I was a very early adopter of real time feedback measures with clients. These tools measure the client response to treatment in each session, which allows a practitioner to track how the client is progressing, and if not, is able to detect and adjust the treatment to ensure greater efficacy. Research studies found that this feedback model doubled client outcomes and reduced negative cases by 50 per cent. Now, some 15 years on since I began using this system, a wide range of real time feedback systems have been developed. Dr Scott Miller was one of the first to develop a real time feedback system, PCOMS. In this thoughtful article he and and his associates review developments in this approach and some of the challenges it faces. Potential improvements in clients is not driven simply by the tools that may only alert the practioners to dangers. Rather it is how practitioners respond to client feedback in deliberate practice that really matters. To read a deep and interesting review of how workers improve their practice click here.