Understanding therapists’ use of routine outcome monitoring in a low-embedded context. A qualitative study in Italian public health services

OBJECTIVE: Routine Outcome Monitoring (ROM) improves psychotherapy outcomes, yet its integration into routine clinical practice remains limited in settings where it is not structurally embedded. This study examines how psychotherapists engage with and make sense of ROM in such low-implementation contexts, using Italian public mental health services as an empirical case. METHODS: Fifteen psychotherapists who used ROM for 12 to 36 months within a larger clinical trial were interviewed about their experiences. Interviews were audio-recorded, transcribed, and analyzed using Constructivist Grounded Theory. RESULTS: Therapists described ROM as a flexible resource rather than a fixed tool, articulated along two dimensions: as a clinical technique within the therapeutic dyad and as an organizational device supporting supervision and service processes. Its usefulness depended on clinicians' ability to integrate these dimensions. ROM supported patient engagement, clinical decision-making, and monitoring of treatment progress, while also enabling organizational and supervisory functions. However, insufficient training limited its consistent use. CONCLUSIONS: In non-mandatory contexts, ROM integration depends on clinicians' capacity to construct its clinical meaning and extend its use across professional domains, highlighting the role of contextual and training factors.