Outcomes of Counseling and Psychotherapy

How Are Outcomes Evaluated?

Efficacy and effectiveness are two ways in which the outcomes of counseling and psychotherapy are discussed. Efficacy refers to the therapeutic benefits found in comparison of the treatment and a no-treatment control group within the context of a controlled clinical study. In contrast, effectiveness refers to the benefits of therapy that occur within a mental health practice context. In the former instance, the question is whether a treatment or intervention is found to achieve a greater benefit for clients than no treatment. If so, the treatment is said to be “efficacious.” In the latter instance, the question is one of how effective counseling is for those clients who seek and receive treatment within the community.

It is alleged that clinical studies create an artificial context in which the therapy that takes place is not characteristic of how treatments are provided in an actual community context. Consequently, finding that a treatment is efficacious cannot be assumed to mean that it is effective (i.e., is beneficial to clients in practice settings). Although there is merit in this criticism, effectiveness findings are generally compromised by the absence of a control group within a practice setting against which to compare client therapeutic gains. As a result, it may not be possible to convincingly determine whether the benefits derived by clients receiving counseling in community [Page 711]settings are due to the treatment or to some other extraneous factors.

Significance of Therapy Outcomes

In the consideration of counseling and psychotherapy outcomes, it is important to ask, “When is an outcome significant?” The significance of therapy outcomes can be evaluated in several ways. Outcomes can be evaluated in terms of their statistical significance, and they can be evaluated in terms of the clinical significance or clinical relevance.