Measurement is making us better


In the last two decades, and certainly since the pandemic, more people are paying attention to mental health and willing to try counseling. In that time, the number of U.S. adults who sought mental health care in some form has increased 65%, from 27 million in 2002 to 42 million in 20211. 

Clearly, people are searching for answers. Is the counseling profession providing solutions? And how does Christian counseling fit into the outcomes equation?

A May 2023 article in The New York Times Magazine summarized the latest research on the effectiveness of “talk therapy.” One prominent researcher called it “remarkably effective.2 The article zeroed in on the most significant factor in counseling outcomes: the strength of the client’s bond with the therapist – a powerful predictor of whether a client continues in therapy and achieves a good outcome. 

In 2022, Christian Family Solutions implemented a continuous improvement program called Better Outcomes Now (BON). BON is a measurement tool that asks clients to contribute feedback on their progress during the course of treatment. The feedback is used to create conversations between the client and the therapist about treatment goals, progress, and the therapist’s responsiveness to needs. The feedback is monitored by a clinical supervisor who can work with each therapist to help improve their work with clients. 

Dr. Brandon Hayes, who supervises outcomes research at CFS, says CFS has had good BON scores from the beginning, and they continue to improve.

Just over 1,000 clients have provided ratings data since June of 2022. 

For those 1,000 clients, the effect size of treatment is .87 – significantly higher than what is typically found in other clinics. 

Effect size has become the most relevant way to evaluate the effectiveness of therapy. Effect size not only measures whether significant change occurred; it also measures how much change occurred. So these results show that counseling at CFS helps and it helps to a large extent. What’s even better is the effect size of the last 100 client raters, which was .93 at the time of this writing. 

“An increasing effect size among the most recent raters shows that we are using the feedback to improve our counseling practices,” says Dr. Hayes. “We’re having more targeted, focused sessions, and clients are receiving more benefit from treatment.”

Dr. Hayes is enthused about the outcomes CFS clinicians are achieving with their clients. “Not only are we demonstrating that we help clients, we are doing so at a level that exceeds what is expected,” he says.  “The unique factor that contributes to these great outcomes is the Gospel. I believe these results demonstrate the effectiveness of our approach – evidence-based mental health care integrated with the Gospel.”

An evidence-based approach

BON is recognized as an evidence-based practice by SAMHSA (Substance Abuse and Mental Health Services Administration), which means it is empirically proven to improve outcomes. It’s one of the reasons CFS chose BON over other measurement tools. BON is used by many other large mental health clinics.

Invigorated by the BON data, Dr. Hayes continues to champion the unique combination of evidence-based practices and the Gospel at CFS. “Christian counseling has been harshly judged in the past because there were people out there who would simply do a devotion and pray and not address the mental and emotional health of the client with an evidence-based approach. Prayer and devotion are important activities, and we would consider those the realm of pastoral care. BON is a vehicle for us to communicate that you can incorporate faith with evidence-based clinical practices in a treatment plan. And not only does it maintain the effectiveness of the treatment – it appears to enhance it.”

That’s because God’s Word, wherever spoken, has impact. Even and especially in a counseling session.

“BON shows us the results we’re getting for improving lives now. When we pair great clinical work with the Gospel, we know we have eternal impact, which is beyond measure.”



1 Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey Results

2 “Does Therapy Really Work? Let’s Unpack That.” Susan Dominus, The New York Times Magazine, May 16, 2023


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