outcome was treatment retention measured as the rate of attendance to planned treatment sessions and dropout. The secondary outcomes were current cannabis and other drug use assessed with the European Addiction Severity Index (EuropASI). Several explorative outcomes were analyzed. Blind assessments of drug use were conducted three and six months after baseline. Outcome analyses were conducted on both the treated sample with at least one psychotherapy session (n = 82) and the intention-to-treat sample (n = 100).The results showed no incremental effect of the PCOMS compared to the TAU condition, for neither treatment retention, drug use, or therapeutic alliance. The main findings align with previous studies that have found no incremental effect of the PCOMS when employing outcome measures independent from the PCOMS intervention. The results are interpreted with caution due to implementation difficulties, which at the same time, suggest challenges when employing the PCOMS in large outpatient clinics for drug use treatment.

In their recent article in Psychological Services, Duncan and Sparks (2020) criticize our meta-analysis on the Partners for Change Outcome Management System (PCOMS; Østergård, Randa, & Hougaard, 2020) and judge it to be misleading and flawed. This reply points out omissions and mistakes in Duncan and Sparks (2020) and highlights our decisions regarding inclusion criteria, choice of outcome measures, and analytical strategy. We argue that the use of the PCOMS Outcome Rating Scale might inflate effect sizes because of social desirability. Therefore, independent outcome measurement is necessary for a stringent evaluation of the PCOMS as a routine outcome monitoring system.