About eight months ago, I sat in a counselor's office at my university and we closed the therapy session with her asking me how I was doing.

"I'm doing a lot better," I said. "Thanks for all the help you've been. It means a lot."

But in truth I was lying. I was actually doing worse. Life had gotten harder and I was faced with unorthodox challenges and grief that inevitably made me barely able to sleep, drinking too much, taking out my anger on my friends, and a multitiude of other self-destructive behaviors.

I was more depressed than the first time I saw the counselor, but I didn't want her to know it. I didn't want her to see it as an affront to her competency or aptitude as a social worker. The truth was she cared a lot, and it showed. The truth was she was very competent, asked all the right questions, gave me great coping mechanisms, and it showed.

But even if you have the best social worker in the world, you can still get worse. And I did, but I didn't want her to take it personally.

I remembered all this when I read "What Your Therapist Doesn't Know" by psychologist Tony Rousmaniere in The Atlantic. In the article, Rousmaniere explains his initial strong resistance and to big data in his practice:

Psychotherapy is unlike any other field, I'd thought, with the arrogance that comes from being untested. We work in a human relationship. What we do can't be measured.

All of these ideas changed, however, when Rousmaniere, as a 34-year-old young therapist, had a patient named Grace. Grace was a recovering heroin addict who had been clean for six months. She was an unemployed single mother who'd been in a plethora of abusive relationships, and she was in the process of putting her life together and retaining custody of her son.

Everything seemed to be going well. She had a boyfriend that respected her, and she attended NA meetings regularly. When prompted for feedback, Grace assured Rousmaniere that their sessions were productive, but her responses were often rushed with a forced smile. When Rousmaniere told his supervisor about Grace's process, his supervisor was cautious:

"Getting clean is hard," she told me, "but staying clean is harder."

It became clear that Rousmaniere's supervisor was right: Grace no-showed three appointments, and relapsed on heroin when she reappeared. Everything in her life was falling apart. She had no jobs, no boyfriend, and was using regularly.

A couple months later after relapsing, Grace died, and her son was in foster care. The events led to an crisis-like episode of introspection for Rousmaniere. He asked himself "What could I have done differently? How could I become a more effective therapist?" He began to recall a talk about whether psychotherapy could benefit from data and analytics. After Grace died, he found himself open-minded to infusing more data into his practice.

Rousmaniere goes on in the article to explore whether performance feedback, which gives therapists awareness of how well they're doing their job, would improve psychotherapy's effectiveness. But, of course, in a highly challenging and sensitive field like psychotherapy, incorporating objective feedback and data is extremely difficult. Especially in confidential and extremely sensitive settings, therapists work in private and sheltered environments that don't allow for objective feedback.

And when clients talk to their therapists, they're often sugarcoating their responses as to not offend their therapists. Matt Blanchard and Barry Farber of Columbia University asked 547 patients in an online therapy whether they were dishonest about the effectiveness of their therapy and therapeutic relationship.

What they found was alarming: 93% of respondents reported having lied to their therapist. 72.6% reported lying about at least one therapy-related topic. The most common motives for lying included the following rationales:

Romantic and sexual feelings for a therapist.

"I wanted to be polite"

"I wanted to avoid upsetting my therapist"

"This topic was uncomfortable for me."

To counter the dishonesty that often accompanies therapy feedback, Margarita Tartakovsky describes an approach known as feedback-informed treatment or FIT. The approach allows using data receiving formal feedback to enhance client well-being and decreasing dropout rates and no-shows. The scale allows clients to be honest about bad negative feedback to their therapists, and for therapists to collect accurate data for how their clients are really doing.

Rousmaniere himself used FIT to great effect: he had a client named June who reported that the skills Rousmaniere was teaching her was good. But then, when she took the FIT survey on an iPad and responded to "always" to a question of whether she feels fearful, and "never" to a question of if she enjoys her spare time. He didn't check her graph that much at first given her perceived progress in the sessions, but when he did, he saw that her chart showed a red alert. Her symptoms hadn't progressed. She was actually at a higher risk of deterioration and suicide.

He thought there was a mistake in the software, since June told him therapy had been helpful the whole time. But when he used the data to ask her how she was really doing, she said:

"I'm sorry, but I think I'm worse. I just don't want you to think it's your fault; it's mine. You've been really helpful."

Without the data, Rousmaniere wouldn't have ever known. But he goes on to describe the aversion and skepticism he encounters with his peers about using the FIT system and big data in general in psychotherapy. Metrics can't identify all the nuances within a patient or a single session, which is a very valid concern, and the systems can give false positives and negatives.

But while data and metrics aren't the final word on whether a patient is sick, and never should be, they still provide valuable information that is important for psychotherapists to heed.

I know it's difficult and a challenge to use metrics and data because I was when I first started out as a volunteer in my school's suicide hotline or a Crisis Counselor at the Crisis Text Line. I've had conversations with people on the phone that made it seem like they've gotten a lot better, only to have them call back several times later as "chronic callers". My supervisors would make management plans to try to get them to seek more sustainable and effective help, as we were not actual trained therapists, but trained volunteers.

At the time, I took it as an insult. Just because they kept calling back with the same problems meant that life was happening, not that our time, effort, and services wasn't effective. I worked on the suicide hotline on the phone and had trouble believing that I wasn't being helpful at all.

It wasn't until I worked on the Crisis Text Line that my opinion on management plans and data indicating ineffectiveness changed. Once I started working with the anonymity behind the Crisis Text Line, texters started to be a lot more honest about how they were feeling after each conversation. Some said they felt exactly the same, if not worse. Some told me that they felt a lot better acknowledging their strengths.

The data the Crisis Text Line uses to help me improve and get better has been effective. The research shows that the best counselors need to adapt their language to the people they're talking to. Using the language of the texter themselves has been an essential point of feedback for me to improve.

Using the data and feedback for June, Rousmaniere's therapy with June gradually improved. His errors improved each time he got a consultation from video-taped sessions. He adjusted and adapted his approach, and rather than being an authority figure for June, he started being acting as a peer. The next two years, she graduated with honors in college and thanked Rousmaniere.

Big data will never be the end-all-be-all for psychotherapists, and it's an insult to say that it is. But it can definitely help, and therapists should look to data as a TAs in a classroom rather than the teachers themselves. Readers to Rousmaniere's piece expressed concerns about ethical measures of patients to be aware of how FIT and data is used in therapy. To a patient, it's valid that he or she can be suspicious of the data being used against them and being forced to use medication or kicked out of therapy.

Like everything, relationships are still essential in psychotherapy. Clients have the right to not participate in data measures like FIT if they don't want to, and clients should be collaboratively involved. Furthermore, not every psychotherapist or social worker is going to have the resources to implement the data. Not everyone will have iPads. Not everyone is going to have an expert for consultation on that data.

To be more effective using the data, society needs to devote more time and resources towards the use of data in the therapists' office. As an inner-city special educator, I have seen data-driven instruction implemented at my school to great effect. And if it works in a field as challenging as urban education, it's possible for data to be an effective tool in the therapist's office.