What Do Standard Outcome Measures Miss? Patient and Parent Perspectives on Perceived Change in Child and Adolescent CBT

Routine outcome monitoring in child and adolescent psychotherapy relies largely on standardized symptom measures and global success ratings. While these instruments capture changes in symptom severity, it remains unclear to what extent they reflect the aspects of therapy that patients and parents themselves experience as helpful and relevant for sustained well-being. Using pre-existing routine care data from an outpatient CBT setting, this study examines open-ended follow-up responses from children, adolescents and their parents collected six months after treatment completion. Participants were asked to describe what they perceived as particularly helpful during therapy and what contributed to well-being after therapy ended. Responses will be examined using structured qualitative content analysis, combining theory-based and inductive category formation. The aim of the study is to identify patient- and parent-reported indicators of therapeutic change and to examine how these perceived effectiveness factors relate to or extend constructs typically assessed by established outcome measures. By focusing on free-text responses collected within routine outcome monitoring, the study seeks to highlight potential gaps in current assessment practices and to inform the development and interpretation of diagnostic instruments in child and adolescent psychotherapy.