正式反馈指常规收集当事人报告的效果数据，追踪治疗进展并为临床决策提供依据。回顾其三十年的发展历程，正式反馈在有效性检验、临床实施与应用方面取得积极进展，但也暴露出诸多问题。总体来看，正式反馈能够有效提高治疗效果，但其有效性受反馈系统类型、反馈流程、当事人症状严重性及实施环境等因素的影响。在有效性研究中，仍存在跨文化证据不足、特定临床群体验证不充分及作用机制不明晰等问题。在实践与应用层面，面临实施忠诚度不足和临床利用率偏低的困境。个体(咨询师和当事人)、组织及文化层面的因素共同作用于正式反馈的临床应用。最后，提出未来研究的重点方向，并就如何在中国文化背景下有效实施与推广正式反馈提出具体建议。

Over the past three decades, routine outcome monitoring (ROM), or formal feedback (also called measurement-based care), has emerged as a pivotal advance in psychotherapy. ROM entails the systematic collection of client-reported outcomes to track therapeutic progress and guide clinical decision-making. Since the introduction of “patient focused research” in 1996, ROM has garnered sustained scholarly attention due to its demonstrated efficacy in improving treatment outcomes, reducing client dropout, and bridging the research-practice gap.

In China, preliminary studies have reviewed ROM’s clinical effectiveness and applicability. However, research has largely focused on early-stage developments, with limited attention to its overall effectiveness, practical implementation challenges, and strategies for its adoption. Advances in information technology, accumulating meta-analytic evidence, and the global dissemination of ROM have created both opportunities and challenges, motivating this systematic review of three decades of research. This review addresses three core questions: “When and for whom is ROM effective?”, “What implementation challenges exist?”, and “How can ROM research and practice be effectively promoted in China?”

Evidence from over 60 clinical trials and 11 meta-analyses confirms the positive effect of ROM on treatment outcomes, with effect sizes ranging from small (g =.10) to moderate (g =.49). Variability is influenced by several factors including client feedback system, implementation process, client symptom severity, and clinical context. Only two feedback systems have extensive randomized clinical trial (RCT) support: the Outcome Questionnaire−45 System and the Partners for Change Outcome Management System (PCOMS). These two systems account for 74% of the studies included in the recent meta-analysis. The evidence shows that the PCOMS and the use of additional clinical support tools (CST) yield stronger effects, a larger effect for not-on-track clients and those with moderate baseline symptoms, and studies conducted in the U.S. Conversely, feedback may be less effective, or potentially counterproductive, for clients with severe baseline symptoms.

Challenges in ROM research and practice are multifaceted. Cross-cultural and population-specific evidence is limited, with 97% of trials conducted in Western contexts and sparse evidence for children, adolescents, or group therapy. Quantitative studies have primarily focused on therapists, leaving client contributions underexplored despite ROM’s current client-centered foundation. Research design issues, including researcher allegiance and dual use of measures for intervention and evaluation, may introduce bias, although large-sample trials controlling for these factors still support ROM’s effectiveness.

At the clinical level, therapist fidelity remains a recurrent challenge. Effective ROM requires three interrelated clinical processes: collecting client-reported outcome data, sharing feedback with clients, and acting on the data to guide shared decision-making. Evidence suggests that merely collecting or reviewing feedback without collaborative discussion limits its impact. High-quality application, characterized by integrating feedback data into therapeutic dialogue, is critical for enhancing treatment outcomes.

Barriers to ROM adoption operate across individual, organizational, and cultural levels. Individual-level challenges include client concerns about privacy, perceived burdens and therapists’ attitudes, knowledge, and confidence in using feedback. Organizational constraints encompass limited resources, lack of electronic feedback systems, insufficient training, and weak leadership support. Cultural factors, such as “face” concerns in Chinese contexts, may inhibit therapist engagement, particularly when negative outcomes are perceived to threaten professional authority.

Strategies to enhance ROM’s effectiveness and uptake include rigorous, culturally sensitive research, flexible implementation in group or long-term therapy, and technology-assisted data collection. Adoption is further shaped by culture: in non-Western societies like China, therapists’ concerns about perceived risks or “face concern” may be a more salient barrier to its use, indicating training should prioritize mitigating perceived risks. Finally, systemic policy and clinical guideline support are also essential for routine, institutionally supported ROM implementation, as evidenced by initiatives in the United States.

In summary, ROM represents an evidence-based intervention with substantial potential to enhance psychotherapy outcomes, facilitate early identification of stagnating cases, support individualized treatment, and strengthen therapeutic alliances. Despite preliminary domestic research, widespread implementation faces challenges related to cultural adaptation, therapist training, and organizational support. Future work should consolidate empirical evidence, examine client-centered mechanisms, and develop culturally appropriate strategies and policy frameworks to promote routine feedback-based psychotherapy in China. This review provides a comprehensive overview of ROM’s development, current challenges, and future directions, aiming to advance research and standardize evidence-based psychotherapy practice.