Lately I’ve taken a deep dive into all the reasons why mental health professionals resist using PROMs.
There is a surprisingly large body of research on this topic, but I doubt you’ll go looking for it 🙂
And so you’re in luck—I’m going to explain why you may be sceptical about the benefits of PROMs, how that’s understandable, but also why I think you’re wrong.
PROMs..
…Take too much effort and time to use
That’s 100% true.
If
…you employ paper-and-pencil administration or practice management software (which only captures raw responses), hand-score the results yourself and monitor change, manually keep track of who is due for follow-up assessments—and then use an Excel spreadsheet to aggregate your treatment outcomes every few months.
Don’t do that.
Use Measurely instead—which handles all of this for you, and much, much more.
…Are intrusive to the therapy experience and will annoy my clients
Sure, this can be true. If you eat into their therapy time by insisting that they complete PROMs at the end of a session, then I don’t doubt it.
Many people also find it jarring that a human being (i.e. the therapist)—would hand them a piece of paper with questions that they could easily have asked themselves. In other words, clients typically don’t understand the concept of psychometric assessment—the idea that you need to measure things in a standardised way, at the expense of contextual detail.
You can try explaining it to them if you’d like. Or, you can automate the process so that it occurs outside of therapy, is paper-free, and provides ample opportunity for the client to contextualise the results with updates about what is happening in their lives. Most clients are accustomed to idea that clinics collect form data. Make it pain-free and unobtrusive for them, and then you won’t have a problem.
…Are therapeutically useless
It’s true that aggregate PROM scores don’t provide a lot of nuance for therapeutic intervention.
But the individual item responses certainly do. Measurely makes sure you can view your client’s response to each question of an assessment—which can be used to start a conversation and inform the direction of therapy.
Also, I would argue that aggregate scores—which highlight symptom severity—are important from a therapeutic standpoint. A provisional diagnosis like ADHD can be made based on whether an aggregate score has reached a certain cutoff—based on significant prior research. Knowing whether symptoms are severe enough to meet a diagnostic threshold should certainly influence the interventions we employ.
…Can be used by management to interfere with my practice
If this is true then collect your own outcomes—outside of whatever approach management is suggesting for the collection of PROMs.
Or leave the workplace. No manager should be telling you how to interact clinically with your clients.
…Will reveal that I’m not really helping my clients
Now we’re getting to the heart of the matter…
It’s one of the main reasons for practitioners choosing to avoid PROMs and monitor treatment outcomes.
So you aren’t alone.
But let’s get serious. Even if treatment outcomes reveal that most clients aren’t improving symptomatically, this does not mean there is something wrong with you—or that you are ineffective as a therapist.
Even if treatment outcomes reveal that most clients aren’t improving symptomatically, this does not mean there is something wrong with you—or that you are ineffective as a therapist.
Let me say that again: there is nothing wrong with you.
At most, you may need more practice using certain skills or approaches that you are seeking to incorporate into therapy.
Who could honestly say that this last point isn’t true for them? I know it is for me.
But also—people can derive benefit from therapy even without symptom reduction. For example, someone with chronic pain may report unchanging levels of pain intensity—but have a completely transformed relationship to pain as a result of your therapeutic interventions.
If mindfulness is a focus of treatment, we’d expect a change in the orientation to pain, rather than an alteration in pain intensity itself.
The takeaway here is this:
Ignorance is most assuredly not bliss.
If you don’t know where you currently stand—how can you get anywhere else?
…Will lead to judgement by colleagues
If a colleague chooses to judge you because of your treatment outcomes, then they are the one with the problem—not you.
Remember, pride goeth before a fall.
Therapists who are inflated about their treatment outcomes, will soon be deflated.
So better to burst your own bubble now and start getting real.
You can model humility to your colleagues—and ultimately facilitate a shift in culture.
From concealment and defensiveness, to transparency and humanism.
Because when you take off your armour, it encourages others to do the same.
