Working in private practice has changed my relationship with outcome measures in trauma therapy. When I worked in larger services, measures and scores were everywhere. These were expected, monitored, and required. Someone was always asking where they were, whether they had been completed, and whether they had been submitted.
How often do we get asked for the outcome measures in trauma therapy?
Now, nobody asks. It’s rare that anyone will say “where are the outcome measures in trauma therapy”. So something interesting has happened: I rarely use them.
Occasionally, if something is very clear-cut—perhaps a specific phobia, or someone presenting with clear depressive symptoms—I might use an anxiety or mood scale. But most of the time, I don’t. It’s not that I don’t value measurement; it’s that I’ve become more aware of both its usefulness and its limitations.
Are these outcome measures consistent and logical?
Looking back, I can see that the external pressure to complete measures was sometimes helpful. It prompted consistency and reflection. But there were also aspects that never sat comfortably with me. For example, many standard questionnaires ask about symptoms “over the last two weeks,” yet in some services clients are asked to complete them weekly. That inconsistency always felt awkward, even illogical. Perhaps that experience contributed to my ambivalence about scores.
Recently, I’ve been thinking about this again because of research studies. I’m currently involved in research where PTSD symptom scales are used—measures such as the Impact of Event Scale or the PCL-5. These are widely accepted tools. I understand their value. Measuring PTSD symptoms can be meaningful.
There is an important caveat.
In clinical practice, when asking a client to complete a trauma-specific measure—for example, in relation to a car accident—I know that many people don’t answer narrowly about that one event. They respond in a more generalised way, influenced by the whole of their life experience. Let’s face it, it is not easy—how many people have only one traumatic event in their lives? Very few.
This raises an important question. What is being measured?
Let’s assume that good research protocols address this carefully and ensure that measures are linked clearly to specific events. Even then, I sometimes find myself uneasy about how heavily we rely on scores as indicators of recovery.
But I find myself asking additional questions:
- Are they still avoiding certain situations?
- Is there still anxiety in daily functioning?
- Has life expanded, or only the memory softened?
- Is there still more therapeutic work to be done?
Do the outcome measures actually measure change?
Anyone who has worked in services such as IAPT knows another reality: sometimes clients make profound changes, achieve meaningful personal goals, and improve their functioning—yet their scores don’t shift very much. That doesn’t mean therapy has failed. It may simply mean that the measure was too broad, too blunt, or too limited to capture what truly changed.
Of course, the opposite can also happen. Scores improve, but important aspects of recovery remain incomplete.
How we work in EMDR therapy
This is where the three-pronged approach in EMDR becomes so important: past, present, and future.
Processing a memory is never just about reducing how distressing that event feels. We choose memories to process because they are linked to present triggers, present patterns, and future possibilities.
You can explore how this is taught here
Re-evaluation is not simply asking:
“How distressing was it then, and how distressing is it now?”
It is also asking:
- Has the memory been integrated?
- Has present-day functioning changed?
- Is the person moving toward the future they want?
These are core clinical skills we focus on throughout our training.
So yes, when PTSD scores go down and a diagnosis is no longer met, that is worth celebrating. It reflects real progress and real relief.
But it is not the whole story.
Scores are one way of measuring change—just one. As clinicians, researchers, and therapists, we need to remember that recovery is larger than any questionnaire can capture.
If you are looking to deepen your understanding of EMDR case conceptualisation, re-evaluation, and meaningful outcome tracking in clinical practice, you can view all upcoming courses at:
https://mindsyncemdrtraining.com/
Written by: Caroline van Diest
Who are we at Mindsync EMDR Training?
Caroline van Diest – is our Senior trainer. Having started her career as a learning disabilities nurse in the NHS, she trained initially in CBT before starting her EMDR journey. Caroline has worked for many years delivering EMDR training for therapists. She is the co-founder of Mindsync EMDR Training. She is a dynamic trainer, with an interest in storytelling. Caroline likes our delegates to have a clear understanding of EMDR. She will use a lot of clinical examples and story telling in her teaching. There is never a dull moment when Caroline is teaching! Caroline has a special interest in working with neurodiversity, when she is not delivering training Caroline sees clients for 1-1 work as well as running many supervision sessions and fitting in the odd pottery class!
Dr Hannah Bryan – is our Trainer & Consultant. She started her career in the NHS as a Clinical Psychologist. Hannah worked in secondary mental health services. She started her EMDR journey in 2005 and has seen the positive impact EMDR has on clients where other types of therapy seemed very slow going.
She is the co-founder of Mindsync EMDR training. Hannah is really passionate about supporting delegates to grow their confidence and skill in EMDR.Hannah has a special interest in using EMDR within a coaching framework, she also sees clients struggling with their mental health due to their past experiences as well as providing supervision in EMDR.