This is a "legacy" website.
Think of it as a time capsule,
unchanged since 2010.
For more info, please see
The Colorado Center for Clinical Excellence

This is an unusual web page for a psychologist.
I am proud to be part of a leading edge in psychotherapy research and practice that has brought scientifically valid and humanistic methods for tracking therapy effectiveness into the real world where clients can benefit. Below, you will see some graphs showing my effectiveness as a therapist compared to research about the average therapist's effectiveness.

Recent developments in therapy research have provided a practical method for gauging effectiveness. The reasons people seek therapy are often complex, so a standard way of assessing effectiveness in a real-world clinical practice is through clients' estimates of their subjective distress or well-being over time. Studies have consistently shown that measuring this over time can help clients receive better treatment and achieve more change.

The method I use to track effectiveness (called “client-directed, outcome-informed” therapy) is based on what makes therapy most effective, and has been designated a Best Practice in the State of Arizona, and in a growing number of agencies worldwide.

If you are a psychotherapist and are interested in learning how to increase the value of your services and to demonstrate that value ethically, please contact me for more information or check the bibliography and weblink at the bottom of this page.

Effectiveness graphs

Why do I measure my effectiveness?

Why don’t other therapists measure effectiveness?

How does measuring effectiveness help you as a client?

Effectiveness statistics for Jason A. Seidel, Psy.D. P.C.

Bibliography of psychotherapy effectiveness research

Percent of Clients Who Are Clinically
Improved by End of Therapy

Effect Size of Treatment
(Difference in Distress between Beginning and End of Therapy)
*Hansen et al., 2002; **Asay et al., 2002; ***Barkham et al., 2001;
****Hawkins et al., 2004
*Top 25% of therapists, Brown et al., 2005;
**Harmon et al., 2007; ***Miller et al., 2003; ****Hawkins et al., 2004

Why do I measure my effectiveness?
If I ask you for simple feedback about how therapy is going and how you feel, I will be more effective in helping you get the change you want. Research strongly supports this. Some therapists are now being trained in "evidence-based treatments" whose effectiveness is based on the performance of a few highly partisan, highly trained therapists in strictly controlled studies. There is so much variability in quality among therapists that the results of such studies tell us nothing about how effective a therapist is who happens to train in one of these methods. Direct evidence of an individual therapist's actual outcomes is much more valid and meaningful to potential clients. Also, by providing referrers (such as physicians) with data about my overall effectiveness, I can be accountable to them without compromising my clients’ privacy.

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Why don’t other therapists measure effectiveness?
Only 3% of independent psychotherapists collect any kind of effectiveness (“outcome”) data. Extremely few therapists in private practice (perhaps 1 in 10,000) systematically track the outcome of treatment with valid measures.
Why is this?

  • New technology. Effective therapy doesn’t require any technology, but quickly identifying ineffective therapy does. A recently developed method of tracking effectiveness (which I use in my practice) is called the PCOMS, and it takes us only about 2 minutes to complete in the session. Clients usually find it very helpful to see their changes over time, and I can know much more quickly if there’s a problem in how the therapy is progressing for you. Despite a lot of clear research in this area, many therapists are unaware of it, and it is not yet taught in most training programs.

    • Fear of being judged as ineffective. While most therapists are effective (significantly better than no treatment), there is a lot of variation between therapists in how effective they are. It is in a client or referrer’s interest to know this, but many therapists decline to find out where they fall on the “bell curve” of effectiveness.

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    How does measuring effectiveness help you as a client?
    Everyone is unique. Labeling you with diagnoses or scores on tests can’t fully capture how you feel or who you are. Yet, as long as a measurement of change is valid (actually measures what it claims to measure), and is used sensibly and with respect for your individuality, it can help us have a clearer sense of whether therapy is going in the right direction. In fact, some research shows that giving this kind of simple feedback to me (about how well the sessions are going, and how you are feeling in your life from session to session) can be enormously helpful in making therapy more effective.

    The Outcome Rating Scale (“ORS”; Miller et al., 2003) is one of very few measures for clinical practice that is very brief, easy to use, validated with a “gold standard” (the OQ-45), and reflects your point-of-view about things. You, the client, are the most accurate judge of how things are going in your life and in therapy. The ORS is a “guardrail” to keep us on track and alert us to ineffective therapy and a lack of change.

    It is a huge step in a new direction for psychotherapy to be accountable to clients and referrers (and without sacrificing our clients’ privacy or labeling them through unreliable and harmful diagnoses). More than a measure of “satisfaction” with therapy, the ORS is a measure of real change outside of therapy.

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    Effectiveness Statistics for Jason A. Seidel, Psy.D. P.C.
    Since I began measuring outcomes in my practice over five years ago, my clients have experienced significantly more change (about 2x more, based on Effect Size) than they would in typical psychotherapy or with medication—including the type of treatment they would receive in a well-controlled clinical study.

    My 5-Year Accountability Report is a technical blueprint for therapy effectiveness. It concisely displays several well-established indicators of therapist outcomes. It shows my results since I began tracking my clients well-being since June 2004. I have aimed to fulfill the following core principles for presenting effectiveness data:

    • Using widely accepted statistics that are relatively easy to understand and that make cross-therapist comparisons possible.
    • Reporting specific numeric values, sources of bias, and methodologies that increase transparency at a level of rigor that matches peer-reviewed research.
    • Adhering to ethical standards by attending to statistical power, data stability, confidentiality, and appropriate comparison groups.
    • Minimizing sources of bias and increasing validity by accounting for missing or excluded data.

      My data indicate a robust and stable record of helping people change and improve their lives. My clients report a much better outcome than in typical therapy and that matches what clients have told me about the kind of help they received from me in contrast to previous therapists. All therapists think they are better than average. But I encourage all psychotherapists to partner with their clients to actually measure and improve the service they provide. The extra effort is worth it!

      Some of my other results from 2004-2009:

    • About 78% of my clients show a reliable clinical change by the end of therapy. (Jacobson & Truax criterion c method, RCI=5) Studies of therapy effectiveness show that most therapists help 20-70% of their clients achieve reliable change, with some therapists showing that their average client worsens in their care! Most medication studies show that about 50-65% of clients receive a clinical benefit.

    • Researchers use a formula (called a case-mix adjustment) to establish the "average" amount of relief that clients are likely to experience from therapy, based on how distressed they feel when they start therapy. By definition (among all therapists), 50% of clients will feel more (and 50% will feel less) than this expected amount of change. In contrast, about 81% of my clients experience more than the expected amount of change by the end of therapy.

    • My average client who started therapy as clinically distressed is better off at the end of therapy than about 98% of these clients at the start of therapy. Studies of therapy effectiveness show that the average therapist with clinically distressed clients has a percentage of 65-80%.

    • My clients who have experienced a reliable positive change in well-being stay in therapy with me for an average of 16 sessions (median = 11).

    • The majority of these clients experience a reliable change within the first 4 sessions.

    • Clients who do not experience reliable positive change in therapy with me stay for an average of 10 sessions (median = 4). Contrast that with the common situation in which clients get “stuck” in therapy for many months or years, without any change, and without any indication they should fire their therapist. There are situations in which several years of therapy may be very helpful. However, it is good to have clear feedback early on about whether therapy is actually helping!

    • Compared with the average cost, duration, effectiveness, and side effects of medications for clinically distressed clients, psychotherapy can be demonstrably cheaper, faster-acting, more effective in the long term, and with no troubling side effects!

    • Please note that no one can predict the duration or outcome of any one person's therapy experience based on the statistics of a whole group, and simple outcome scores cannot possibly do justice to the richness and complexities of life. Yet data such as these can inform your decision about starting or continuing your course of treatment.

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    A brief bibliography on psychotherapy effectiveness and outcome research
    Asay, T.P., Lambert, M.J., Gregersen, A.T., & Goates, M.K. (2002). Using patient-focused research in evaluating treatment outcome in private practice. Journal of Clinical Psychology, 58(10), 1213-1225.
    Anker, M.G., Duncan, B.L., & Sparks, J.A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693-704.
    Barkham, M., Margison, F., Leach, C., Lucock, M., Mellor-Clark, J., Evans, C., Benson, L., Connell, J., & Audin, K. (2001). Service profiling and outcomes benchmarking using the CORE-OM: Toward practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology, 69(2), 184-196.
    Brown, G.S., Lambert, M.J., Jones, E.R., & Minami, T. (2005). Identifying highly effective psychotherapists in a managed care environment. American Journal of Managed Care, 11(8), 513-520.
    Duncan, B.L., Miller, S.D., & Sparks, J.A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy. San Francisco: Jossey-Bass.
    Gawande, A. (2004, December 6). The bell curve: What happens when patients find out how good their doctors really are? The New Yorker Online. Available through
    Hansen, N.B., Lambert, M.J., & Forman, E.M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329-343.
    Harmon, S.C., Lambert, M.J., Smart, D.M., Hawkins, E., Nielsen, S.L., Slade, K., & Lutz, W. (2007). Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools. Psychotherapy Research, 17(4), 379-392.
    Hawkins, E.J., Lambert, M.J., Vermeersch, D.A., Slade, K.L., & Tuttle, K.C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14(3), 308-327.
    Hubble, M.A, Duncan, B.L. & Miller, S.D. (1999). The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association.
    Lambert, M.J. (2004). Bergin and Garfield’s handbook of psychotherapy and behavior change, 5th Ed. New York: Wiley.
    Miller, S.D., Duncan, B.L., Brown, J., Sparks, J.A., & Claud, D.A. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2(2), 91-100.
    Miller, S.D., Duncan, B.L., & Hubble, M.A. (2004). Beyond integration: The triumph of outcome over process in clinical practice. Psychotherapy in Australia, 10(2), 2-19.
    Wampold, B.E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, N.J.: Lawrence Erlbaum.

    Also, see The International Center for Clinical Excellence  for more information and resources.

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