Reactions of practitioners to the introduction of a standard instrument to monitor clinical outcomes

This paper describes, step by step, the efforts made by the authors to introduce a clinical monitoring system into a marital and family counselling clinic in Tel Aviv, Israel. The monitoring system which was chosen for that purpose was the McMaster Clinical Rating Scale (MCRS). Systematic training helped the counsellors to become more receptive to the idea of monitoring, acknowledge its potential utility, and try it out. However, they failed to use the instrument fully and regularly, until finally the whole effort had to be abandoned. It emerged that the assumptions underlying the system fit the agency's ideology, but not the actual practice of counselling and supervision. Furthermore, the administrative and technical environment may not have been adequate to assure counsellors sufficient rewards for compliance. A vicious circle developed: The monitoring instrument was regarded by partationoner as irrevlent as long as the information it provided was not integreated into counselling and supervision.