Case Examples

Real PM stories...


CelestHealth Solutions


"There is one particularly salient session that stands out from using the BHM-20. I had been working with a 23-year-old client who was a professional student enrolled in a first year in her Masters of Business Administration program. She had originally come into therapy to address issues with social anxiety. I had been seeing her approximately 10 sessions during the fall semester, throughout which her BHM-20 scores had indicated linear improvement; however, for this session her scores had abruptly declined from yellow/green to red. When the client walked into my office and I asked her how she was doing, she said—“pretty good!”—with enthusiasm. I indicated to her that I was surprised to hear that response and recounted some of items she had endorsed on the BHM-20. She regarded with me surprise and said, “I didn’t think you even looked at that stuff” and proceeded to talk to me about her notably difficult week. In psychotherapy research, it is important that we focus on the science of feedback. However, in this moment as a psychotherapist, all that seemed important to me was that I had been alerted to change in my client’s distress through a quick glance at a change in color. This allowed me to deepen the content of the session immediately, whereas it might have taken us some time to get into the client’s difficult week or perhaps she might not have brought it up at all."

To learn more about the BHM-20 and other measures offered by CelestHealth Solutions...


Kopta, M., Owen, J., & Budge, S. (2015). Measuring psychotherapy outcomes with the Behavioural Health Measure-20: Efficient and Comprehensive. Psychotherapy, 52(4), 442-448. 

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"A male therapist at a large university counseling center was treating a female college freshmen client in individual psychotherapy. The client’s initial presenting concern was anxiety and worries over her poor academic performance for which she received academic probation. Considering that the client’s father was a university faculty and the client’s lack of knowledge about university education, the therapist initially noted a possibly poor relationship between the client and her father. In working with the client’s anxiety and worries, the therapist noted the client’s naivete ́ in interpersonal relationships, including her rapid progression in her romantic relationship with an international student with whom she was engaged. As the work continued, the therapist noted his client’s overdependence on him for emotional support and kinds of support for which he felt the client’s mother should be providing, including decisions about her upcoming wedding plans.

As the client’s wedding neared, the client’s outcome worsened and was identified as a signal warning case on the OQ system. At that point the “red” signal and [a feedback message] along with the client’s progress graph were provided to the therapist.


The generation of the signal alarm activated the provision of CSTs intervention as described earlier. On the ASC, the client was identified a “red” signal case on social support. The ASC feedback intervention led him to realize the extent of the client’s family issues. He discovered that the client’s parents were disapproving of the client’s choice of mate and were unsupportive of their daughter’s upcoming wedding. The feedback in concert with other clinical data led the therapist to shift his treatment to actively intervening to help the client develop good relationships with her parents. The client’s overall outcome improved as reflected on the eventual improvement in her OQ scores."

To learn more about the oq measures...


Lambert, M. & Shimokawa, K. (2011). Collecting Client Feedback. Psychotherapy, 48(1), 72-79. 


"A demonstration of the use of [PM in] evaluating and repairing ruptures [in support groups for parents of children with Autism Spectrum Disorder], as well as leaders’ dialectical positions when attending to both group and individual processes, is illustrated in the following case description.

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Figure 1. Daniella’s changes in working alliance, compared with other group members. Feedback is presented as mean scores. WAI 􏰁= Working Alliance Inventory.

Figure 1. Daniella’s changes in working alliance, compared with other group members. Feedback is presented as mean scores. WAI 􏰁= Working Alliance Inventory.

Daniella used to work as a teacher in a school for disabled children, before receiving her son’s diagnosis. During group sessions, she tended to take on an authoritative role, without much consent on behalf of other members. This was further enhanced during Session 2, when parents started to discuss the question of boundaries in light of children’s behaviors. Feeling strongly that she knew what to do, Daniella communicated her “guidelines” to other parents, while providing instructions on how and what to do during tantrums. Noticing the negative attitude toward her observational and distant comments, as well as her assumption of a position that did not allow others to express their thoughts and emotions, one of the leaders decided to approach Daniella, remarking: “Maybe we should hear how others feel regarding this subject before we turn to solutions.” The leaders made a decision to interrupt Daniella who was giving advice in a detached manner because it was likely to inhibit group cohesion. This intervention led to a decrease in Daniella’s group alliance as seen in Figure 1. The group leaders were able to take note of her decreased alliance score and consider her needs during the next session. Therefore, in the next session the leaders actively encouraged her to express her knowledge, saying: “Maybe you have some ideas, seeing that you have experience with this topic?” Because the leader was able to see the drop in Daniella’s alliance score after the previous session, he actively attempted to repair the rupture at the next session by inviting her to share her thoughts and advice on another topic raised in the group. After this session, Daniella’s alliance score increased, indicating that she had “survived” the interruption within the group. This also highlights the benefit of having [PM] to guide leaders who may not be aware of how interventions negatively impact members."

Tzur Bitan, D., Zilcha-Mano, S., Ganor, O., Biran, L., & Block, Y. (2018). Routine measurement and feedback in support groups for parents of children with autistic spectrum disorder. Psychotherapy, 55(2), 191-195. 

Last updated: 3/06/2018