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www.heartandsoulofchange.com 10/29/2010 On Becoming a Better Therapist Chapter Four Discussion Barry Duncan, Psy.D. www.heartandsoulofchange.com Psy.D. 954.721.2981 www.whatsrighwithyou.com barrylduncan@comcast.net 1

www.heartandsoulofchange.com 10/29/2010 2

www.heartandsoulofchange.com 10/29/2010 Winter Getaway! Training of Trainers  HSCP Training of Trainers (TOT): Jan. 31- Feb. 4, 2011 (24 hours of CEs) This intensive training experience gives you all you need to train others and implement CDOI. And it provides the first step in becoming an HSCP Certified Trainer of CDOI. Getting in the Zone Becoming Better at What We Do • Two things: One is your commitment to monitor the alliance and the outcome of the services. The second is your investment in yourself, your own growth and development. Client feedback provides the method for both, the compass for the journey. 3

www.heartandsoulofchange.com 10/29/2010 Becoming Better Isn’t It Good, Norwegian Wood • Feedback v TAU; Both persons reliable or sig. change—50.5% v. 22.6%; ES: .50; 4 xs # of clin. sig. change • FU: TAU-34.2% v. 18.4% Feedback Anker, M., Duncan, B., & Sparks, J. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a sep./divorce rate naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693-704. Regarding Therapist Variability Feedback Improves Outcomes • Norway: 9 of 10 got better outcomes • Therapist in low effectiveness group became the BEST with feedback! 4

www.heartandsoulofchange.com 10/29/2010 How Therapists Develop Orlinsky & Rønnestad • 5000 therapists (11,000) • The Pinnacle of Development—Healing Involvement: committed & affirming, high level of empathic skills, conscious Orlinsky, D. E., Rønnestad, M. H. (2005). How psychotherapists develop: of “flow,” feeling effective, Washington, DC: APA. & dealing constructively w/ difficulties. Immediately Fascinating A Unified Profession • What is immediately fascinating about this study is the consistency of results across profession, nationality, gender, and theoretical orientations. Psychotherapy, in all its variations, seems to be a unified profession, despite what our professional org. and theories tell us. • 5

www.heartandsoulofchange.com 10/29/2010 Healing Involvement Us at Our Best • Our immersion into our client’s story is so complete, our attunement so sharp, that the path required for change becomes eminently accessible. Sometimes you feel the texture of your connection with clients, an intimate space where you both know that there is something very good about this conversation. This is HI—the reason we do the work and the intrinsic reward it offers. How can we make it happen more often? First Source of Acceleration Cumulative Career Development • Improvement in skills, increasing mastery, & surpassing past limitations. • 86% “highly motivated” to pursue prof. dev. • Therapists continually evaluate where they are versus where they started 6

www.heartandsoulofchange.com 10/29/2010 Cumulative Career Development Getting Better All the Time? • All of us want to think that we are getting better. • But are we getting better or are we having the same year of experience over and over? • How do we know if we are getting better or deluding ourselves? Do We Really Know? • Dew & Reimers had therapist grade their effectiveness, A+ to F— 67% said A or better; none rated below average. • Providers don’t know Sapyta, J., Riemer, M., & Bickman, L. Feedback to how effective they are clinicians: Theory, research, and practice. Journal of Clinical Psychology: In Session, 61, 145-153 7

www.heartandsoulofchange.com 10/29/2010 Measuring Outcomes Removes Ambiguity • Allows you to use the evidence about therapist growth without falling prey to pitfalls of a therapist-centric view of success. • Cumulative Development Tracking Doesn’t have to be Complicated Start by entering data into Excel, & tracking outcome with simple calculations: ave. intake & final session scores, ave. change score, the % of clients who reach reliable or clinically significant change, & “drop outs.” 8

www.heartandsoulofchange.com 10/29/2010 Reliable or Clinically Significant Change •Reliable •Clinically change is a significant change of 5 change is 5 or or more: more points more than on the ORS attributable plus crossing to chance, the clinical measuremen cutoff or 25 t error or maturation Cumulative Career Development ASIST and MyOutcomes.com • The single bit of information that tells you the most is the % who reach target— the 50th percentile trajectory for clients entering services with the same intake score. 9

www.heartandsoulofchange.com 10/29/2010 Becoming Better Consider Benefits of Tracking Outcome • Allows a systematic trial and error application of new learning as well as the refinement of the tried and true mechanisms that we know enhance outcomes. • Tracking cumulative career development enables reflection and action about effectiveness. Sources of Acceleration Step 2. Theoretical Breadth Therapists at every stage who combined several theoretical perspectives were the “most growing” & more likely to exp. Healing Involvement. 10

www.heartandsoulofchange.com 10/29/2010 Becoming Better at What We Do Expand Your Theoretical Breadth • Loosen your grip on the “truth” of any approach • Theoretical loyalty brings certainty (certain failure); theoretical promiscuity brings uncertainty (but fits more clients) Believing in the Truth Not Rocket Science • Can hold only 3/4 systems • But far more frames or structures or explanations. • Open up to Franks observation that the important stuff is that models offer a rationale and a ritual. • They don’t require 2 yrs of supervision to understand or implement, but keep that under your hat. 11

www.heartandsoulofchange.com 10/29/2010 How Do You Broaden Theoretical Horizons? • Start with those that fit your views of human nature, problems, and solutions, & their relatives. • Set self conscientiousness to the side—let the client’s theory be your theory with that client…Claire • Be proactive. Play “on other hand” games Biggest Source of Development 3. Currently Experienced Growth • “What have you done for me lately?” • Our work is a calling, so our dev. is important to us—so much so that we keep a finger on the pulse of it at all times. 12

www.heartandsoulofchange.com 10/29/2010 Perhaps the Most Significant Finding The perception of getting better over time and a palpable experience of current growth enliven therapy and staves off burnout. Currently Experienced Growth Both the reward for doing our work and our greatest ally for sending the grim reaper of burnout packing. 13

www.heartandsoulofchange.com 10/29/2010 How Do We Attain Currently Experienced Growth • Experiential learning thru clinical work • Beyond cliché, helpers believe that clients are the best teachers— our primary access to Growth Attention to the Here and Now Clients teach us with their responses—whether they are benefiting & whether our service is a good fit—as well as their reactions & reflections re the next step. Clients who are not benefiting offer us the best opportunity for learning, helping us step outside our comfort zones. 14

www.heartandsoulofchange.com 10/29/2010 Proactively Consider the Lessons and Reflect • Any difference can be an important marker that highlights your currently experienced growth. Perhaps you did something for the first time with a client, or a light went on and you now understand something in a different way. Making the Best of Currently Experienced Growth • Review current clients, consider lessons. • Empower yourself, like your clients, to enable the lessons to take hold. • Articulate how client lessons have changed your work, your identity & how you describe what you do… 15

www.heartandsoulofchange.com 10/29/2010 Getting Better Is Part of Your Identity • But you have to keep your head and heart in the game in spite of all the reasons that conspire —like funder mandates, unrealistic productivity requirements, meaningless paperwork, and gut-wrenching client circumstances to —for you to accept monotony and negative outcomes. Ensuring Development with Outcome Feedback • Client feedback monitors outcome & plots cumulative career development. • Tailoring services leads to theoretical breadth to serve more clients. • Securing client feedback places providers in accelerated courses of development, in the front of the class to see and hear the lessons of the day—to experience currently experienced growth. 16

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by Barry Duncan on Oct 30, 2010

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