Assessing treatment outcome. I. Adjustment in the community

In recent years, the re-examination of treatment outcome has substantially advanced the sophistication with which the issues involved have been conceptualized. This study is directed toward the empirical elaboration of four of these issues as they relate to adjustment in the community. They may be stated briefly as the extent to which a) a common outcome pattern exists across different dimensions of adjustment; b) the vantage point of the observer influences adjustment ratings; c) judgments of overall improvement encompass the major dimensions of adjustment; and d) judgments of overall improvement represent changes in adjustment levels. With regard to the first issue, the data indicate that each major dimension of adjustment has a somewhat different pattern over time. Secondly, a substantial consensus exists between patients and their significant others concerning patients' adjustment relative to the adjustment of other patients as described by them and their significant others, although not in terms of the actual magnitude of their adjustment. Third, global improvement ratings are related to two dimensions of adjustment primarily (symptomatology and social involvement), and they are virtually unrelated to other major dimensions. Finally, global improvement ratings are highly reflective of the current level of adjustment. The relevance of these findings to outcome assessment is discussed and some suggestions are offered.