Expected Treatment Response (ETR) Overview

The ETR provides a benchmark for tracking client progress in therapy based on large normative datasets. It allows clinicians to compare an individual client’s progress against expected outcomes derived from hierarchical linear modeling (HLM) applied to extensive treatment data.

• How ETR is Generated:
  The ETR curves are derived from a normative sample, consisting of over 300,000 ORS administrations, using hierarchical linear modeling (HLM). This statistical approach plots average trajectories of change based on initial client functioning levels, enabling clinicians to see whether clients are progressing as expected.
  
  
• Purpose of ETR:
  The primary goal of ETR is to alert clinicians when a client is not making expected progress, thereby enabling timely intervention. Research by Wampold and Brown (2006) highlights that therapists often lack awareness of typical trajectories of client change, making tools like ETR essential for benchmarking outcomes.
  
  
• How ETR is Used Clinically:
  In clinical practice, ETR graphs plot the client's ORS scores over time against normative data:
  • Green Line: Represents the positive expected treatment response for a client based on their initial ORS score.
  • Red Line: Represents the boundary below which a negative outcome is indicated.
  • Black Line: The client's actual progress plotted session by session.

• Clinicians can use this visual feedback to:
  • Identify at-risk clients: If a client's score falls significantly below the ETR curve, it suggests a higher risk for dropout or poor treatment outcomes.
    
    
  • Make timely adjustments: Deviations from expected progress can prompt changes in treatment approach, additional support, or referrals to different services.
    
    

Statistical Foundations and Sample Size

• The clinical cutoff for the ORS was determined using Jacobson and Truax’s (1991) method, with a score of 25 distinguishing between clinical and non-clinical ranges.
  
  
• The ETR is based on a large normative sample of over 300,000 ORS administrations, ensuring high statistical validity in expected trajectories.
  
  

Benefits of Using ETR

• Evidence-Based Practice: ETR aligns with APA’s evidence-based practice principles by integrating client feedback and scientific data to tailor treatment.
  
  
• Early Identification of Treatment Failure: By tracking client progress against ETR, clinicians can detect non-responsive cases early and adjust interventions proactively.
  
  
• Enhanced Client Engagement: Visual feedback helps clients understand their progress, fostering transparency and collaboration in treatment.