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What You Will Learn from This Article
- The principles and benefits of Measurement-Based Care (MBC)
- How MBC can be integrated into psychoanalytic-informed psychotherapy
- The importance of patient involvement in treatment evaluation
- Practical applications of MBC in clinical settings, including individual and system-based approaches
- Insights from real-world case studies demonstrating the value of Measurement-Based Care on evaluating patient outcomes
Introduction
I'm Steve Ackerman, a treatment team leader and psychoanalyst in the Austen Riggs Center Residential Treatment Program. And I'm Seth Pitman, Associate Director of the online Intensive Outpatient Program at Riggs. The two of us have developed Measurement-Based Care (MBC) programs in our respective areas at the Center that integrate measurement tools into psychoanalytic therapy, ensuring that patient voices remain central to the treatment process.
In this article we provide an overview of an online course we offered via the Erikson Institute of the Austen Riggs Center regarding how Measurement-Based Care can integrate systematic and routine assessments into treatment processes. While commonly utilized in cognitive-behavioral and medically driven therapeutic models, MBC has been underexplored in psychoanalytically informed care. In this piece, we explore how MBC can be effectively applied in psychoanalytic settings to understand treatment outcomes and therapeutic relationships, while shaping treatment interactions.
If this topic is of interest to you, check out the course in its entirety and receive free CE/CME from our online catalogue.
What is Measurement-Based Care?
MBC involves the systematic collection of data to track patient progress and refine treatment plans accordingly. Traditionally, data collection in medical settings has been retrospective, meaning it informs future care rather than benefiting the current patient. MBC, however, is designed to adapt treatment in real-time, allowing therapists and patients to make informed decisions together.
Key Benefits of MBC
- Enhances the therapeutic alliance by joining patients and treaters in a shared task
- Allows for early detection of alliance ruptures or negative therapeutic reactions
- Increases patient engagement by giving them a voice in their own treatment
- Helps therapists refine their approach through real-time feedback
- Improves clinical outcomes by identifying barriers to treatment success
Why Measurement-Based Care Matters in Psychoanalysis
While MBC has often been associated with structured, symptom-focused treatments, its principles can be successfully adapted to psychoanalytic frameworks. Psychoanalytic therapy emphasizes understanding the patient's unconscious dynamics, subjective experiences, and emotional patterns. When combined with MBC, clinicians can create a more tailored and responsive treatment approach.
How MBC Complements Psychoanalysis
1. Tracking Progress Beyond Symptom Reduction: Many therapy outcome measures focus primarily on symptom improvement. Psychoanalytic-informed MBC assesses symptom improvement and goes deeper, examining underlying conflicts, relational patterns, and self-perception changes.
2. Identifying Treatment Ruptures: Psychoanalytic therapy is relationship-driven, making it crucial to detect early signs of resistance or disengagement. MBC processes can reveal alliance shifts and highlight moments when a patient may struggle with deeper issues.
3. Encouraging Patient Reflection and Agency: Instead of merely collecting data, therapists can use the information to invite patients into discussions about their experiences, allowing them to take a more active role in their treatment.
4. Refining Therapist Development: MBC data informs therapists about their strengths and areas for growth, fostering professional development over time.
In the full online course, we present an in-depth case study to illustrate how a psychoanalytically informed approach to MBC can help clinicians highlight mismatches between patient’s self-reported symptoms and clinical presentation, uncover transference dynamics that might otherwise go unnoticed, and identify signs of deterioration that require a shift in therapeutic interventions.
Using MBC in Individual Practice
For therapists in private practice, implementing MBC does not require large-scale system integration. It can be as simple as introducing a few key assessments to enhance reflection and therapeutic dialogue.
Steps for Private Practitioners to Implement MBC
1. Choose a Small Set of Measures: Start with simple, widely validated tools that capture common symptoms like depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder-7; GAD-7), the patients’ experience of the therapeutic alliance (Working Alliance Inventory; WAI), or even more nuanced measures like psychic pain scale to capture suicide risk from multiple angles.
2. Integrate into Regular Sessions: Have patients complete measures periodically and discuss results collaboratively.
3. Monitor Therapist Effectiveness: Consider tracking your own experience of the working alliance by filling out the therapist version of the WAI or using countertransference measures, such as the Therapist Response Questionnaire (TRQ), to gather additional diagnostic information about your patients.
4. Use Data to Enhance, Not Replace, Discussion: The key is to bring results into sessions as a conversational tool rather than letting them dictate treatment.
5. Take a Long-Term Perspective: Collect and review data over months or years to assess patterns in both patient outcomes and your own clinical development.
Conclusion
Measurement-Based Care in psychotherapy examines treatment outcomes by integrating systematic data tracking, improving patient engagement, and refining therapist interventions. At the heart of this approach is the commitment to centering the patient’s experience.
By combining structured assessments with deep, relationally driven inquiry, therapists can:
- Identify overlooked patient struggles
- Strengthen therapeutic engagement
- Improve treatment outcomes
- Refine their own clinical skills
For therapists, MBC provides a structured approach to improving patient outcomes by incorporating common validated self-report measures along with tools that capture psychoanalytically relevant concepts such as psychic pain and countertransference. This evidence-based practice fosters better patient engagement, identifies hidden treatment barriers, and strengthens therapeutic alliances, ensuring that therapists remain responsive to both the evolving needs of their patients and their own professional growth – whether in large institutions or private practice.
MBC represents an invaluable tool for deepening psychotherapy’s impact.
We hope this article was both informative and helpful to you. The full online course is available for free online and you can earn continuing education credit after you view the presentation and successfully complete a short quiz derived from the content.
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