Measuring the therapeutic bond: Why we’re building measurement into Chronicler

This blog post is a personal one. It’s an attempt to bring clarity to one of the primary reasons I felt compelled to add forms and measurement tools to Chronicler. At the time of writing this article, we’re actively developing these measurement tools guided by these principles.

From its inception, Therapy Shelf has been a space to build the tools I wanted in my own practice, tools I felt would benefit the community at large. But throughout my journey, from my pre-licensed days to my current work as a therapist and supervisor, one challenge has plagued me more than any other: Progress in therapy is notoriously difficult to measure.

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The need for clarity goes beyond imposter syndrome

Early in my career, I spent many nights caught in a loop of internal inquiry. I’d ask myself: “Am I actually good at this? Are my clients truly getting better? Would they be better off doing something else with their time and money? Maybe I’m just not cut out for this.”

We often dismiss these thoughts as "imposter syndrome." But the more I’ve grown in this field, the more I believe these doubts don't just point to a lack of confidence; they point to a genuine lack of clarity. No wonder new therapists feel like they are walking in the dark, they are!

Lord Kelvin (I think) once wrote, “If you cannot measure it, you cannot improve it.” In a field where we are the catalysts for transformational growth and healing, how can we strive for excellence if we don't have a map of where we’ve been? When I see my clients suffering, I feel a deep responsibility to be better: to provide a safer, warmer, and more effective environment. But without measurement, we are navigating the internal world of the client by starlight alone.

The case for measurement

Measurement serves as a vital lantern in the often elusive and shadowy landscape of psychological change. By providing tangible markers, it helps us navigate through the starlight and the uncertainty of the therapeutic process, offering a way to anchor our work. When we have a way to quantify shifts in thoughts, sensations, or behaviors, we gain a valuable feedback loop. This data provides a level of objectivity that helps us move beyond hoping for improvement and into knowing that our interventions are working. It serves to ground our clinical intuition, providing a mirror that reflects the reality of a client's growth back to them and to us. This desire for a clearer picture of progress is what originally prompted me to explore more ways of tracking the clinical path.

Perhaps the most misunderstood aspect of measurement is the idea that it somehow replaces the "feeling" of therapy. In reality, I view these metrics as a springboard to empathy. When a form reveals a spike in distress that a client was unable to verbalize in person, it creates an immediate opportunity for deeper attunement. It gives us a starting point to explore the nuances of their internal world that might otherwise remain hidden.

This becomes especially critical when it comes to therapeutic ruptures. Often, a client might not feel safe enough to tell us to our faces that the work isn't helping or that a specific session felt off. However, they might express that shift in their survey scores. By catching these declines early, measurement gives us the chance to initiate repair, to address the disconnect, and to strengthen the alliance before the client checks out. You can read more about my philosophy on the intersection of data and the therapeutic heart in this post. 

Mapping the journey

In my practice, I’ve often sat with clients and manually tried to "map" their progress, drawing timelines on whiteboards or in notebooks and identifying milestones to help them see how far they’ve come. While these visual exercises are powerful for summarizing the narrative of our work together, they rely heavily on our shared memory and mood during that specific session. This works to a certain extent, but I always wished I had raw, tangible data to back up those drawings. Having a consistent baseline of information collected over months allows us to see patterns that the human brain might overlook, such as a subtle but steady decrease in anxiety or a gradual increase in social engagement that neither of us fully noticed in the moment.

By giving clients a view into their own responses over time, we move therapy out of the abstract and into the visible. When a client can see their journey mapped out, they gain a sense of accountability and investment. They can see the benefit of their hard work and reward themselves for the internal accomplishments they’ve made.

This visibility lasts far beyond the fifty-minute session, extending into the space between meetings where the real work of life happens. By maintaining this connection to their progress throughout the week, clients can sustain a sense of optimism and momentum that might otherwise fade. It transforms their therapeutic journey into a tangible story of resilience that they truly own.

Human-centric by design

It is important to acknowledge that clinical surveys can never be the only valid source of information in a therapeutic relationship. However, we do not have to fall into all or nothing thinking by assuming that if a tool isn't perfect, it is never useful. While a form cannot capture the entirety of a person's lived experience, dismissing these tools entirely overlooks the valuable insights they can provide alongside our clinical observations.

I know that "measurement-based care" often receives valid criticism. Therapy is a realm of relationship-building; it is not a math problem. If measurement is done in a cold, clinical way, it risks stripping the soul out of the work. That is why we designed the forms in Chronicler to be human-centric. We believe measurement should be an extension of empathy, not a replacement for it.

I believe that the tools we use should be frictionless and intuitive. Forms optimized for mobile use allow clients to provide updates in moments that fit naturally into their day; like while they sit in the waiting room. By making the process unobtrusive, we ensure that providing feedback feels like a moment of reflection rather than another piece of clinical homework.

Furthermore, these tools should preserve the sacred client hour. By moving these surveys outside of the session, we ensure that we protect the clinical hour for the deep, relational work that forms the bedrock of the therapeutic alliance. We want your time together to be spent in connection, not in administrative data gathering.

Finally, these assessments provide a multi-dimensional perspective on the client's progress. They are meant to offer a more nuanced window into the client’s internal landscape: their cognitive patterns, emotional shifts, and somatic sensations. This data doesn't replace clinical intuition; it informs it, allowing us to meet our clients exactly where they are with a more complete understanding of their experience.

The future of chronicler

We intend for these measurement forms to grow and expand, becoming more useful with every update. Our goal isn't just to track symptoms; it is to further elucidate and empower the work we do together.

I believe that by integrating data with deep empathy, we can finally answer those late-night questions with confidence. We aren't just "hoping" for change; we are witnessing it, measuring it, and improving our craft to better serve those who trust us with their healing.

Chronicler is part of Therapy Shelf. We are dedicated to empowering therapists with the technology they need to stay focused on what matters most.