Day2PanelBarryDuncan

www.heartandsoulofchange.com June 18, 2010 Consumer Feedback and Partnership Feedback and the Heart and Soul of Change Barry Duncan, Psy.D. www.heartandsoulofchange.com 954.721.2981 www.whatsrighwithyou.com barrylduncan@comcast.net Saul Rosenzweig, Ph.D. Founder of Common Factors 1

www.heartandsoulofchange.com June 18, 2010 Common Factors: Saul Rosenzweig •First known explication of common factors, influencing a whole generation of theorists •Original invocation of the Dodo Bird, foretelling 65 years of data: “Everybody has won, and all must have prizes” Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. Journal of Orthopsychiatry, 6, 412-15. Learn More About Saul Rosenzweig • For Saul’s article, and more visit: http://heartandsoulofchange.com/resources/articles/ • Duncan, B. (2002). The Founder of Common Factors: A Conversation with Saul Rosenzweig. Journal of Psychotherapy Integration, 12, 10-31. • Duncan, B. (2002). The Legacy of Saul Rosenzweig: The Profundity of the Dodo Bird. Journal of Psychotherapy Integration, 12, 32-57. • Duncan, B. (2010). Saul Rosenzweig: The founder of common factors. In B. Duncan et al (eds.), The Heart and Soul of Change: Delivering what works (pp. 3-22). Washington, DC: APA 2

www.heartandsoulofchange.com June 18, 2010 Implication of the Dodo Bird Verdict All 400 approaches work because: Of factors common to all therapies So what are the factors? Factors Accounting for Successful Outcome 40.0% Spontaneous Remission Client/Extratherapeutic Common Factors Relationship Models/Techniques 30.0% 15.0% Placebo/Hope/Expectancy 15.0% Lambert, M. (1986). Implications of Psychotherapy Outcome Research for Eclectic Psychotherapy. In J. Norcross (Ed.) Handbook of Eclectic Psychotherapy. New York: Brunner/Mazel. 3

www.heartandsoulofchange.com June 18, 2010 Lambert Challenged the Sanctity of the Model • Lambert’s portrayal of the elements of successful psychotherapy bravely differentiated factors according to their contribution to outcome, opening a new vista of understanding models and their relative importance to success. Meta-Analysis More Satisfying Picture • Recent findings from meta- analytic studies paint a more complicated but satisfying picture of the factors, their effects, & relationship to each other. • Factors are interdependent, fluid, dynamic, & dependent on who the players are & their interactions 4

www.heartandsoulofchange.com June 18, 2010 Client/Extratherapeutic Factors (87%) Feedback Effects 15-31% Alliance Effects Treatment Effects 38-54% 13% Model/Technique 8% Model/Technique Delivered: Therapist Effects Expectancy/Allegiance 46-69% Rationale/Ritual (General Effects) Duncan, B. (2010). On becoming a better therapist. 30-?% Washington DC: American Psychological Association Client is the of Change • Client’s Resources, Resiliencies, and Relational Support • Client’s View of the Alliance • Client’s View of Progress &Expectation of Success 5

www.heartandsoulofchange.com June 18, 2010 Bottom Line “The quality of • Without the heart, the patient's participation . . . not much is going [emerges] as to happen…or in a the most sage scholar’s important words… determinant of outcome." Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of process -outcome research: In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 307-390). New York: Wiley. 6

www.heartandsoulofchange.com June 18, 2010 Client/Extratherapeutic Factors (87%) Feedback Effects 15-31% Alliance Effects Treatment Effects 38-54% 13% Model/Technique 8% Model/Technique Delivered: Therapist Effects Expectancy/Allegiance 46-69% Rationale/Ritual (General Effects) Duncan, B. (2010). On becoming a better therapist. 30-?% Washington DC: American Psychological Association Alliance As An Overarching Framework The Alliance is the Soul • Transcends any beh & is a property of all—from tech. to scheduling an appt • Purpose is to engage in purposive work • Have to earn it each & every time; alliance is our craft; practice elevates to art 7

www.heartandsoulofchange.com June 18, 2010 Bottom Line • Without the soul, “Over a 1000 not much is going studies…and alliance predicts to happen…or in a outcome over sage scholar’s and above early words… change." Anker, M., Owen, J., Duncan, B., & Sparks, J. (in press). The alliance in couple therapy. Partner influence, early change, and alliance patterns in a naturalistic sample. Journal of Consulting and Clinical Psychology. 8

www.heartandsoulofchange.com June 18, 2010 But What About This Client? • While the data give general guidance, it does little to inform what will help a particular client. • To know what is therapeutic, the client’s view regarding both the alliance and outcome is key. • The real question: Does this client experience this interaction at this time and place to be therapeutic? And the only way to do this is via client feedback Client/Extratherapeutic Factors (87%) Feedback Effects 15-31% Alliance Effects Treatment Effects 38-54% 13% Model/Technique 8% Model/Technique Delivered: Therapist Effects Expectancy/Allegiance 46-69% Rationale/Ritual (General Effects) Duncan, B. (2010). On becoming a better therapist. 30-?% Washington DC: American Psychological Association 9

www.heartandsoulofchange.com June 18, 2010 A Proposal: Feedback as a Common Factor • Effects indep. of the measure • Improves outcome regardless of process • Improves outcomes across discipline, clinical setting, client pop., and therapists, regardless of the model Feedback As A Common Factor • Attaining feedback is common. • Any goal-directed, symptom-oriented discussion of progress involves client feedback. A process of give and take is characteristic of many therapies. • Many believe it is part of their normal activities. 90% reported they regularly asked clients about progress • Systematic client feedback formalizes what most aspire to: sensitive to feedback and interested in results. 10

www.heartandsoulofchange.com June 18, 2010 Feedback As A Common Factor • Overlaps with & affects all factors—tie that binds • Soliciting feedback is a living, process that engages clients in monitoring outcome, heightens hope, fits client preferences, maximizes therapist-client fit, and is itself a core feature of change. 40+ Years of Data Say… No one approach works better than another. Factors common across all approaches account for change— change—Feedback helps you integrate and enhance the effects of these factors 11

www.heartandsoulofchange.com June 18, 2010 Clients Are the Lions of Change Until lions have their historians, tales of hunting will always glorify the hunter. African Proverb Clients The Heart of Change Client outcome feedback makes consumers the historians of their own change Partnering w/clients to monitor outcome engages most the potent factor of change 12

www.heartandsoulofchange.com June 18, 2010 The Alliance The of Change Alliance feedback enables a fit between client expectations, preferences, and services Does not leave the alliance to chance—applying over 1000 studies showing the relationship of the alliance to positive outcomes 13

Day2PanelBarryDuncan

by Barry Duncan on Jun 04, 2010

Accessibility

Categories

Upload Details

Usage Rights

1 Embed 40

Statistics

Day2PanelBarryDuncan — Document Transcript