Therapist-Client Agreement in Assessments of Clients' Functioning

Objective: We aimed to assess the extent to which therapists' reports of client functioning track their clients' changing experience of their own functioning from session to session (temporal congruence) as well as the extent to which they over-or underestimate their clients' functioning (level or directional bias) and to examine whether these indices predict treatment outcomes. Method: The participants included 384 clients who were treated by 77 therapists. Both clients and therapists rated the clients' functioning each session. The clients also completed pre-and posttreatment outcome measures. Results: Using multilevel modeling, we found that therapists' reports regarding their clients' functioning tended to be temporally congruent from session to session with their clients' reported functioning. In addition, on average, therapists did not show a level bias (i.e., did not over-or underestimate their clients' functioning). Finally, temporal congruence (but not level bias) predicted better treatment outcomes. Conclusion: These findings highlight the importance of tracking clients' fluctuating symptoms over time. Thus, we discuss their implication for the policy and practice of providing session-by-session feedback to therapists.