OnBecomingCh2DiscussionSlides

www.heartandsoulofchange.com On Becoming a Better Therapist Chapter Two Discussion Barry Duncan, Psy.D. www.heartandsoulofchange.com Psy.D. 954.721.2981 www.whatsrighwithyou.com barrylduncan@comcast.net 1

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www.heartandsoulofchange.com 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 Started Just the Facts Ma’am  The nuts & bolts, not for starting next month, or even next week—but with your next client  Feedback is the way to transcend average. 3

www.heartandsoulofchange.com 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. Regarding Therapist Variability Feedback Improves Outcomes  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! 4

www.heartandsoulofchange.com Provider Variation Feedback Improves Effectiveness C ounselor's 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- First Things First Why You Might Be Reluctant  You need more paperwork like a hole in the head.  Therapists can get really worked up over anything that adds paperwork, especially when they don’t see it as clinically useful. 5

www.heartandsoulofchange.com First Things First Why You Might Be Reluctant  Feedback about the benefit & fit need not be cumbersome or intrusive. Only a couple of minutes & no intrusive questions.  Feedback the best hope to improve, clients appreciate your dedication to getting it right, & it is painless and can fit your natural way. Starting With the Predictors Change and the Alliance •Client’s rating of the alliance the best predictor of engagement and outcome. •Client’s subjective experience of change early in the process the best predictor of success for any particular pairing. 6

www.heartandsoulofchange.com Sooner Rather Than Later Who drops out? B •The bulk of change occurs sooner A rather than latter Howard, K. et al. (1986). The dose-effect response in psychotherapy. American Psychologist, 41, 159-164. Some clients do take longer, but the mythology never dies N=4676; 77% attended 8 or less, and 91% 12 or less Note that even for the clients who take longer, change starts early…just is flatter Baldwin, S., Berkeljon, A., Atkins, D., Olsen, J., & Nielsen, S. (2009). Rates of change in naturalistic psychotherapy: Contrasting dose-effect and good-enough level models of change. Journal of Consulting and Clinical Psychology, 77(2), 203-211. 7

www.heartandsoulofchange.com 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 Download free working copies at: http://www.heartandsoulofchange.com CORS 8

www.heartandsoulofchange.com Clients The Heart of Change Partnering w/clients to monitor outcome engages most the potent factor of change Skill Building Becoming Outcome Informed 3 Skills of Outcome Informed Practice (The Three I’s)  Introducing the Measures  Integrating Client Feedback into Practice  Informing and Tailoring Services Based on Client Feedback 9

www.heartandsoulofchange.com The Outcome Rating Scale An Introduction  Remember our earlier conversation? During the course of our work together, I will be giving you two very short forms asking you how you think things are going and whether you think things are on track. To make the most of our time together and get the best results, it is important to make sure we are on the same page with one another about how you are doing, how we are doing, and where we are going. Your answers , your perspective will be our guide. Will that be ok with you? The First Meeting The “Clinical Cutoff” •The dividing line between a 40 clinical & “non-clinical” “non- 35 population (25). For children O u tc o m e S c o r e 30 25 (32) & adolescents (28); 20 caretakers (28) 15 •Between 25-33% score in 25- 10 5 the “non-clinical” range. “non- 0 1st 2nd 3rd 4th •The slope of change Session Number decreases as clients approach Actual Score Line 2 25th % 75th % the cutoff. 10

www.heartandsoulofchange.com The Clinical Cutoff Only 2 Choices, But Do It Either above or below. Mention client score as it relates to the cutoff & have the client make sense of it. 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 11

www.heartandsoulofchange.com 40 Years of Data say… •Client’s rating of the alliance the best predictor of engagement and outcome. outcome. •Client’s subjective experience of change early in the process the best predictor of success for any particular pairing. The Alliance Over 1000 Research Findings  Quality of the alliance more potent predictor of outcome than orientation, experience, or professional discipline  Same holds true for youth and family therapy 12

www.heartandsoulofchange.com The Alliance Deserves Respect 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 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 13

www.heartandsoulofchange.com 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 14

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www.heartandsoulofchange.com 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, “You're making a big mistake"? 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 16

www.heartandsoulofchange.com Nuances of the Measures 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…Heuristic Clinical Use but No Continuity  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 About the Book and the Webinars The American Psychological Association is the publisher www.apa.org/pubs/books 2. Just the Facts, Ma’am’ 3..How Being Bad… 4.Getting in the Zone 5. Heart and Soul of Change 6.Wizards, Humbugs, Witches 7. For the Love of the Work 17

www.heartandsoulofchange.com Questions and Answers 18

OnBecomingCh2DiscussionSlides

by Barry Duncan on Aug 27, 2010

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