Psychotherapy progress and outcome monitoring in the real world of private practice

Abstract

The Canadian Psychological Association (CPA) Task Force on Outcome and Progress Monitoring (OPM) in Psychotherapy recently issued a lengthy report recommending widespread implementation of OPM in publicly and privately funded psychotherapy practices and urging the CPA to change its Canadian Code of Ethics for Psychologists to require psychologists to give progress monitoring testing procedures weekly. This recommendation also extends to all practising psychotherapists. Although the Task Force offers many valid arguments for why OPM is important in certain clinical contexts, it fails to take into account psychologists and psychotherapists who are in private practice, including those whose training, experience, and expertise directly challenges such sweeping generalisations. In addition, it is largely out of touch with clients' needs and preferences, as well as the diversity of therapies they seek and require. It ignores practical, financial, and ethical parameters for such mandates and fails to note how the therapeutic relationship, frame, and quality of treatment could be drastically transformed by technocratic impositions. Finally, it appears to be motivated by political considerations rather than optimal treatment standards in private practice environments. I address many problems linked to the Task Force's directives and broad oversimplifications, arguing that current practices show more fidelity to the real world of private practice and privilege the right to maintain independence in clinical judgement rather than follow a superimposed, prescriptive model governing psychotherapeutic praxis.