How to Know If Therapy Is Working—Before It Isn’t

Let me get straight to it. As therapists, we want to believe we’re making a difference. We want to believe that our clients are improving—and that we’ll know it if they’re not. But here’s the inconvenient truth: we’re not as good at spotting poor outcomes as we think we are.

In fact, research shows we tend to overestimate our effectiveness and miss the signs that clients are quietly drifting away or silently struggling. Too many drop out before the work is done. Too many leave without benefit. And too often, we don’t find out until it’s too late.

That’s why I developed the Partners for Change Outcome Management System (PCOMS). Not because I wanted more data. But because I wanted more connection. More client voice. More transparency. More real collaboration.

And the good news? It works.

The Evidence Is In

In our recent article, The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice, Jacqueline Sparks and I lay out the case for PCOMS as a “both/and” solution. It honors the relational soul of therapy while providing a scientifically credible way to track outcomes and prevent failure.

A few highlights from the research:

• PCOMS improves client outcomes across individual, couple, family, and group therapy.
• It helps identify clients not making progress early—when we can still do something about it.
• It’s brief, easy to use, and designed for real-world practice—not just research labs.

But enough about us. Let’s talk about you—and how you can use this in your practice today.

How to Use PCOMS Without Losing the Heart of Therapy

Here’s the beauty of PCOMS: it’s not “just another form.” It’s a living, breathing conversation starter. It’s a way to put your client in the driver’s seat—and still guide the car. Here’s how you can bring it into your sessions—starting this week.

1. Start Every Session with the ORS

The Outcome Rating Scale (ORS) is a four-item, visual analog scale your client fills out in under a minute. It captures how they’re doing in their personal life, relationships, social world, and overall.

What you do:

• In the first session, briefly explain that you are using the ORS to ensure their voice remains central and that therapy is beneficial;
• Then, hand them the form (or tablet) and say: “Take a minute to show me how you are doing in these major areas of life
• After they fill it out, ask: “Tell me about the lowest score—what’s happening here?”

That’s it. No psychobabble. No checklist of symptoms. Just an open door into their world.

2. End Every Session with the SRS

The Session Rating Scale (SRS) is just as simple—four items to gauge how they felt about the session: the relationship, focus, approach, and overall experience.

What you do:

• As you close the session, say: “Before we wrap, how was this for you?”
• If scores are low—or even if they’re not—ask: “What could we do differently next time to make this more useful for you?”

Here’s the magic: your clients learn that it’s safe to tell the truth. And you get real-time feedback to make therapy more responsive.

3. Look at the Data—Together

Whether you’re using paper or Better Outcomes Now (BON) the key is sharing the scores with your client.

Plot their progress. Give clients credit for change. Watch the trends. And when things aren’t moving?

Say it out loud:

“We’ve had a few sessions now and your scores haven’t really changed. What are your thoughts? Do we need to shift direction, try something different, or talk about what’s not working?”

These “checkpoint” and “last chance” conversations are where change is born.

4. Use It with Couples and Families

Here’s where it gets even better. PCOMS isn’t just for individuals—it’s built for systems.

When working with couples or families:

• Each person fills out their own ORS and SRS
• Use the scores to spark dialogue about divergent experiences

You’d be amazed what opens up when a mother’s low CORS score contrasts with her son’s high one—or when a couple sees their alliance scores side by side.

The tools give everyone in the room a voice. And for many families, that alone is transformative.

Why This Matters for You (Yes, You)

If you’ve ever had a client disappear without warning…
If you’ve ever wondered if you were truly helping…
If you’ve ever wished for a clearer way to navigate therapy…

PCOMS is your answer.

It doesn’t replace your clinical intuition—it sharpens it.

It doesn’t kill the relationship—it deepens it.

And it doesn’t take over therapy—it opens therapy up.

Ready to Start?

• Here’s how:
• Download free copies of the PCOMS measures, ORS and SRS
• Or enjoy the BON convenience of tablet administration and automatic graphing and analysis.
• Try it with just one client this week
• Invite honest conversations about progress and process
• Let the client lead—and join them there

You don’t need a new credential or to add yet another model or technique to your repetoire. You just need a pencil (or a tablet) and an open heart. Let’s bring outcomes and relationships together. Let’s make therapy better—one client, one conversation at a time.

Because our clients deserve it. And so do we.