How therapists can attain better results by regularly taking client feedback.

The other day, I told my wife that the two most important things I learned in graduate school were:
1) how little I know; and
2) I had doomed myself to a life of perpetual student-hood.

Put another way, every time I reached a perceived intellectual summit, I discovered that there were much higher summits of knowledge on the distant horizon. Unless I was content with achieving and remaining at the level of mediocre expertise that I had just attained, I would have to set forth and climb the next mountain. And then, there would be the next mountain, and the next, and so forth, and so on. There would never be a final summit to climb because there is always something more to learn. And to acquire that knowledge, one must remain a student, with a student’s endless list of questions.

I believe this experience and perspective is common to most, if not all, of those who strive for an advanced degree in any field. There are, of course, those few who may feel that they can set aside the student cap and robes and rest on their laurels. But it won’t take long before they are left behind in the proverbial dust of their rapidly progressing field. They become intellectual dinosaurs. I know that this might sound depressing, but the truth is that it is depressing. And, potentially dangerous.

An attitude that a diploma indicates that learning has been completed is particularly dangerous in fields where the primary purpose is to help people. There is nothing potentially more hazardous than someone trying to apply ideas that are not supported by evidence. This is why the medical field adopted the evidence-based practice as its standard bearer. Not long after, for much the same reasons, the field of psychotherapy adopted its own version of evidence-based practice including telehealth. According to the American Psychological Association, a psychotherapy practice needs to use the best available research and clinical expertise in the context of patient characteristics, culture, and preferences in order to be considered as evidence-based.

MyOutcomes, with its web-based Outcome Rating Scale (ORS) and Session Rating Scale (SRS), is included in SAMHSA’s National Registry of Evidence-based Programs and Practices because it helps the therapist integrate the client’s characteristics and preferences. The ORS and the SRS provide the client with a voice to generate constant feedback to the therapist about the progress being made and the therapist-client relationship.

Being a provider of psychotherapy can be challenging. Not only does the therapist need to keep up with the research and continually hone their clinical skills, but they need to be constantly learning about their client, who is not a single-dimensional cut-out of a human being. Rather, the client is a multidimensional person with characteristics that are in a state of flux as well as being relatively constant over time. When you include the therapist’s characteristics, culture and preferences, you have a very complex situation with multiple factors that have the potential of affecting whether successful outcomes will be achieved or not.

Two such important factors are early change and the therapeutic alliance. If change does not begin early and/or there isn’t a strong alliance between the therapist and the client, the chances of the client deteriorating or dropping out of treatment are increased.

Obviously, there are various variables that can influence these two factors. Things such as empathy, group cohesion, goal consensus and collaboration, coping style, counter-transference, genuineness, and positive regard are among a long list of variables that can impact the therapeutic alliance and affect the direction of therapeutic change.

But before the therapist can respond and make appropriate alterations to how any of these variables come into play, the therapist needs to know that something needs to be changed. Stated differently, before the therapist can bring any needed change to their therapeutic approach, they need to know that the desired change isn’t happening or that the therapeutic alliance is threatened or non-existent. By providing information regarding changes in the client’s subjective experience of distress or the strength of the therapeutic alliance, the ORS and the SRS, respectively, can alert the therapist to the very real possibility that the client isn’t showing any improvement or the therapeutic alliance is deteriorating.

We need good teachers, tools and mentors to help guide us and provide us insight into the challenges we need to surmount in order to achieve our goals. For many psychotherapists who desire to continue improving their effectiveness, learning comes in the form of clinical supervision and direct client feedback. Case notes, diagnostic scores, the supervisor’s knowledge of the research and the supervisor’s clinical skills play a valuable role in clinical supervision. Little to nothing of the client’s preferences, expectations and views of the therapeutic process and their own progress may not ever find its way into supervision, even though these factors have been demonstrated to play a vital role in successfully achieving the therapeutic goals. Of course, if MyOutcomes has been effectively integrated into the therapist’s practice, this information is available. By using MyOutcomes, the client’s ORS and SRS scores can play a vital role in directing clinical supervision with feedback informed treatment and help all those involved in identifying at-risk clients prior to those clients dropping out.