A comparison of three methods of identifying reliable and clinically significant client changes: commentary on Hageman and Arrindell.

Objectives of this commentary are to (1) note major similarities and differences of three methods of identifying reliable and clinically significant client changes, (2) demonstrate how graphs can be used to identify reliable and clinically significant client changes with each method, (3) describe uses and interpretations of overlaid graphs, (4) draw attention to an alternative to the Hageman and Arrindell method of estimating true score changes, and (5) caution users of the three methods against interpreting reliable and/or clinically significant changes which occur in psychotherapy as evidence of therapy 'efficacy' or 'effectiveness'.