This article outlines how, at Rula, we prioritize symptom improvement because it reflects meaningful progress in our clients’ mental health, functioning, and overall well-being. This is why Rula includes client symptom improvement as one of our key quality indicators: when clients feel better, they’re more empowered to live in alignment with their values - and as therapists, supporting that growth is at the heart of our purpose.
How Does Rula Measure Symptom Improvement?
By tracking client progress you can deepen your understanding of how therapy is helping your client feel better. One of the key ways we measure progress is through the GAD-7 and PHQ-9, which are both routinely administered as part of Rula’s Measurement-Informed Care survey system for patients.
As a part of your quality metrics at Rula, you may notice a percentage for “Symptom Improvement” or ARR/DRR based on the surveys that your client completes. This percentage is calculated over time, comparing the clients’ baseline score to their score after 8 weeks of therapy. This is aligned with the industry Healthcare Effectiveness Data & Information Set (HEDIS) metrics tied to Anxiety Response Remission (ARR) and Depression Response Remission (DRR). It is a great way to show that the care you are providing your client is having a meaningful impact.
What Counts as Improvement?
We consider a client to have improved if either of the following happens:
- Their score decreases by 50% or more, showing a meaningful response to treatment, or
- Their score drops to the mild range or below (≤7 on the GAD-7 or ≤5 on the PHQ-9), indicating remission.
This metric isn’t about evaluating individual therapists - it's about learning together. When we understand how clients are progressing across the board, we can identify what’s working, notice patterns, and offer better support to both therapists and the people they serve.
Use Measurement-Informed Care (MIC) to Track and Tailor Treatment
MIC is like a clinical compass and can help track progress for the client. It is most powerful when it’s reviewed with the client and integrated into a therapeutic conversation. Normalize ups and downs, and frame the scores as useful signposts - not judgments. Celebrate progress, and when symptoms worsen, explore context and adjust the treatment plan together.
Try saying:
- “Your score dropped a bit - what felt different this week?”
- “This is great progress. What do you think has contributed to the improvement?”
This can be helpful to identify concrete strategies that are helpful to the client, using this momentum to inspire hope and generate further ideas that can support continued symptom improvement.
Use an Evidence-Based Treatment Approach that Demonstrates Effectiveness for the Client’s Presenting Problem
Start by matching your treatment approach to the client’s symptoms and preferences. Research indicates that modalities with a strong research base tend to improve symptoms more effectively (Cuijpers et al., 2019).
For example, if you’re working with a client with anxiety, consider CBT or ACT. If trauma is central, EMDR, IFS, or PE may be more appropriate.
Introduce the approach clearly so clients understand the structure and rationale, and the modality as needed.
Recommend Additional Services as Needed
Look out for signs that therapy alone isn't enough, such as spikes in measurement scores, safety concerns, functional decline, or plateaued progress. Collaborate with the client to explore appropriate resources and frame referrals as empowered steps. When appropriate, refer to:
- Peer support or groups
- Food/housing support
- Intensive Outpatient Programs (IOP) or Partial Hospitalization Program (PHP)
Try:
- “Would you be open to exploring other supports that might help alongside what we’re doing here?”
- “I want to make sure you’re getting the full support you deserve- let’s talk about a few options.”
Here’s an article explaining how to connect a Rula client to a higher level of care.
Psychoeducation to Normalize and Empower
Research shows that increasing a client’s understanding of what’s happening to them can reduce shame and increase agency (Donker et al., 2009). Offer short, tailored, culturally-relevant education about the client’s diagnosis, symptoms, and other aspects relevant to their treatment. Check in to ensure the client feels informed- not overwhelmed- and connect the information to their lived experience.
Helpful things to try include:
- “What you’re describing is actually a common reaction to stress. Can I share more about why that happens and what we can do about it?”
- “Sometimes it helps to understand how anxiety shows up in the body- would it be okay if we talked through that?”
Cultivate Hope, Agency, and Self-Compassion
Believing that change is possible is a key predictor of improvement (Wampold, 2015). Celebrate progress, and help clients reframe setbacks as opportunities to learn.
You might say:
- “It makes sense that you’re struggling with this- it shows how deeply you care. And the fact that you’re here working on it is powerful.”
- “Healing isn’t linear. Every step you take is still part of the path forward.”
Symptom Improvement Is a Shared Journey
Symptom improvement doesn’t rest on a single tool - it’s built through the consistent, compassionate use of many. Whether you’re reviewing MIC scores, teaching emotion regulation, exploring behavioral patterns, or simply holding space, you’re helping clients reclaim their agency and move toward a more meaningful life.
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