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We asked you to tell us what proportions of your clients improve, stay the same, and deteriorate.  You told us, and we’ve compared your responses to those from a 2012 study which asked the same question, and to some established benchmarks. What do you think we found?

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Estimated reading time: 9 minutes

Why this survey, and why now?

We’re facing a range of challenges that are making the futures of therapists, especially those in private practice, increasingly challenging.

These include a flatlining economy, shrinking disposable incomes, increasing engagement with free AI-powered chatbots and ‘therapists’, the distortion of the therapy marketplace by mega-providers like BetterHelp, and the continuing flow of newly trained practitioners into the profession. Perhaps connected to these, enquiries appear to be dropping off for many of us.

Given this context, we need to be able offer prospective clients a compelling reason to invest their time and money in us, rather than somewhere else. I’m going to argue that one compelling reason is that we have hard evidence that what we do, as individual therapists, makes an impact.

In judging that impact we may rely on our felt sense, or perhaps testimonials, but relatively few of us seem to base those judgments on actual data.

In the 2012 study of self-assessment bias we’ve highlighted in recent blogs, Steven Walfish found that 58% of respondents believed that 80% or their clients improved. 21% of them believed that 90% or more of their clients improved. Nearly half (48%) believed that none of their clients showed deterioration.

The Therapy Meets Numbers survey 2025

This was the question asked in the 2012 study and that we asked of you in the last blog:

What percentage (0–100%) of your clients get better (i.e., experience significant symptom reduction) during treatment? What percentage stays the same? What percentage gets worse?

We also asked: a) How do you describe yourself professionally? b) How long have you been practicing as a therapist? c) What are your estimates of improvement, no change and deterioration based on?

The survey was posted in the last TMN blog, as well as Facebook and Linked In therapy forums, and X (formerly Twitter). Thirty-one of you were good enough to respond. We’d hoped for a larger number but to all of you that took the time – THANK YOU.

We’ve run the numbers and compared your responses to those given by respondents to the earlier study. There are differences between the two, some surprisingly big.

Below:

1. Our respondent profiles: professional title; length of practice experience, and what estimates of improvement, no change and deterioration are based on.
2. Their estimates, and how those compare with the 2012 survey.
3. Differences within respondent profiles. For example, do psychotherapists estimate higher levels of improvement than counsellors? Is there a difference between the estimates of those based on ‘felt sense’ as opposed to those drawing on actual outcome data?
4. How their estimates compare with sample benchmark data from published studies? 

Our 2025 respondent profile

How do you describe yourself professionally?

Those describing themselves as counsellors (15) were the largest professional grouping, with psychotherapists the next largest at 10. 

How long have you been practising therapeutically?

The forty-two percent (13) that indicated they’d been practising between 10 and 20 years formed the largest group. They  were followed by 10 indicating More than 20 years (32%) and 7 indicating between 6 – 10 years (23%).

What are your estimates of improvement, no change and deterioration based on?

Fifty-five percent (17 in all) indicated that their responses were based on their ‘felt sense’ that clients had improved. For some this may have included feedback from clients. Twenty-three percent (7) indicated that responses were based on data from use of outcome measures. One person was moved to suggest (twice) that these were the wrong questions. These entries have been removed from subsequent percentage calculations.

2012 and 2025: What’s different, and what stands out?

Overall, respondents to our current survey rated their improvement rates significantly lower than those in the 2012 study.

The average improvement rating for the earlier study was the 77.0%. In our study the average rating was just under six points lower at 71.1%. As you’ll see further on, however, the average for estimates based on data from outcome measures was 77.8%, a figure remarkably close to the 2012 study.

Whereas 21% of respondents in the 2012 study believed that 90% or more of their clients showed improvement, in our study that figure was only 7%. An even wider disparity was evident in the proportions believing that 80% or more of their clients improve (58% in the earlier study and 31% in ours).

Significantly fewer in our study believe that none of their clients deteriorate (35% compared with 48% in the earlier study. Later, we’ll show whether these proportions are different depending on whether respondents use outcomes measures or their felt sense as the basis of their estimates. 

Differences between group segments

Within each of our groups (professional title, length of practice experience, basis for estimating improvement rates) were there discernible differences between segments? Do psychotherapists estimate higher levels of improvement than counsellors, for example? Is there a difference between the estimates of those based on ‘felt sense’ compared with those drawing on actual outcome data?

Counsellors v Psychotherapists

Did one of these two professional groupings estimate their improvement rates to be higher than the other?

Here, although the sample size is small, there’s evidence of clear blue water between the estimates of those describing themselves as counsellors and psychotherapists. Nearly twelve percentage points separate the two. Whether those estimates bear any relationship to each group’s actual outcomes, we sadly don’t know.

Length of professional practice 

Were there differences in estimates related to respondents’ length of practice experience? Did those with greater experience estimate their improvement rates to be higher? 

Here, we see some marginal differences, with those having more than 20 years’ experience pitching their estimates slightly higher than the others. If this held true for a larger sample size, it might be at odds with the couple of studies which have shown that, on average, outcomes seem to deteriorate somewhat with experience.  

Estimations based on ‘felt sense’ or data from use of outcome measures? 

Were there differences between respondents who based their estimates on their felt sense (including feedback from clients), and those basing them on their use of outcome measures?

There was a difference. The average estimate of the proportion of clients improving for the 17 basing their estimates on felt sense was 71.5%. For the seven that based their estimate on data from the use of outcome measures was just over six percentage points higher at 77.8%.

Correspondingly, ‘felt sensers’ estimated their rates of No change and Deterioration as higher than those drawing on data from outcome measures.

Given the small sample size, we shouldn’t read too much into this difference, but I will suggest that basing estimates on data from measures is always likely to be the more accurate of the two.

How do estimates compare with published benchmarks for improvement?

Below we’ve compared the responses to the 2012 study and our own with two sets of published benchmarks from primary care and workplace counselling. Each draws on data from the CORE Outcome Measure (CORE-OM).

Admittedly, these benchmarks are a little dated, but good quality benchmarks such as these are, sadly, a little thin on the ground. Each, however, has been published in a peer-reviewed journal and comprises data drawn from several thousand client data sets.

What stands out from these comparisons is how marginal the differences are. The improvement estimate from our study for those using data from measures of 77.8% (albeit based on small numbers) is remarkably close to the figure from the CORE primary care practitioner figure (76.1%). Otherwise, there are only a few percentage points separating each.

How do we make sense of these data?

Firstly, let’s not try and read too much into them. Estimates which are not based on data are essentially guesswork. Also, different benchmarks exist, for example those from the annual NHS Talking Therapies programme. These consistently show rates of recovery (the criteria for which is essentially non-reliable improvement) running at a touch over 50%.

It’s interesting that the ‘felt sense’ estimates from our survey are somewhat more modest than those based on actual data and the estimates from the 2012 study. And maybe that’s the point. Maybe we are a little more modest, whether it’s from being a largely UK-based set of respondents, or from having absorbed a little more of the research since 2012.

Either way, you’ll know that within every average lies a range, and unless you’re using outcome measures in your work, you’re not going to know where you sit on that range. Are you, relatively speaking, at the higher end, the lower end, or around the middle? And where would you like to be?

My improvement rates over the past five years

Those of you who’ve responded to the past two surveys have been good enough to share your thoughts and your data with us, and now I’m going to do the same.

I’ve been collecting outcome data routinely for clients, using the same set of measures and the same platform (Pragmatic Tracker) for the past five years. In the next blog, I’ll be sharing that data with you.

Do stay tuned!

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