FEEDBACK INFORMED TREATMENT

Collaborating with and becoming accountable to our clients

Client and extratherapeutic factors. Includes clients resources, external support and ideas about change

The Therapy Alliance

Wampold 2001- The great psychotherapy debate.

FACTORS AFFECTING OUTCOME

In a study involving over 2000 therapists and clients Brown found that therapeutic encounters in which no improvement occurred by the third visit did not on average result in improvement over the entire course of treatment.

Clients who worsened by the third visit were twice as likely to drop out as those reporting progress

Variables such as diagnosis, severity and type of treatment not as important as knowing if the client believed they were making progress

Heart and Soul of Change p389-406

EARLY CHANGE

Agreement on Goals

Agreement on Tasks

Relational Bond

Congruent beliefs on how people change (Client’s theory of change)

Bordin E S . (1979)The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252-260

Gaston L (1990). The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations. Psychotherapy

THERAPEUTIC ALLIANCE

Counsellors need to monitor constantly the clients experience of :

Change and improvement in the areas of their life that brought them to therapy.

The strength of their alliance with the therapist.

Ankar, Duncan and Sparks- The effect of feedback on outcome in marital therapy. Journal of Consulting and Clinical Psychology 2009

Shimokawa K, Lambert M & Smart D (2010) – Enhancing treatment outcomes of patients at risk of treatment failure: meta-analytic and mega-analytic review of Psychotherapy quality assurance system- Journal of consulting and clinical psychology 78 298-311

FEEDBACK

We need to have measures which are:

ReliableValidFeasible

FEEDBACK MEASURES

Important that we are clear with the client why we are asking them to do this

If counselling is going to help it should start to help early

The client’s assessment of the therapy alliance is shown to be the more directly related to outcome than the therapist’s assessment

INTRODUCING THE MEASURES

Discuss each line and the overall score with the client

What is making them go up or down. What needs to happen to make them start to improve or continue to improve

Leave time at the end of the session to score and discuss the SRS especially if it is on the low side.

INTEGRATING THE MEASURES

If no progress shown on the ORS after 3 or 4 sessions it is time to discuss with the client what this means

Go over each line in the SRS Brainstorm with the client what would be of

more assistance. Different approach, different counsellor or continue as we are for now.

CHECKPOINT SESSION

After 6 to 8 sessions and no improvement time to look seriously at alternatives

Important to be able to fail successfully and make a successful referral based on the client’s feedback

Clients who fail to make progress with one counsellor can frequently work successfully with another one.

By not letting go we could be standing in the client’s way to recovery.

LAST CHANCE DISCUSSION

A score above the cutoff generally tells you nothing

If the client scores below 36 or below 9 on any line we need to acknowledge this and invite a discussion

If the client scores above the cuttoff but clearly lower than in previous sessions we need to explore this with them

RESPONDING TO THE SRS

Establish a culture of feedback Take every opportunity to let clients know

that you need and value their feedback. Let your clients help you become a better

therapist

CULTURE OF FEEDBACK

Relationships Australia MandurahTel 95836000Email bill.robinson@wa.relationships.com.au

To download the measures go to

www.scottdmiller.com For further support and ongoing discussion

go to www.centerforclinicalexcellence.com

Contact Bill Robinson

www.Fit-Outcomes.com

www.MyOutcomes.com

TRACKING YOUR OUTCOMES