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Measurement-Based Care in EMDR Therapy:
Making Progress Visible

By Andrew M. Leeds, Ph.D.
October 9, 2026

What is Measurement-based care (MBC?) What are the potential benefits for clinicians in using MBC? What are perceived barriers to MBC? This article addresses these questions for EMDR trained clinicians. Measurement-based care (MBC) involves routinely using validated patient-reported outcome measures, then reviewing the results with patients to guide clinical decisions. MBC is not simply collecting questionnaires for the record. The essential value in MBC lies in using repeated scores to support a shared conversation about progress, obstacles, safety, and next steps. In psychotherapy, this approach is also called routine outcome monitoring (ROM) or clinical feedback.

ROM has several benefits for clients and clinicians. Repeated measures can reassure skeptical clients they are making real progress by detecting even modest specific improvements. Identifying and discussing these specific improvements strengthens the therapeutic alliance. ROM can also alert clinicians when the current course of treatment is ineffective or is leading to worsening symptoms. Identifying these situations quickly can help prevent premature dropout from treatment and lead clinicians to modify their stance or treatment plan.

Paradoxically, most clinicians believe that up to 85% of their clients improve or recover when statistically 30% to 50% of patients fail to respond to treatment (Boswell, et al., 2015). Thus, both clinicians and clients benefit when they implement ROM by quickly recognizing worsening symptoms or simple lack of progress. Recent research reviews suggest that ROM with feedback produces improvements in outcome and reduces dropout, with particularly meaningful benefits for clients who are not progressing as expected (Barkham et al., 2023; McAleavey et al., 2024).

Despite these significant and documented benefits, there are several commonly perceived barriers to MBC. Measures are often viewed as screening instruments rather than as repeated, longitudinal data that can help guide treatment decisions. For clients, barriers can include questionnaire fatigue, accessibility needs, and concerns about confidentiality. Client concerns increase when they complete measures but do not have results discussed in treatment.

Clinicians can have issues with time requirements and workflow. Someone must distribute the measure, ensure completion, score it, place it in the chart, visualize the trend, discuss results with the client, and document any action taken. When those tasks depend on paper forms, manual scoring, or manual data entry, MBC becomes an unfunded administrative demand.

There are simple solutions to these challenges. First, is the use of a small, clinically coherent battery. Next is the creating a predictable schedule—for example, intake, periodic reassessment, discharge, and follow-up, rather than administering every measure at every session. Finally, modern technology can automate the entire process for distribution, administration, scoring, trend graphs, and data retention. There are now simple, free or low-cost, automated solutions to these MBC challenges.

For EMDR-trained clinicians, MBC can strengthen individualized assessment and case conceptualization that guide the eight phases of EMDR therapy. EMDR clinicians monitor target-specific change through Subjective Units of Disturbance (SUD) and Validity of Cognition (VOC). Those ratings are important indicators of what is occurring with a particular target memory during and between sessions. The PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) add a broader clinical lens. They can show whether target reprocessing is accompanied by changes in overall PTSD symptoms, depression, anxiety, and overall functioning.

The PCL-5 is particularly useful for monitoring PTSD symptom burden before and after EMDR reprocessing. It assesses the 20 DSM-5 PTSD symptoms and helps track symptom change (Weathers et al., 2013). Recent research estimates that a reduction of roughly 9 to 12 points may represent a minimally important change. PCL-5 score changes need to be interpreted in relation to baseline severity, the client's own account of recovery, and the clinical context (Blanchard, et al., 2023). A persistent plateau or elevated score can prompt a collaborative review of target sequencing, avoidance, dissociation, present-day threat, blocking beliefs, therapeutic alliance, or unmet support needs.

The PHQ-9 and GAD-7 are especially useful when PTSD co-occurs with major depressive disorder or clinically significant anxiety. Repeated PHQ-9 scores can clarify changes in hopelessness, anhedonia, withdrawal, sleep disturbance, or suicide-related concerns. Any endorsement of the PHQ-9 self-harm item necessitates clinically appropriate risk assessment. The GAD-7 can identify generalized anxiety that may contribute to avoidance, hyperarousal, or difficulty engaging in trauma processing. In research examining the treatment of individuals with major depressive disorder, MBC has been liked with higher remission, lower symptom severity, and better medication adherence. (Zhu et al., 2021).

The Multidimensional Inventory of Dissociation-60 (MID-60) can extend this assessment set when complex dissociation is clinically plausible. Derived from the longer MID, the 60-item self-report measure screens for the full range of dissociative symptoms and can help identify presentations that warrant a fuller diagnostic assessment. The MID-60 is not, by itself, a diagnostic instrument. For EMDR clinicians, administering the MID-60 is especially important before standard trauma reprocessing when the history or presentation suggests identity disruption, amnesia, trance states, depersonalization, derealization, or other indicators of a possible dissociative disorder. Recent validation research based on 13,177 clinical assessments found excellent internal consistency, high test-retest reliability, and evidence that MID-60 scores decreased across repeated administrations over 2 to 12 months, supporting its use in screening, formulation, and progress monitoring (Kate et al., 2026). Thus, periodic MID-60 administration can also serve ROM: it can help clinician and client track change in dissociative symptoms, detect destabilization, and decide whether pacing, stabilization, consultation, or modified EMDR procedures are needed. Elevated results should lead to careful clinical follow-up and, when appropriate, a structured dissociative-disorder assessment rather than an automatic diagnostic conclusion (Leeds et al., 2023).

MBC supports clinical humility and collaboration. A temporary symptom increase after difficult trauma reprocessing may reflect transient activation rather than deterioration. In contrast, sustained worsening across measures, reduced functioning, escalating dissociation, or increased risk should prompt deliberate reconsideration of pacing, stabilization, treatment planning, and level of care. Used in this way, routine measures do not reduce EMDR therapy to numbers. They give clinician and client a reliable, patient-centered way to ask: Is our work helping in the ways that matter to you, and what should we do next?

Clients are more likely to view questionnaires as useful when their clinician explains the rationale, shares the results, and demonstrates that responses affect treatment.
Clinicians can provide an explanation such as: “I use these brief measures periodically so we can see patterns that are sometimes hard to notice session to session. The scores are not a grade and does not replace our conversation.”

An automated MBC system generates simple graphs. These visual trends make it easier to distinguish a one-week fluctuation from a persistent plateau or clinically significant decline. Clinicians can discuss results in a way that matches client preferences, keeping discussion brief when scores are stable, linking trends to treatment strategies, and using visual displays where helpful.

EMDR clinicians can connect trend lines to specific reprocessing outcomes:
“Your SUD for this target reached zero, and your PCL-5 is declining. Are you noticing more freedom in the situations you had avoided?”
“Your PCL-5 has improved, but the PHQ-9 remains high. Could we explore what still feels depressive or hopeless, and whether that changes what we need to do next?”
“Your MID-60 findings and recent decrease in detachment suggest you are making real gains and risking more connection. How does that fit with what you have been noticing in your social and personal interactions?”

Clinician implementation of measurement-based care (MBC) can address legitimate concerns about time, clinical relevance, autonomy, and patient convenience. Clinicians can use a small core battery selected for a clearly stated purpose. Measures can be sent and administered electronically before appointments, with automated reminders. Results can be made available at the start of the next session and can inform the direction of continuing therapy. Automatic scoring, and automatically generated trend graphs support clinicians confirming or adjusting their treatment plans with their clients. The progress note can indicate, “Measures were reviewed with client; the trend was… the clinical interpretation was… the appropriate action was…”

For EMDR-trained clinicians, adopting measurement-based care through a dedicated platform such as MeasureBasedCare.com can make routine outcome monitoring remarkably practical by streamlining measure delivery, scoring, longitudinal tracking, and client-facing feedback. When EMDR clinicians decide to use an automated platform, it dramatically reduces administrative work. Clinicians can then devote attention to the clinical questions that matter: whether trauma reprocessing is producing broader improvement; whether depression, anxiety, dissociation, coping skills, or safety requires additional attention; and whether pacing, stabilization, target selection, or the treatment plan should change. Appropriate technology at MeasureBasedCare.com allows clients to decide whether to respond with on smart phone, a tablet, or a computer. They can face and answer just a single question at a time, in English or Spanish, verbally or with a single click. Clinicians can be assured protected health information remains secure with a Business Associate Agreement in place. Clinicians interested in presenting treatment outcome research at a conference or in a journal article that incorporates data from MBC will find essential ethical guidance in Persons, et al. (2021) and a study design protocol in Valdiviezo-Oña (2023). Appropriate technology at MeasureBasedCare.com allows clinicians to implement MBC and to view and share trend charts to strengthen a collaborative, visible, and responsive EMDR treatment process.

References

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McAleavey, A. A., de Jong, K., Nissen-Lie, H. A., Boswell, J. F., Moltu, C., & Lutz, W. (2024). Routine Outcome Monitoring and Clinical Feedback in Psychotherapy: Recent Advances and Future Directions. Adm Policy Ment Health, 51(3), 291-305. https://doi.org/10.1007/s10488-024-01351-9

Persons, J. B., Osborne, T. L., & Codd, R. T., III. (2021). Ethical and legal guidance for mental health practitioners who wish to conduct research in a private practice setting. Behavior Therapy, 52(2), 313–323. https://doi.org/10.1016/j.beth.2020.04.012

Valdiviezo-Oña, J., Montesano, A., Evans, C., & Paz, C. (2023). Fostering practice-based evidence through routine outcome monitoring in a university psychotherapy service for common mental health problems: A protocol for a naturalistic, observational study. BMJ Open, 13(5), Article e071875. https://doi.org/10.1136/bmjopen-2023-071875

Van Wert, M. J., Malik, M., Memel, B., Moore, R., Buccino, D., Hackerman, F., Kumari, S., Everett, A., & Narrow, W. (2021). Provider perceived barriers and facilitators to integrating routine outcome monitoring into practice in an urban community psychiatry clinic: A mixed-methods quality improvement project. Journal of Evaluation in Clinical Practice, 27(4), 767–775. https://doi.org/10.1111/jep.13457pubmed.ncbi.nlm.nih

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