Networker2011

www.heartandsoulofchange.com 3/25/11 Becoming a Better Therapist A Roadmap to Professional Development Barry Duncan, Psy.D. www.heartandsoulofchange.com Psy.D. 954.721.2981 www.whatsrighwithyou.com barrylduncan@comcast.net 1

www.heartandsoulofchange.com 3/25/11 How Do We Get Better? 2

www.heartandsoulofchange.com 3/25/11 How Do We Get Better Pop Quiz Question #1: False Becoming more Diagnosis has no accurate at diagnosis relationship to improves treatment Outcome in Mental matching and Health/Substance therefore outcomes Abuse Services Quotable Quotes about Diagnosis “Psychotherapy is the only form of treatment which, at least to some extent, appears to create the illness it treats” Jerome Frank (Frank, 1961, p. 7). Reliability: “To say that weve solved the reliability problem is just not true…Its been improved. But if youre in a situation with a general clinician its certainly not very good. Theres still a real problem, and its not clear how to solve the problem" Robert Spitzer, lead •Creates the Illness editor of DSM III (Spiegel, 2005, p. 63). •Reliability not good •It’s BS Validity: “There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it… these concepts are virtually impossible to define precisely with bright lines at the boundaries.” Allen Francis, lead editor of DSM IV (Greenberg, 2010, p. 1). 3

www.heartandsoulofchange.com 3/25/11 How Do We Get Better Pop Quiz Question #2: False Finding the right Study after study, and approach or studies of studies selecting evidence show that all based treatments treatments are the will improve right treatment—for treatment— outcomes some clients. Evidenced Based Treatment None Have Shown Superiority •Nothing wrong with EBTs but Dodo highlights fatal flaw: Being better than placebo/TAU is not saying much— much—if a friend went out on a date, you asked about the guy, your friend replied, “He was better than nothing—he was unequivocally better than watching TV or washing my hair.” How impressed? Rosenzweig, S. (1936). Some implicit common factors in diverse methods in psychotherapy. •And the conclusion… Journal of Orthopsychiatry, 6, 412-15. 6, 412- 4

www.heartandsoulofchange.com 3/25/11 How Do We Get Better Pop Quiz Question #3: False Personal therapy and While therapists find increasing our self personal therapy awareness makes us a invaluable, it neither better person and helps nor hinders improves our outcomes outcomes. Geller, J., Norcorss, J.,& Orlinksky D. (2005). The Norcorss, psychotherapist’s Own Psychotherapy. New York: Oxford Univ. Press. How Do We Get Better Pop Quiz Question #4: FALSE Professional No difference in Training and outcomes between Continuing disciplines, training Education have a models, and not one direct impact on study supports CE as outcomes. outcomes. helping outcomes 5

www.heartandsoulofchange.com 3/25/11 The Value of Training Another Nail in the Coffin  Didn’t matter to outcome if the client was “seen by a lic. doctoral–level counselor, a pre- doctoral intern, or practicum student.” Nyman, S. J., Nafziger, M. A., Smith, T. B. (2010). Client outcomes across counselor training level within a multi-tiered supervision model. Journal of Counseling and Development, 88, 204-209. How Do We Get Better Pop Quiz Question #5: FALSE The accrued The cold hard reality wisdom of clinical is that experience experience, years of makes no difference. seasoning, improves outcomes 6

www.heartandsoulofchange.com 3/25/11 Experience Is the Best Teacher? Getting Better All the Time?  Less experienced therapists achieve about the same results as their more seasoned colleagues.  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? So how do we? There Is No Roadmap! And… How Do We Keep On Keeping On? Let’s face it… sometimes being a therapist feels like the worst job on earth 7

www.heartandsoulofchange.com 3/25/11 Worse that Tarring Roofs and Draining Septic Tanks Or Being the New Crewmember Who  Just beamed down to a hostile planet with Kirk, Bones, and Spock. 8

www.heartandsoulofchange.com 3/25/11 Media Depictions Cast Us as Kooks & Crackpots  Often blamed for creating a nation of wimps or otherwise causing the decline of western civilization with our encouragement of self indulgence, preoccupation with feelings, and Stuart Smalley daily affirmations. Then There Is the Economic Situation  The golden days of private practice are over  The typical agency therapist faces many hardships—seemingly unattainable productivity, insurmountable paperwork, more & more intrusive funder oversight, threat of layoff 9

www.heartandsoulofchange.com 3/25/11 And Does Not Even Speak To  The emotional downsides, the sometimes overwhelming tragedy of the human condition that seems inured to our best efforts—the stories of suffering that are hard to shake. Becoming Better But We don’t do this work because we thought we would acquire the lifestyles of the rich and famous. 10

www.heartandsoulofchange.com 3/25/11 And We Knew • at the outset that mixing it up in the morass of human misery would not be a walk in the park. Being a Therapist Is More of a Calling • That smart, creative indvs make the sacrifices only to earn far less than others says something • Required servitude w/o the promise of rags to riches only makes sense b/c it is more of a calling than a job—a quest for meaning & fulfillment 11

www.heartandsoulofchange.com 3/25/11 But Many of Us Are Battle Weary • and in the face of media ridicule, cultural devaluation, & financial uncertainty may have forgotten why we enlisted in the therapy rank & file in the first place. How do we keep going? • The answer may surprise you How Helpers Develop Orlinsky & Rønnestad • Not only the answer but also captures the heart of our aspirations and the very soul of our identity. Massive 20 year study of Orlinsky, D. E., Rønnestad, M. H. (2005). How psychotherapists develop: Washington, DC: APA. 11,000 providers of all stripes and flavors from many countries 12

www.heartandsoulofchange.com 3/25/11 What Is Immediately Fascinating • is the consistency of results across discipline, nationality, gender, and theoretical orientation. Psychotherapy, in all its variations, seems to be a unified, despite what our warring professional organizations & theories tell us, toward one, true cause, Healing Involvement. Becoming Better Healing Involvement Committed & affirming, high level of empathic skills, conscious of “flow,” feeling effective, & dealing constructively w/ difficulties. We keep on keeping on because we really, really like connecting deeply with our clients and helping them get better. 13

www.heartandsoulofchange.com 3/25/11 Analysis of a 392 Items Healing Involvement • Healing Involvement represents us at our best—those times when 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 Healing Involvement—the reason we do the work and the intrinsic reward it offers. So, what causes this, and more importantly, how can we make it happen more often? Here Is The Psychotherapist’s Distinctive Narrative: Two Ways • First, it emerges from a therapist’s long-term experience of cumulative career development, improving clinical skills, increasing mastery, & gradually surpassing past limitations, as well as gaining a positive sense of our clinical development since we began. 14

www.heartandsoulofchange.com 3/25/11 Cumulative Career Development • Therapists want to think of themselves as learning more and getting better at what they do over time. As we accrue the hard earned lessons offered by different settings, modalities, orientations, and populations, we want to come out on the positive end of any agonizing reappraisal of our experience. • But the Most Powerful Influence Currently Experienced Growth • or what we are learning from our real time, day to day clinical work. We like to think of ourselves as developing now. CEG translates to positive work morale and energizes therapists to apply their skills on behalf of clients. 15

www.heartandsoulofchange.com 3/25/11 How Do We Attain Currently Experienced Growth • Beyond cliché, we believe clients are the best teachers & our best access to CEG • 97% endorsed practical learning from clients; 84% said influence high We Never Lose the Desire Cumulative Career Development • Even in the arguable decline, we have an inextinguishable passion to get better • 86% “highly motivated” to pursue prof. dev. • No profession more committed—Therapists want to continue to get better over their careers 16

www.heartandsoulofchange.com 3/25/11 Maybe Not Front Page News Think about It • Consider Networker Symposium & the # of late career practitioners. This is our unique narrative—our own professional growth & getting better at what we do appears to be the lifeblood of our identity, & more. But why is it so important? Currently Experienced Growth • Enables optimism & openness to the daily grind. Increases likelihood of Healing Involvement. • Here & now growth remoralizes us, repairs abrasions & stressors of & fights routinization, disillusionment, & loss of empathy. 17

www.heartandsoulofchange.com 3/25/11 In Other Words • Currently Experienced Growth buffers against burnout. We need to Grow Currently Experienced Growth David Orlinksy • “Is the balm that keeps our psychological skin permeable—many believe that the constant hearing of problems would lead to being emotionally callused, to a ‘thick skin.’ But we need ‘thin skin,’—open, sensitive, & responsive to contact with clients.” 18

www.heartandsoulofchange.com 3/25/11 Currently Experienced Growth • Reward for doing the work & our greatest ally for sending the grim reaper of burnout packing. • Most striking aspect of study: our growth is our primary way to fend off disenchantment. Part and Parcel to Our Identity • Is a continual retrospective evaluation of where we are versus where we have been, looking for evidence of our mastery of the work, & an ongoing filtering of our here and now clinical experiences, mining for the golden moments that replenishes us. 19

www.heartandsoulofchange.com 3/25/11 But How Do We Know We Are Mastering Anything • You know when a roof is tarred or a tank drained but how do you know therapy is beneficial? Outcomes are hard to define. • And apparently we are not very good judges of it Poor Judges of Outcomes Providers Don’t Know  Graded 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 20

www.heartandsoulofchange.com 3/25/11 It is Not that We Are Not Naïve or Stupid  Impossible to know in any reliable/valid way.  We have to measure outcomes. “Not that!”  Not about becoming “accountable” for funding sources or to justify your existence via showing “proof of value” or “return on investment.” This Time It’s Personal It’s About Becoming Better  It’s part of your identity, about survival. Can’t leave dev. to chance—it’s an ins. policy against burnout.  Measuring outcomes allows you to wade thru the ambiguity & discern your growth from a perspective outside of your own. 21

www.heartandsoulofchange.com 3/25/11 Use Study Findings Without Falling Prey to Own Biases • Our perceptions are important but we need the checks and balances. • Collecting data addresses the most sig. finding of the study—the perception of getting better & a palpable experience of current growth enliven therapy & staves off burnout. Translating Developmental Research Five Steps To Accelerate Your Development • Step One: Measure outcomes • Two: Track your cumulative career development. Monitor effectiveness over time in service of implementing strategies to improve outcomes. • It permits you to learn from your experience, not repeat it, and to reflect on your growth in a meaningful way. 22

www.heartandsoulofchange.com 3/25/11 First Things First Why You Might Be Reluctant  Finding out is risky  What if you find out that you are not so good? What if you are in the wrong profession?  The only way we improve is thru feedback. It takes courage. But so does walking in a room with someone in distress. Good Reasons to Take the Risk 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. 23

www.heartandsoulofchange.com 3/25/11 Barry Finds the Spot in the Norway Picture By Coincidence Clients Do Benefit But So Do We  Norway: 9 of 10 got better outcomes  Feedback raised effectiveness of the lower ones to their more successful colleagues.  Therapist in low effectiveness group became the BEST with feedback! 24

www.heartandsoulofchange.com 3/25/11 Provider Variation Feedback Improves Effectiveness C ounselors O utcom es (n = 30 or more case s) 1 .8 M ean E ffec t S iz e for all C as es 1 .6 1 .4 Effect size 1 .2 1 0 .8 0 .6 0 .4 0 .2 0 4) 4) 7) 5) 9) 8) 5) 0) 8) 8) 7) 7) 1) 1) 0) 9) 7) 5) 4) 1) 1) 0) =9 n=7 n=6 n=6 n=5 n=5 n=5 n=5 n=4 n=4 n=4 n=4 n=4 n=4 n=4 n=3 n=3 n=3 n=3 n=3 n=3 n=3 (n ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 C ounselor Miller, S.D., Duncan, B.L., Sorrell, R., & Brown, G.S. (February, 2005). The Partners for Change Outcome Management System. Journal of Clinical Psychology, 61(2), 199-208. 61(2), 199- 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. Other options available at heartandsoulofchange.com 25

www.heartandsoulofchange.com 3/25/11 Cumulative Career Development Step Three: Implement Strategies • Models/techniques, but… • Practice well the skills of the craft—the alliance. At some point, craft becomes art. Relational repertoire likely parallels your development Therapists Variables that Predict Change Therapists with the best results:  Are better at the alliance across clients; alliance ability accounts for therapist differences  Alliance predicts change Baldwin et al. (2007). Untangling the alliance-outcome correlation. Journal of Consulting and Clinical Psychology, 75(6), 842-852.; over and above early Anker, Owen, Duncan, & Sparks (2010). The alliance in couple therapy. Journal of Consulting and Clinical change Psychology, 78(5), 635-645. . 26

www.heartandsoulofchange.com 3/25/11 The Alliance: Over 1000 Studies The Alliance: • Relational Bond • Agreement on goals 38- 38-54% • Agreement on tasks Seven Times the Impact of Model/Technique…Accounts for Most of Therapist Variance Duncan, B. (2010). On Becoming a Better Therapist. Washington, DC: APA Research into Practice The Alliance •Increasingly, the relationship is viewed as merely “setting the stage” for the “real” treatment: •Confronting distorted thoughts; •Recovering forgotten memories; •Asking special questions; •Tapping on or waving fingers in front of the face…but the data say: •The alliance deserves far more RESPECT…It ain’t easy! Norcross, J. (2010). The Therapeutic Relationship. In B. Duncan et al. (eds.). The Heart and Soul of Change. Washington, D.C.: APA. 27

www.heartandsoulofchange.com 3/25/11 My Task, Your Task You Know It Ain’t Easy  Gotta try and understand the anger; gotta figure out a way for it all to make sense (validation)  Gotta find stuff about the client to like, to appreciate  Gotta work on her goals, and get her involved in purposeful work Alliance As An Overarching Framework The Alliance is the Soul  Transcends any beh & is a property of all—from tech. to scheduling appt  Purpose is to engage in purposive work  Have to earn it each & every time; alliance is our craft; practice elevates to art 28

www.heartandsoulofchange.com 3/25/11 Cumulative Career Development Take Charge • Track effectiveness by 30 client block. • Implement ideas, practices, & models, as well as building skills. • Will readily see whether efforts are paying off. • But how do I get started? Partners for Change Outcome Management System 3 Skills of PCOMS (The Three I’s)  Introducing the Measures  Integrating Client Feedback into Practice  Informing and Tailoring Services Based on Client Feedback 29

www.heartandsoulofchange.com 3/25/11 Becoming Better Measuring Outcome •Give at the beginning of the visit; Client •Scored to the places a mark nearest millimeter. on the line. •Add the four •Each line 10 scales together cm (100 mm) in for the total score. length. •Reliable, valid, feasible Becoming Better Creating A Culture of Feedback •When scheduling, provide rationale for seeking feedback; convey commitment to their goals and highest quality of service…in your own words •Work a little differently; •If we are going to be helpful should see signs sooner rather than later; If not helpful, we’ll seek consultation & consider a referral. •No one has ever said: Bad idea! 30

www.heartandsoulofchange.com 3/25/11 The Outcome Rating Scale An Introduction  The ORS is an outcome measure that allows us to track where you’re at, how you’re doing, how things are changing or if they are not. It allows us to determine whether the therapy is being helpful so we can do something different if it’s not helping. It also is way to make sure that your perspective stays central here, that we are addressing what you think is most important. It only takes a minute to fill out and most clients find it to be very helpful. Would you like to give it a try? The First Session Whatever It Takes  You can’t over-explain…  Clients get this. Face validity.  Whatever explanation the client gives is ok. Some will say: “You mean like poor to well?” or “Like 1 to 10?”  It’s their subjective experience that matters so their understanding of the measure is paramount. 31

www.heartandsoulofchange.com 3/25/11 The First Meeting The “Clinical Cutoff” 40 •The dividing line 35 between a clinical O u tc o m e S c o r e 30 25 20 & “non-clinical” “non- 15 10 population (25). 5 0 •Cutoffs also for 1st 2nd 3rd 4th Session Number youth and Actual Score Line 2 25th % 75th % caretakers. The Clinical Cutoff Only 2 Choices  Either above or below.  Mention client score as it relates to the cutoff & have the client make sense of it.  Scores under cutoff: reporting distress similar to others seeking services— the lower the score, the higher the distress. Looking for a change; in the right place! 32

www.heartandsoulofchange.com 3/25/11 The First Meeting Over the Clinical Cutoff •Explore why the client entered therapy; two reasons: specific reasons: problem or mandated/coerced •If mandated, ask for referral’s rating as catalyst for conversation; doesn’t mean they are lying •Don’t stir the cauldron or pick scabs. First Session: Connect ORS to the Client’s Described Experience  Atsome point, connect the client’s described experience of their lives to the marks on the scales 33

www.heartandsoulofchange.com 3/25/11 The ORS The Bare Bones  No specific content—skeleton to which clients add flesh & blood of their experiences.  At the moment clients connect the marks with what they find distressing, the ORS becomes a meaningful measure of their progress and potent clinical tool  Get a good rating! PCOMS Prevent Drop Out Clients drop out for 2 reasons: therapy is not helping (monitor outcome) & alliance problems—not engaged or turned on. Direct way to improve effectiveness is to keep people engaged in therapy. Gotta measure the alliance 34

www.heartandsoulofchange.com 3/25/11 The Session Rating Scale Measuring the Alliance •Give at the end •Score in cm to of session; the nearest mm; •Each line 10 cm •Discuss with in length; client anytime total score falls •Reliable, valid, below 36 feasible Becoming Better A Culture of Feedback with the SRS •When scheduling a first appointment, provide a rationale for seeking feedback regarding the alliance. •Work a little differently; •Want to make sure that you are getting what you need; •Take the “temperature” at the end of each visit; •Feedback is critical to success. •Restate the rationale prior to administering the scale. •How not to do the SRS 35

www.heartandsoulofchange.com 3/25/11 Make My Day 36

www.heartandsoulofchange.com 3/25/11 The Session Rating Scale An Introduction  Let’s take a minute and have you fill out the other form that asks your opinion about our work together. It’s kind of like taking the temperature of our relationship today. Are we too hot or too cold? Do I need to adjust the thermostat? This information helps me stay on track. The ultimate purpose of using these forms is to make every possible effort to make our work together beneficial. If something is amiss, you would be doing me the best favor if you let me know. Can you help me out? The Session Rating Scale Traditionally  Told us with their feet  Will let us know on SRS before telling/bolting.  Takes work for candor.  Disparity in power & socio- economic, ethnic, or racial diff., can make it tough. When was the last time you told your physician, “Youre making a big mistake"? 37

www.heartandsoulofchange.com 3/25/11 But Don’t Stress It’s Okay  Keep encouraging client to let you know…  Have to KNOW: No bad news. Not a measure of competence or anything negative about you or the client. Gift from the client that helps you to be better.  Unless you really want it, you are unlikely to get it.  You won’t get it from everyone. The Session Rating Scale A Quick Visual Check  Scores < 36 or 9cms should be discussed.  SRS is good or its not. Either thank the client for the feedback, & invite them to share future concerns; or thank client & explore why their ratings are lower so that you can fix the concern.  Building the Alliance 38

www.heartandsoulofchange.com 3/25/11 X X X X Now we’re ready to be better therapists, but first we must heed the words of a noted psychotherapy scholar Sage Psychotherapy Scholar: Mae West? Granted, at first When I’m blush, these good, hardly seem like I’m very words for good, but when therapists to live I’m bad, by—but, as it I’m better. turns out, they are. 39

www.heartandsoulofchange.com 3/25/11 Becoming Better Helping Every Single Client  When clients are not benefiting provides the opportunity to do your best work and learn the most—gives you the possibility of being helpful to everyone you see. Sound too good to be true? It’s not. Becoming Better PCOMS Identifies Clients Not Responding  When outcome is bad in other words, you can make it better by changing something about the therapy to turns things around; and if things don’t turn around, by moving the client on to a different provider or service 40

www.heartandsoulofchange.com 3/25/11 Becoming Better Two Choices: Not Rocket Science  Either the client is improving or not. If not, the client is at risk.  Engage client in discussion about progress, and what should be done differently if there isn’t any.  Keeps clients engaged so that a new direction can be planned. Becoming Better When I’m Good, I’m Very Good  When ORS scores increase, when you’re good, a crucial step to be very good is help clients see gains as a consequence of their own efforts and make sense of its meaning so repeat in the future. 41

www.heartandsoulofchange.com 3/25/11 Becoming Better When I’m Bad, I’m Better  Involve the client in monitoring progress & the decision about what to do next, to elicit his or her ideas & formulate a plan.  The discussion repeated in all meetings, but later ones gain significance and warrant additional action: Checkpoint and Last Chance Discussions. Becoming Better When to Say When  Stimulates both client and therapist to struggle with continuing a process that is yielding little or no benefit.  To support what is working & challenge what is not. Urgency increases over time 42

www.heartandsoulofchange.com 3/25/11 Checkpoint Session: An Opportunity to Be Better  Be transparent— comment about the lack of progress and seek feedback from the client about what he/she thinks it means Becoming Better First, the Alliance  “It doesn’t look like we are getting anywhere. Let’s go over the SRS to make sure you are getting exactly what you are looking for.” Going thru SRS and eliciting client responses in detail can help you & the client get a better sense of what may not be working. 43

www.heartandsoulofchange.com 3/25/11 Checkpoint Conversation Do Something Different  Nothing may come of talk about the alliance. Don’t worry. Making effort helps.  Invite others from support system, use a team or co- therapist, a different approach; referral to another therapist, religious advisor, or self-help group—whatever seems of value.  Any ideas are implemented, and progress is monitored. Becoming Better The Last Chance Discussion  Driving into desert running on empty, “last chance for gas.”  Depicts the necessity of stopping and discussing the implications of continuing w/o change. 44

www.heartandsoulofchange.com 3/25/11 Last Chance Thoughts The Longer w/o Change, the Quicker to #5 1.What does the client say? 2.What have you done differently? 3.What can be done differently now? 4.What other resources can be rallied? 5.Is it time to fail successfully? Becoming Better The Last Chance Discussion  At the least, consultation  Referral seriously discussed.  Rarely justified to continue past typical period.  Rarely is not never. Highly idiosyncratic & uniquely negotiated. Keeps us honest, addresses the lack of change transparently—new for me. 45

www.heartandsoulofchange.com 3/25/11 When I’m Bad, I’m Better Failing Successfully  Repeat commitment to help them achieve goals.  Failure says nothing about them or their potential.  If client wants, meet until arrangements are made.  But rarely continue with clients who show no improvement. Being Bad Can Make You Better  Helps clients you are already effective with by empowering change—helps those not benefiting by enabling other options and, in absence of change, the ability to move the client on.  When we’re good, we’re very good, but when we’re bad, we can be even better. 46

www.heartandsoulofchange.com 3/25/11 Clinical Nuances Not a Perfunctory Piece of Paper  Administering, But Don’t Get It. Clients must understand purpose (monitoring outcome, privileging their perspective); Therapists must understand same + make them meaningful  Administering, Using Some. But not the clinical cutoff or numbers…Use but no continuity; questionable data integrity  Administering, Using Some. But not connecting to the client’s experience or reasons for service  Administering the SRS. But seeing it as reflective of competence rather than an alliance building tool Back to Currently Experienced Growth Clients Are the Best Teachers • Impossible to sit with people in disaster, witness journey to a better place & not be changed. • Teach us about the human condition & ways people transcend adversity & cope w/the unthinkable. • Tracking outcomes takes this notion to a different & more immediately practical level. 47

www.heartandsoulofchange.com 3/25/11 Tracking Outcomes: Keeps Our Utmost Attention on the Here and Now • Clients teach us with their responses about the benefit & fit of service—as well as their reflections about the next step. Those clients not responding to our therapeutic business as usual help us step outside of our comfort zones. Learning from Clients Ongoing Reflection • Separate graphs: clients changing and not • Articulate changes and lessons • Note how it was done • Make before/after distinctions • Reflect about the new chapter in your dev as well as your identity 48

www.heartandsoulofchange.com 3/25/11 Step Four: Proactively Consider the Lessons Clients Teach • Any difference can be an important marker that highlights your CEG. Perhaps you did I’ve never done that before! something for the first time with a client, or a light went on & now you understand something in a different way. Learning from Clients Our Norwegian Colleague • I became more transparent, more courageous. I felt more secure and conveyed it. • Clients and I got more concrete about change, how it started, and what else would be helpful. • Feedback sharpened my focus—pinpointed that we have a common purpose. 49

www.heartandsoulofchange.com 3/25/11 Our Norwegian Colleague (cont) Be Proactive • Feedback helped me take risks and invite negative comments. • Made me more secure, I am far more daring. I am now more collaborative and allow things to emerge rather than following a set way to work. The Orlinsky and Rønnestad Study Says Something Important  About who we are & what we have to do remain a vital force in clients’ lives. Tracking outcomes enables a big picture view of your cumulative career dev. & a microscopic view of your currently experienced growth. 50

www.heartandsoulofchange.com 3/25/11 Step Five: Continual Professional Reflection  Both perspectives (CCD and CEG) allow you to continually reflect about your development and test your assumptions, adjust to client preferences, master new tools and learn new ideas. Continual Professional Reflection Identities and Descriptions • Reflect about your identity & construct a story of your work that captures what you do. • Edit and refine your identity & accounts— evolve a description that captures you and what you do. 51

www.heartandsoulofchange.com 3/25/11 You Do What Labor or Art What we do is a measure of who we are. If we imagine our work as labor, we become laborers. If we imagine our work as art, we become artists. Jeffrey Patnaude The Fuel of Our Development The Love of the Work  Foster parents (actual aunt and uncle) trying to do right thing  Bio parents lost parental rights; dad in jail; both poly substance addicted; using while pregnant; many ups and downs; Emily had many dx; a real handful  Aunt worried about “attachment” and didn’t know if she could do it anymore; struggling 52

www.heartandsoulofchange.com 3/25/11 Into My Treasure Chest I Felt the Pure Joy • Of that moment, this decision that gave a kid another chance. I still do. This was Healing Involvement, that intimate space where we connect with people & their pain in a way that opens the path of what can be rather than what is. This is the reward for what we do For the Love of the Work Becoming Better at What We Do • Your unique narrative as a therapist says you already have what it takes. Two things can help: One is your commitment to monitor 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—your love of the work provides the rest. 53

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Networker2011

by Barry Duncan

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