Counselors in the 21st century must not only respond to the pressures of managed care but also support the best interests of their clients. Criticism from consumers and professionals about the lack of empirical evidence of the efficacy of counseling as well as pressure from managed care companies have prompted a focus on evaluating treatment outcomes. This article provides a framework for developing standards of care by highlighting issues in outcome research in general and by reviewing treatment outcomes for obsessive-compulsive disorder.