Effective Therapy

Therapy has helped quite a number of people. As mentioned on my homepage, when therapists measure, then there is a sharp increase in the effectiveness of therapy.  However, an award winning research study found that only 3% of Canadian psychologists measure outcomes and alliance in therapy.  In the vast majority of psychotherapy, the therapist verbally asks how the client is doing, rather than measuring.

I have been collecting data since 2008, on all of my clients.  This is over 1000 clients.  The average client in my practice enters therapy with a score of 16.2 on a 40 point scale of psychological distress (the Outcome Rating Scale).   On average, they improve 12.4 points, to a score of 28.6.   A score of 25 is the clinical cutoff on the ORS, and scores above 25 indicate the person is not reporting psychological distress.(1)  On average, this happens within 5 sessions.  Of course, there is variation.  Some clients have far more improvement, others less. (2)

In the largest randomized clinical trial ever done in marriage therapy, the researchers had each therapist treat half their clients the usual way, which is to ask how they were doing.  For the other half of the clients, the therapists handed out the same scales I use in my work with clients.  The results were dramatic.  At the end of therapy, only 10% of couples in the verbal inquiry condition said that both of them were happy.  However, 40% of couples in the objective feedback condition said that both of them were happy at the end of therapy.  Of course, the real test is whether the couple stayed together or not.  If the couple were able to give objective feedback to the therapist, they had half the separation rate of the couples who did not give objective feedback, 6 months after therapy ended. (See references below).

Similar results were found in another study, where half the couples responded to the scales to give objective feedback and the other half were treated with verbal inquiry.  3 times as many couples in the feedback condition had clinically significant improvement by the end of the study, compared to the couples where the therapist asked how things were going.

So, depending on how you look at the data, when a therapist hands out the scales, the effectiveness of couples therapy is doubled, tripled, or even quadrupled.  The good news is that I use the same process of measurement that has been shown to markedly increase the chances of you being happy as a couple, and staying together.


If you are interested, you can call the Core Center of Health in Kelowna to book an appointment at 250-862-2673, or email me at info@drkuelker.com




Ionita, G. & Fitzpatrick, M. (2014) Bringing Science to Clinical Practice A Canadian Survey of Psychological Practice and Usage of Progress Monitoring Measures. Canadian Psychology, 55(3):187-196

Anker, Duncan, & Sparks (2008) Using Client Feedback to Improve Couple Therapy Outcomes: A Randomized Clinical Trial in a Naturalistic Setting, Journal of Consulting and Clinical Psychology, 77, 693-704.

Reese, RJ, Norsworthy, LA., Toland, MD., Slone, NC. (2010). Effect of client feedback on couple psychotherapy outcomes. Psychotherapy: Theory, Research, Practice and Training. 47. 616-630.


1  It is possible that the responses of clients to the scales are shaped by a desire to please me, rather than representing true recovery.  However, studies by Dr. Reese at the University of Kentucky show no meaningful amount of response bias on the scales.

2. It is theoretically possible that the improvement in my clients is due to spontaneous recovery.  However, many other studies of spontaneous recovery show that the rate of recovery is roughly 1 or 2 points on the ORS, rather than 12.4