A new meta-analysis published in The Lancet Psychiatry offers compelling evidence that what clients value most from psychotherapy often goes unmeasured by traditional outcome tools.
Led by Michaela Ladmanová of Masaryk University, the study analyzed data from 177 qualitative studies spanning eight decades and 24 countries. The findings show that clients report a range of meaningful benefits from therapy that extend far beyond a reduction in mental health symptoms.
The researchers consisted of a group of individuals from universities across Europe, led by Michaela Ladmanová of Masaryk University in the Czech Republic.
“The meta-analysis showed that clients value outcome dimensions beyond symptom reduction, such as deeper self-understanding, enhanced self-agency, and greater social engagement,” the authors write. “By examining psychotherapy outcomes across various diagnoses and therapeutic approaches, we highlight limitations in traditional outcome measures, showing the need for more comprehensive, client-centred assessment tools and the value of incorporating qualitative methods into understanding dimensions of change.”
All eight researchers involved in the study have also been psychotherapy clients themselves. Their approach aimed to better capture the nuanced, lived experiences of people in therapy—something that is often lost in standard clinical metrics.
The authors argue that symptom-focused assessments fail to reflect the complexity of what clients hope to achieve and actually experience in therapy. These outcomes, they suggest, require broader, qualitative tools that can account for personal growth, emotional processing, and changes in how people relate to themselves and others.
Rather than treating mental distress as a problem to be fixed through measurable symptom reduction, the findings highlight the importance of meaning, relationship, agency, and narrative in processes of healing. It points to a broader view of psychological life, understanding therapy as a space where people seek coherence, dignity, and transformation within the context of their lived realities. In doing so, the research invites us to reconsider what constitutes evidence, what counts as change, and whose experiences are considered legitimate in defining the aims of care.
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These outcome measurement tools exist. Clinicians generally don’t care to use them.
However, if goal of psychotherapy research is to demonstrate to health insurance companies and national health services of health outcomes of therapy, the ones mentioned in the article aren’t particularly convincing for securing payment.
Clinicians, you have to pick a lane. If you want psychotherapy to be treated like a healthcare intervention and be considered healthcare professionals, you need to conceptualize your work through a lens of psychopathology, symptoms, diagnoses, etc. we know that this just isn’t the case for people’s wellbeing. Mental illnesses are not illnesses in a meaningful sense.
If you want to use psychotherapy as a relational service to sell individuals a sense of greater meaning, agency, and engagement, then recognize that if you want to make a decent living that justifies your years of education, you are not doing healthcare. Likely you will only be working with already wealthy people who who can afford this excersie and you will not be helping anyone who is actually in a rough place.
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It is important to realize that a focus on “symptom reduction” was pushed by the APA in order to justify the medicalization of “mental health treatment” and specifically to justify the use of drugs to “treat” such “symptoms.” It is easy to underestimate how reframing mental/emotional distress as “symptoms” plays into the hands of the current “thought leaders” and pushers of a drug-based “treatment” paradigm. Focusing on other “outcomes,” particularly on learning from CLIENTS what they regard as positive results, is essential if we want to overcome the current destructive model of thinking about “mental health!”
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