Improve Patient Outcomes with the Help of Technology

A lot of therapists making the shift to telemedicine have experienced a few hiccups along the way.

Online therapy itself is new and most clinicians have not had any proper training on how to translate their in-person work to a digital platform. Plus, the switch to technology platforms that seem too cumbersome to use, creates even further barriers to providing effective therapy. Who ever dreamed an essential part of a good therapy session would be the client’s ability to log on?

As therapist and client experiment with online therapy, feedback is essential to figuring out what is working, and how to fix what is not. To keep communication open and transparent I recommend setting aside dedicated time each session to discuss the transition, and what has and hasn’t felt supportive.

Without this, it can be difficult to truly gauge whether the patient is satisfied with the mental health services they have received. If they are dissatisfied, they are less likely to share this information with you, which jeopardizes their outcome.

MyOutcomes for Mental Well Being is a company that provides practitioners with software that allows patients to give feedback on a session-by-session basis.  Practitioners and patients can view this feedback immediately, allowing for adjustments to improve the therapeutic alliance and increase the likelihood of the client achieving clinically significant, reliable change from the psychotherapeutic treatment or program provided.

Improve patient outcomes with the help of technology

MyOutcomes is committed to helping those in the mental healthcare field improve patient outcomes and simplify outcome reporting, offering standardized therapy outcome measures ideal for both in-person and Telehealth sessions. MyOutcomes recently released Telehealth Solution promises to dramatically simplify the routine monitoring of treatment outcomes, making remote administration as simple and engaging as face-to-face.

Here is what some of your colleagues are saying about these new features:

“That’s exactly the feature I’ve been looking forward to. Other companies use direct access links all the time, I was wondering why MyOutcomes wasn’t providing that option.”

“Like it! Often clients would find the login and password via email as a bit clunky.”

“This is way faster since the virtual platform I use has a chat function, so rather than me copying and pasting the login information or the client having to refer back to their email, I like that they can just click a link that I send them.”

There are four new ways to collect outcome and session ratings from clients. Perfect for Telehealth or in person sessions where clients want to use their own device


  1. Send Access: It can be as simple as opening Give Access and clicking the button to send an email with access options to the client.
  2. Single Reminder: This option provides the opportunity to preselect a time and date to send an email with a customizable message to remind them to complete the scales and provide them with login access.
  3. Recurring Reminder: Clicking the Recurring Reminder button will open a page that now includes the custom message “ield option. Great for weekly group sessions.
  4. Direct Access Link: You can completely eliminate login issues by sharing the link in real time through your text or chat function. This link will enable the client to access their survey with one click.

To learn more read: MyOutcomes 2021 Telehealth Solution

Free Resource Reveals the True Path to Better Results


Turns out it’s more than just a common quality of highly effective therapists, humility is actually a prerequisite!

Studies confirm “professional self-doubt” is not only a strong predictor of both alliance and outcome but actually a prerequisite for acquiring therapeutic expertise. Speaking specifically to the field of psychotherapy in, Humility: The paradoxical foundation for psychotherapy expertise, the authors, Hook, Watkins, Davis, and Owen , define humility as “valuing input from the other (or client) … and [a] willingness to engage in self-scrutiny.”

Does this sound like you?

We all profess humility and I know as an ethics bound professional that you already ask for feedback and have likely already encountered some negative feedback from a client. When you have received negative feedback about treatment progress or experienced a rupture in the therapeutic alliance, ask your self how ofter you were able to:

1: Fix the problem?

2: Learn from the feedback and apply it in future encounters?

Did you confidently answer yes, all the time to both questions, because this is the path your colleagues are taking to go from average to excellent. Only you know how far down this journey you have gone, or are willing to go, but what I do know is that both MyOutcomes® and The International Center for Clinical Excellence (ICCE) are dedicated to providing you with the tools and training you need to see noticeable improvements in treatment results.

Take the Path to Better Results

On January 15, 2021 MyOutcomes is releasing a new series of Better Results with Scott Miller Interviews. The series is full of stories and free practical advice and resources to help you develop a more feedback informed practice. This four-part Netflix style series can be binge watched in under two hours.

If you have participated in the past, then you know that besides free giveaways, MyOutcomes will also be including a great bonus package. The Get FIT Now bonus package will be available for the first 100 Mental Health Professionals who sign up between January 15th and 31st, 2021.

Without giving to much away, I have to tell you that the first 10 participants to sign up online for MyOutcomes or FIT eLearning will be receiving a free paperback copy of Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness! This step-by-step guide demonstrates how to collect and use client outcome data to create an individualized professional development plan and measure improvements in the quality of the service you provide.

Sign up now

To make sure you don’t miss out, get on the wait list now: This free Feedback-Informed Treatment Webinar Series will only be available for download from Jan 15-31. More free resources and exclusive content will be revealed on the release date!

Share with your colleagues so they don’t miss out on advanced notice.

Get on the waitlist for premier access, Friday, January 15th

The Power of Outcome Driven Recovery in Mental Health


Recovery in Mental Health - MyOutcomes

Discover the power of an Outcome Orientated Approach to Recovery

Join me Friday 27, May 2016 in the historic market town of Newark, on the River Trent, for a coming together of minds to share experience and research on the benefits and challenges of embedding the routine administration of the ORS and SRS into a recovery oriented service delivery model. This event is free for Lincolnshire Partnership NHS Foundation Trust (LPFT) staff and students having their placement with LPFT, and only £65 for external delegates and £25 for service users and carers.

Keynote speakers include:

  • Mike Slade – Understanding the outcome of recovery
  • Sami Timimi – Background and evidence to Outcomes Orientated Approaches
  • Dianne Tetley – Delivering Outcomes Orientated Approaches to Mental Health Services (OOAMHS)
  • Bob Bohanske- My experience of embedding recovery in mental health services

Register Now

A demonstration of MyOutcomes® UK will also be provided at the event.

MyOutcomes®UK is a secure, web-based feedback and data management system that supports the practical application of an Outcomes Orientated Approach to the delivery of Mental Health Services (OO-AMHS). Patients simply input feedback at the beginning and end of each session with the practitioner, and the software displays a graphical interpretation of this feedback to check patient functioning and the quality of the therapeutic alliance. Reports  created from aggregated data enable clinicians and managers to monitor therapeutic outcomes by case-load, team, or service, and for generating recovery and service activity metrics.

Only two days after the public launch of MyOutcomes®UK, Dianne Tetley and Sami Timimi from Lincolnshire Partnership NHS Foundation Trust, and I won The Medipex NHS Innovation Award for Mental Health and Well-being for our work on MyOutcomes®UK.  The Medipex Innovation Award showcases pioneering ideas and technologies developed by NHS staff working with industry and academia internationally to improve patient care and make services more efficient.


Watch this introduction to MyOutcomesUK to learn more or better yet join us in Kent May 27th!

Power of Outcome


Register Now

PCOMS Therapist Survey

PCOMS Therapist Survey

Examining the Influence of Feedback Orientation and Feedback Environment on Clinician Processing of Feedback from Client Outcome Measures.

Dear Readers of the Effective Therapist Blog,

My name is Logan Rife and I am a doctoral candidate in the Collaborative Program in Counseling Psychology at The University of Akron. As a student, my use of the Partners for Change Outcome Management System or PCOMS helped inspire my dissertation which specifically seeks to examine therapists' responses to client outcomes measures such as PCOMS.

I am reaching out to you in the hope that you will help me with my data collection by participating in an online survey. The survey takes, at most, 15 to 20 minutes to complete. At no point during the completion of the survey will actual client data be accessed. My research project has been approved by The University of Akron Institutional Review Board.

Here is the link to the survey:

In addition to helping me complete my dissertation, your participation will provide valuable data that can further inform practitioners and mental health agencies on how to optimize their use of PCOMS to improve service delivery.

Thank you for your time and help in this matter as I know all of you are exceedingly busy in your work as therapists. Please do not hesitate to contact me at if you have any questions regarding participating in this study.

Best Regards, Logan Rife G. Logan Rife M.A. Doctoral Candidate Collaborative Program in Counseling Psychology, The University of Akron

Algorithms-How the 8 session estimation with the 8th session success score being the Expected Service Target will hold for trajectories going over 30 or 50 sessions or more

Algorithms in Psychology

Algorithms in Psychology

How the 8 session estimation with the 8th session success score being the Expected Service Target will hold for trajectories going over 30 or 50 sessions or more

These estimations are not based on randomized trials but on actually helping people attend and use the psychotherapy in a broad range of countries and with a wide range of client population. In these estimations, more robust data is available for about 8 sessions that has been predictive of success and so the 8th session estimation is used. If a client is seen for longer, then the data can be entered and compared with the ETR and added and analyzed over time to find out how predictive it is.

Live consultation with Dr. Scott D. Miller

The new accuracy of Client Status Report; no averages!

myoutcomes client status report

Why Average Raw Change, Average Session Change and Average Service Change have been removed?

Initially there were a few assumptions and experiments made with the client status report. Scott quotes: “Actually, an average doesn't really tell us anything and it does not inform the individual case.” He says that because earlier on there were not enough cases available, so they had to use average change to interpret the outcomes, but with the huge database available now, it is possible to more accurately determine whether the client will complete the treatment successfully or not.

Live Consultation with Dr. Scott D Miller on the new accuracy of Client Status Report

Fear is only HIPAA Deep

outcomes system software

MyOutcomes Partners with Compliance Helper

In an age of alarming events that seem to occur with unnerving regularity, I have done my best to avoid being an alarmist. On the other hand, I have no qualms about being a realist. Being a realist is not the same as being an alarmist. A realist is someone who identifies problems and seeks to take reasonable and effective steps to negate those problems. An alarmist is someone who exaggerates the dangers of the world in order to panic the proverbial herd into making risky and costly choices that oftentimes benefits the alarmist or pushes the alarmist's agenda.


In every age, new threats arise that challenge our security. These threats are typically associated with what we consider to be technological, socio-political, and/or economic advances. History is replete with examples of new discoveries, inventions, or other advancements turning out to be double-edged swords: one edge improves life as we know it, while the other edge opens the door to new risks. When the age of pharmacology was first born in the 19th century, the possibility of treating, if not outright curing, so many disorders and diseases became a real possibility. At the same time, the magnitude for substance-abuse and its associated problems grew to a level never seen before. Nothing is without a cost.

In our age, technological advances hold the promise to yield better healthcare that can be delivered more easily to more people. Computers and their attendant software possibilities, the internet, and mobile telecommunications, in unison, have the potential to bring state-of-the-art advances in psychotherapy to therapists and their clients anytime and anyplace. There are few people who would consider advancements that can better the lives of so many as being the equivalent of letting the genie out of the bottle. Nonetheless, taking advantage of these advances requires the creation of electronic records that oftentimes contain personal and sensitive information. And as everyone knows, there are people who want access to that information, whether it be for personal gain, part of a cyberwar stratagem, or it stems from nihilistic tendencies. Luckily, the U.S. Department of Health and Human Services identified the problem and developed a document that outlines what are reasonable and effective steps to address this threat to our privacy and security. This document is the Health Insurance Portability and Accountability Act, or, as it is more commonly referred to, HIPAA.

This age has seen numerous companies moving to take advantage of these advances, such as healthcare funders (either government or private), multi-site agencies, and companies bringing therapeutic tools to the therapist. MyOutcomes, the web-based application of Partners for Change Outcome Management System (PCOMS), is one of a handful of companies attempting to bring electronic tools to those therapists who are ready to modernize their approach to psychotherapy by building an evidence-based, feedback-informed practice. Given the very real threats to our privacy and security, one of the top ten questions any therapist, or even any potential client, should ask is: Is the company they are considering doing business with HIPAA compliant? If not, then this should be considered a strong indication that the company doesn't concern itself with your privacy and security. I give you fair warning; approach such with care.

As in any age when a threat has been identified and a solution has been posed, one can be certain to find the alarmist wolves howling at the gates. The wolves, in this case, are those who are warning of the dire consequences if people fail to become HIPAA certified. In light of these scary warnings, what's a therapist to do except to seek out something that doesn't exist? Not only does it not exist, but it can cost a lot (up to $40k) to purchase the nonexistent. Of course, the alarmist wolves are quite willing to negotiate a price that fits the pocketbook of any mental healthcare provider or agency. But then again, why wouldn't they? They're getting something for nothing and that's a sweet deal that any wolf could sink its teeth in.

Like all ages, we have a world filled with problems, solutions, alarmists, and realists. Realists can see the problem and understands the steps needed to calmly obtain the solution to the problem. The steps needed to protect the privacy and security of your clients has been detailed in HIPAA. Nowhere in the document does it say that certification is a satisfactory or necessary step in becoming HIPAA compliant. What HIPAA does say is that ensuring the privacy and security of your clients is an ongoing process. In other words, HIPAA compliance is not a one-time event, but instead, a process that requires continual monitoring. What is needed for HIPAA compliance is knowledge, expertise, and an ongoing mechanism to monitor the state of HIPAA compliance.

MyOutcomes is a company for the ages. Not only is it the pacesetter for companies offering technologically sophisticated tools and support to therapists who have evidence-based, feedback-informed therapies, but MyOutcomes is at the forefront of those companies that are HIPAA compliant. Providing knowledge and expertise needed to become and remain HIPAA compliant, MyOutcomes' Director of Security is a Certified HIPAA Professional (CHP). To continually monitor the state of compliance, MyOutcomes is licensing Compliance Helper. Compliance Helper is a powerful tool that helps a company keep its policies, procedures, and other documents up-to-date. To provide real evidence to customers that MyOutcomes is HIPAA compliant, Compliance Helper provides four meters to be placed on the MyOutcomes website. These meters will allow customers to see at a glance how compliant MyOutcomes is with its procedures, policies, forms, and regularly scheduled tasks.

In an age filled with so much uncertainty, MyOutcomes' existing customers and potential customers can be certain of two things that set MyOutcomes apart from many other companies. First, the security and privacy of your clients' personal information is as important to us as it is to you. Second, MyOutcomes will do everything that is needed to ensure that the security and privacy of that personal information remains secure and private.


Conducting PCOMS guided Recovery Groups- Closing the Resource Gap in Psychotherapy

myoutcomes feedback informed, PCOMS Guided Recovery Groups

Conducting PCOMS guided Recovery Groups model is built on three key concepts: recovery, group therapy, and CDOI therapy.

At whichever level of community one wishes to consider, there is a growing demand for mental health services that isn't being matched by an equivalent accessibility to mental health services. This disparity between the need for services and the ability to obtain services is related to two core factors. First, there is the economics of the situation. Although it's beginning to change, historically there hasn't been the same degree of financial support offered to those needing mental health care as there has been for those seeking services providing physical health care. Unfortunately, this change is occurring at a time when health dollars are being stretched in every direction. Second, there aren't enough mental health providers available to meet the demand. Although the situation is far worse in developing countries, estimates suggest that developed countries are able to provide mental health care to only about 50% of those who need it.

Although this state of affairs isn't exactly peachy, it isn't dire either. To counter the issue of finite resources available for mental health care, what is needed are innovative models that bring treatment to more of those who need it, while, at the same time, increasing success rates in a more reasonable time period. By achieving those two goals, it may be possible to close the resource gap and provide more affordable treatment to more of those who need it. Training in one innovative model that holds tremendous promise, Conducting PCOMS Guided Recovery Groups: Counselor or Peer Facilitators, has been developed by George S. Braucht. This model is built on three key concepts: recovery, group therapy, and client-directed, outcome-informed (CDOI) therapy.

Recovery, as defined by SAMHSA, is a process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential. Recovery is an evidence-based treatment orientation that, rather than focusing on “curing”, focuses instead, on life functioning. In other words, to achieve positive outcomes, treatment builds upon the resources, skills and strengths of the individual. Ultimately, recovery-oriented treatment shifts the emphasis from finding the “cause” to assisting the client to achieve the life goals they desire. Given the complexity of human behavior, finding causes can be exceedingly difficult and time consuming. Furthermore, although psychotherapy has been traditionally built on the premise of catharsis, or the notion that discovering and confronting the underlying problem will lead to a release of dysfunctional psychic tension, discovering causes doesn't result in perfectly functioning human beings. Recovery is still necessary. Recovery-oriented therapy makes recovery the central goal of treatment.

Group therapy, of course, is a strategy to bring treatment to more people in a more cost-effective way. Group has two other advantages. First, it doesn't need to be led by a trained professional. With the therapist assuming a more supervisory role and enabling peer facilitated group or in the complete absence of available trained professionals, the issue of insufficient therapists to meet the growing mental health care demands can be more directly addressed. The other advantage of group treatment is that it allows the building of community which is one of the major components that supports recovery.

CDOI therapy emphasizes the client's expressed needs and the client's perceptions of the therapeutic process. Research demonstrates that shifting the orientation of the treatment approach to the client's goals and perceptions, successful outcomes are more readily achieved in a shorter period of time. The Partner's for Change Outcome Management (PCOMS) brings the client's own voice into therapy. Listed on SAMHSA's National Registry of Evidence-based Programs and Practices, MyOutcomes is the web-based tool for administering PCOMS. MyOutcomes has repeatedly demonstrated, in a wide range of clinical contexts, to be a valuable tool for helping clients achieve their therapeutic goals.

Just as MyOutcomes has played a critical role in traditional one-on-one, talk therapy relationships, it is now proving to be a valuable tool in managing group therapy sessions. With the advent of MyOutcomes Mobile it is possible for each group member to register their Outcome Rating Scale (ORS) and Group Session Rating Scale (GSRS) responses directly into their own smart phone or tablet, providing the group facilitator with at a glance status updates for all group members.

For therapists, who wish to bring treatment to more of those who need it, while, at the same time, increasing success rates, PCOMS-guided recovery groups is an promising step to take in closing the resource gap in Psychotherapy.

For more information on our state of the art web-based tool, please contact MyOutcomes on Toll Free: 1-877-763-4775


The Old Guard in the 21st Century

outcomes system software

“For therapists who wish to help their clients achieve practical outcomes in therapy, MyOutcomes is the perfect partner to help insure their success”

For the last 30 years or so, a move to engage clients in therapy as participants in the therapeutic process rather than simply being recipients of therapy has been in progress. The argument has been that successful engagement of clients is critical to obtaining more successful therapeutic outcomes. During the latter half of those 30 years, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), have been playing a key role in this move towards more effective psychotherapy in the 21st Century.

As with any new approach, the Old Guard has put their efforts into conserving their traditional approach to psychotherapy, which doesn't include soliciting feedback from their clients. Sometimes resistance to change is coupled with philosophies like, “If it ain't broke, don't fix it.” Of course, such notions are only meaningful if what already exists works perfectly. Anything less than 100% can always be improved upon. It has been well-established that psychotherapy is effective. It has, however, also been well-established that it is far from being 100% effective. Feedback Informed Treatment holds the promise to close that gap.

With or without the Old Guard, the fields of science and healthcare tend to be conservative. This means that we want evidence that something not only works but that it works more effectively than what already exists. If a new treatment doesn't have less unwanted side effects, reduce treatment failures/dropouts, or achieve successful outcomes more quickly than what already exists, why would anyone change their treatment approach?

Recently, Scott Miller and Eeuwe Schuckard produced a slide presentation reviewing a decade and a half of research testing that the idea that monitoring outcomes and soliciting feedback from clients can result in greater therapeutic success for therapists. An ever-growing body of research investigating the efficacy of the ORS and the SRS in various population groups was also presented.

What the research demonstrates is that clients, whose therapists continually monitor and solicit client feedback, are more likely to achieve their therapeutic goals in less time and are less likely to dropout or deteriorate. As for the ORS and SRS, the data continues to show that, despite their elegant yet simple conceptual construction and ease of use, they are highly reliable and highly valid instruments that provide clients a clear voice in their therapy. Furthermore, the research continues to expand the generalizability of the ORS and SRS to wide range of clinical populations.

Of course, customers of MyOutcomes already know this. By providing web-based ORS software and SRS software, MyOutcomes enables psychotherapists to obtain nearly instant feedback that facilitates collaborative therapy. For therapists who wish to help their clients achieve practical outcomes, MyOutcomes is the perfect partner to help insure their success.

This is all great news for the field of mental health. By introducing two easy-to-use measures, clients have a greater chance for successful outcomes, therapists have a greater chance of helping their clients achieve that success, and there is a greater likelihood that we will someday achieve good mental health for all. The only remaining question is: Is the Old Guard willing to join this 21st Century success?


The Abstract Mind Written in Concrete

myoutcomes feedback informed therapy, concrete measurements in psychotherapy

Changes in the mind are possible to quantify and there are concrete measurements in psychotherapy to bolster this!

René Descartes, often referred to as the Father of Modern Philosophy, created a model whereby behaviour could be investigated and described. His two main elements were the “body” and the “mind.” The body is essentially a machine that is responsible for involuntary behaviour and creating “sense impressions” of the world. The body is what we hold in common with other living animals and, therefore, like other animals, it is reducible and corruptible. The mind, on the other hand, is not reducible nor was it corruptible. To Descartes, the mind was the human soul that was responsible for voluntary behaviour and for receiving sense impressions from the body. As many people know, Descartes' mind-body dualism was interactive. As there is only one such structure in the brain, Descartes selected the pineal gland as the place for this interaction. The mind receives information about the world from the body and it sends commands for voluntary movement to the body via the pineal gland.

Various scientific fields, e.g. human anatomy, comparative anatomy and comparative psychology, have much to owe to Descartes. Many medical breakthroughs could not have occurred if it weren't for the Cartesian assumptions underlying these fields. There have also been less than welcome aspects to Descartes' model. To Descartes, the mind wasn't made up of matter like the body was. It couldn't decay. It couldn't be reduced. It was eternal. As such, it couldn't be measured or understood by the same means as the physical universe. To this day, there are those who believe that the mind can't be measured because it is somehow transcendent over the physical world.

Not that there haven't been those willing to challenge this idea. Since Julien de la Mettrie declared that it was quite reasonable to assume that the mind was a phenomenon derived from the matter of the brain, numerous scientists and philosophers have expressed a similar viewpoint through the centuries. Nonetheless, for some, the arguments of these scientists and philosophers have proven to be no more effective than those of an Atheist trying to convince a church full of fundamentalists that there is no God. There are those who refuse to consider that the mind, rather than transcending the physical brain, is simply a property of the physical brain.

During the first part of the twentieth century, this notion that the mind can't be measured was further extended by John B. Watson and B.F. Skinner. The argument of Radical Behaviourism was that the mind wasn't subject to the tenants of positivism. As such, it couldn't be measured. The mind, accordingly, wasn't a proper subject for scientific study.

Behaviourism dominated American psychology for nearly a half century. One of its most important contributions was that it forced those, who believed that the mind could be measured, to prove it. As a result, tools were developed that even the most hardcore sceptic came to agree could measure changes in psychological states or the mind; changes, that couldn't be directly observed or measured.

So the quantification of the mind would seem to be possible after all.

Still there are those who believe that the mind is too ephemeral, too abstract, to be measured or explained in concrete terms.  The irony is that many of those who hold this view typically find themselves as practitioners of psychotherapy; a field that begins and ends with a belief in change.  One question that needs to be answered is how can you change something you can't measure? The answer is, of course, that you can't. Another question is how can you determine if you have changed something if you can't measure it? Once again the answer is that you can't. The problem with the idea that the mind is an abstract construct that can't be measured is that it undermines the entire foundation of psychotherapy. Psychotherapy isn't possible if you can't “see” what you are doing.

The fact is that psychotherapists do believe that change is possible and that changes in the mind are possible to quantify. Whether they want to admit to it or not, psychotherapists are continually using concrete forms of measurements when assessing their clients. When they note a change in the frequency of their client leaving their home, or an increase in work or school productivity, or a reduction in the out-of-control conflicts with their significant other, they are using concrete changes in behaviour as a measure of changes in the psychological state of their client. The only problem is that these measures are not necessarily in and of themselves valid or reliable.

Numerous studies have demonstrated the validity and reliability of MyOutcomes, the web-based application of the Partners for Change Outcome Management System (PCOMS). Still, there are individuals who question the ability of tools, like the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), to measure the mind. Their argument is framed in the belief that the mind is abstract while measurement is concrete and never the twain shall meet.

What these individuals likely object to, is the use of the number produced from the ORS sliding scale to indicate the subjective experience of distress.

Using sliding scales to measure subjective psychological states has a long and accepted history in psychology. For example, research investigating anxiety as a motivational factor for alcohol consumption will use a sliding scale that the subject adjusts to indicate their subjective experience of anxiety.

The ORS and the SRS are only continuing this long tradition. The ORS measures how much distress the client feels they are experiencing and whether that level of distress is increasing or declining. The SRS measures how strong the client feels their relationship with their therapist is. Psychological states such as distress and relational states such as the therapeutic alliance can't be measured or observed directly. However, the values that the client gives to their own internal psychological states, provides the therapist insight into what the client is experiencing. And for the therapist who wants to help their client to successfully achieve their therapeutic goals, this insight will prove to have very concrete value.

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