This document discusses what makes an effective or "master" therapist. It begins by arguing that psychotherapy is a relational endeavor dependent on the client and therapist's connection, not just evidence-based treatments. The most important thing a therapist can do is identify clients who are not benefiting and change course.
It then discusses four questions about what makes an effective therapist. In response to the first question about what they do, the author emphasizes routinely measuring outcomes and the therapeutic alliance to ensure client perspectives are central. For the second question about who they are, the author believes their belief in clients and psychotherapy's ability to create change is important.
In response to the third question about what defines an extraordinary therapist, the author argues
Most therapists want to improve their skills and help more clients. However, research shows that factors like personal therapy, specific treatment approaches, training, or experience do not necessarily correlate with better outcomes. After studying thousands of therapists over 15 years, one key factor was identified - "Healing Involvement", where therapists are fully engaged with clients through empathy, skills, efficacy, and handling difficulties constructively. This state can be achieved through career development improving skills over time, self-care reducing burnout, and connection to purpose and values in their work.
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
This document summarizes an approach called Outcome-Informed, Client-Directed therapy. It discusses how current estimates show around 50% of clients drop out of therapy and one-third to two-thirds do not benefit from usual strategies. The approach focuses on accurately identifying clients not responding to therapy early on through standardized measures of outcome and alliance. This allows therapists to address the lack of change and keep clients engaged in more effective treatment. Case examples are provided to demonstrate how routinely monitoring progress and the therapeutic relationship can improve outcomes.
This 2 page article, which appeared in The Iowa Psychologist, provides an ultra brief summary of what makes therapy effective (the common factors) and how we can get better at what do: namely, add PCOMS, harvest client existing resources, and rely on that neglected old friend, the therapeutic alliance.
Qualitative study of therapists working at Stangehjelp in Norway who are applying the principles of deliberate practice in their efforts to deliver more effective treatment services.
Feedback condition achieved nearly four times the amount of clients reaching reliable or clinically significant change. Nearly a 50% less separation/divorce at rate at follow up.
PCOMS as an Alternative to Psychiatric Diagnosis (Duncan, Sparks, & Timimi, 2...Barry Duncan
Part of an incredible series about diagnostic alternatives by the Journal of Humanistic Psychology edited by Sarah Kamens, Brent Dean Robbins, & Elizabeth Flanagan
This document discusses what makes an effective or "master" therapist. It begins by arguing that psychotherapy is a relational endeavor dependent on the client and therapist's connection, not just evidence-based treatments. The most important thing a therapist can do is identify clients who are not benefiting and change course.
It then discusses four questions about what makes an effective therapist. In response to the first question about what they do, the author emphasizes routinely measuring outcomes and the therapeutic alliance to ensure client perspectives are central. For the second question about who they are, the author believes their belief in clients and psychotherapy's ability to create change is important.
In response to the third question about what defines an extraordinary therapist, the author argues
Most therapists want to improve their skills and help more clients. However, research shows that factors like personal therapy, specific treatment approaches, training, or experience do not necessarily correlate with better outcomes. After studying thousands of therapists over 15 years, one key factor was identified - "Healing Involvement", where therapists are fully engaged with clients through empathy, skills, efficacy, and handling difficulties constructively. This state can be achieved through career development improving skills over time, self-care reducing burnout, and connection to purpose and values in their work.
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
This document summarizes an approach called Outcome-Informed, Client-Directed therapy. It discusses how current estimates show around 50% of clients drop out of therapy and one-third to two-thirds do not benefit from usual strategies. The approach focuses on accurately identifying clients not responding to therapy early on through standardized measures of outcome and alliance. This allows therapists to address the lack of change and keep clients engaged in more effective treatment. Case examples are provided to demonstrate how routinely monitoring progress and the therapeutic relationship can improve outcomes.
This 2 page article, which appeared in The Iowa Psychologist, provides an ultra brief summary of what makes therapy effective (the common factors) and how we can get better at what do: namely, add PCOMS, harvest client existing resources, and rely on that neglected old friend, the therapeutic alliance.
Qualitative study of therapists working at Stangehjelp in Norway who are applying the principles of deliberate practice in their efforts to deliver more effective treatment services.
Feedback condition achieved nearly four times the amount of clients reaching reliable or clinically significant change. Nearly a 50% less separation/divorce at rate at follow up.
PCOMS as an Alternative to Psychiatric Diagnosis (Duncan, Sparks, & Timimi, 2...Barry Duncan
Part of an incredible series about diagnostic alternatives by the Journal of Humanistic Psychology edited by Sarah Kamens, Brent Dean Robbins, & Elizabeth Flanagan
Barry's standard handouts providing a narrative description of what he presents. Includes a discussion of the common factors and the Partners for Change Outcome Management System
The Norway Couple Project: Lessons LearnedBarry Duncan
The document discusses lessons learned from studies on using client feedback to improve outcomes in couple therapy. A large randomized clinical trial in Norway found that routinely collecting and discussing client feedback on progress and the therapeutic alliance using brief measures led to better outcomes compared to treatment as usual. Specifically, couples receiving feedback showed greater improvement in their relationships and were less likely to deteriorate over time. The findings suggest incorporating systematic client feedback into routine practice can help therapists improve outcomes for couples across different therapy approaches.
The article discusses the development and research supporting the Partners for Change Outcome Management System (PCOMS). PCOMS uses two brief measures - the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) - to collect feedback from clients at each session on their progress and the therapeutic alliance. The ORS and SRS were developed to be brief and feasible for routine use. Research shows providing therapists feedback based on these measures improves client outcomes compared to treatment as usual. The article outlines how PCOMS was developed and refined, presents supporting research on the measures' psychometrics and clinical usefulness, and discusses examples of implementing PCOMS in behavioral health settings.
A figure illustrating what meta-analytic research suggests about the factors running across all therapies that account for change in psychotherapy. From On Becoming a Better Therapist, 2nd Edition by Barry Duncan published by APA (2014).
This article argues that client perspectives have been overlooked in psychotherapy integration efforts. It proposes conducting therapy within the context of the client's own theory of change, which privileges the client's voice as the source of wisdom and solution. The client should be seen as the heroic driver of the therapeutic process, not just as an object of assessment and intervention by the therapist. Research shows that client factors such as strengths, perceptions of the therapeutic relationship, and resources account for the majority of improvement in therapy. Therefore, integration approaches should focus on understanding and incorporating the client's own ideas about the problem and how change occurs.
What Is Client Directed Outcome InformedScott Miller
Client Directed Outcome Informed (CDOI) clinical work privileges the client's perspective and uses their feedback to guide treatment in a partnership between client and provider. Several mental health and substance abuse treatment organizations that have implemented CDOI report improved outcomes like higher retention rates and lower costs from reduced sessions and cancellations. Research shows involving clients in decisions about their treatment and focusing on whether treatment is working improves success rates by an average of 65%.
This is the validation study of the Group Session Rating Scale (GSRS). In a nutshell, this study found more than acceptable reliability and validity with not only an alliance measure but also with group climate and cohesiveness scales. The GSRS was also predictive of last session outcomes. An RCT comparing PCOMS to TAU in group therapy has been submitted.
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
PCOMS: A Viable Quality Improvement Strategy for Public Behavioral HealthBarry Duncan
This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.
Excellence in therapy: An Interview with Scott D. Miller, Ph.D.Scott Miller
1) The interviewee, Scott Miller, became involved in psychotherapy through a series of fortunate events and encounters with inspiring professors during his university studies.
2) Miller believes that diagnostic codes are not very useful or informative. He finds it more useful to understand each client's unique characteristics to tailor therapy to the individual.
3) Most therapists do good work, but therapists vastly overestimate their own effectiveness by around 65% on average. Outcomes have remained fairly stable over time despite efforts to improve. Feedback from clients is important for improving practice.
Slone, N. C., Reese, R. J., Mathews-Duvall, S., & Kodet, J. (2015). Evaluating the Efficacy of client feedback in group psychotherapy. Group Dynamics: Theory, Research, and Practice, 19, 122-136. doi:10.1037/gdn0000026
The Partners for Change Outcome Management System: Duncan & Reese, 2015Barry Duncan
Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O'Donnell, & Lambert, 2012). Systematic client feedback offers one solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only two have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence based Programs and Practices: The Outcome Questionnaire-45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of the Partners for Change Outcome Management System, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large scale data collection, to re-prioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.
Article by Dr Mary Haynes about her agency's journey to a recovery orientation via CDOI and PCOMS published in the SAMHSA Recovery to Practice Newsletter.
Deterioration in Psychotherapy: A Summary of Research by Jorgen FlorScott Miller
This study explored how 10 Norwegian psychologists think about patient deterioration in psychotherapy. The psychologists showed a lack of common terminology around deterioration and underestimated its occurrence. They received little education on deterioration and felt uncomfortable discussing it. The study highlights the lack of awareness around negative outcomes in education and practice. It aims to provide a better basis for quantitative research on how deterioration is interpreted.
The original validation of the CORS for kids and the ORS for adolescents. Allowed the benefits of client based outcome feedback to expand to youth and family and paved the way to the current RCT with kids in the schools.
Duncan & Sparks Ch 5 of Cooper & DrydenBarry Duncan
THIS CHAPTER DISCUSSES
•
Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•
PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
Although many of you may not be interested in the psychometric details of the ORS and SRS, it does bear importantly on whether there are seen as credible. Jeff Reese and I (Duncan & Reese, 2013) recently exchanged views with Halstead, Youn, and Armijo (2013), debating when a measure is too brief and when it is too long. Here is our paper. First regarding when a measure is too brief: There is no doubt that 45 items, 30 items, or even 19 items is psychometrically better than 4 items, and that the increased reliability and validity of longer measures likely result in better detection, prediction, and ultimate measurement of outcome. But how much better is the really the question. Are these differences clinically meaningful and do they offset the low compliance rates and resulting data integrity issues from missing data? These are the questions that require empirical investigation to determine how brief is too brief, although from my experience, the verdict has already been rendered. But when is a measure too long? The answer is simple: When clinicians won’t use it.
When children and teens present with behaviour and emotional problems the lure of a quick fix is
understandable and drugs present a ready-made solution. Therapists are often hesitant to talk about
medication and defer to medical professionals. In this paper DUNCAN, SPARKS, MURPHY and MILLER
highlight the explosion in the use of psychotropic medications for children and teens. This trend flies in the
face of the American Psychological Association’s recommendation of the use of psychosocial interventions
as the first intervention of choice with children and teens. The reliability and validity of psychiatric diagnoses is
questioned, in particular against a background of fluctuations in child development and social adaptations,
and a compelling critique is provided of the current research findings on the effectiveness of psychotropic
medications including antidepressants and ADHD medications. Therapists are urged to shed their timidity
and discuss openly the risks and benefits of medication with the knowledge that there is empirical support
for psychosocial interventions as a first line approach. Recommendations are offered to engage clients as
central partners in developing solutions—medical or non-medical—that fit each child and each situation.
Reality therapy focuses on addressing clients' present unsatisfying relationships and ineffective behaviors by teaching them choice theory. The therapist guides clients to evaluate their current behaviors, identify their needs and wants, and make plans to behave more effectively. Reality therapy uses the WDEP method - exploring the client's wants, the direction of their behaviors, having them self-evaluate, and creating plans for change. The goal is for clients to learn how to better meet their needs and develop more satisfying relationships.
Cognitive behavioral therapy (CBT) can help treat a wide range of mental health issues like depression, anxiety, sleep problems, and more. It involves identifying unhealthy thought and behavior patterns and replacing them with adaptive ones. Therapy typically involves short-term goal-oriented sessions where the therapist helps the client understand how their thoughts influence their feelings and behaviors. While the duration varies per client, CBT is generally a short-term therapy that can see benefits after just a few sessions.
Barry's standard handouts providing a narrative description of what he presents. Includes a discussion of the common factors and the Partners for Change Outcome Management System
The Norway Couple Project: Lessons LearnedBarry Duncan
The document discusses lessons learned from studies on using client feedback to improve outcomes in couple therapy. A large randomized clinical trial in Norway found that routinely collecting and discussing client feedback on progress and the therapeutic alliance using brief measures led to better outcomes compared to treatment as usual. Specifically, couples receiving feedback showed greater improvement in their relationships and were less likely to deteriorate over time. The findings suggest incorporating systematic client feedback into routine practice can help therapists improve outcomes for couples across different therapy approaches.
The article discusses the development and research supporting the Partners for Change Outcome Management System (PCOMS). PCOMS uses two brief measures - the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) - to collect feedback from clients at each session on their progress and the therapeutic alliance. The ORS and SRS were developed to be brief and feasible for routine use. Research shows providing therapists feedback based on these measures improves client outcomes compared to treatment as usual. The article outlines how PCOMS was developed and refined, presents supporting research on the measures' psychometrics and clinical usefulness, and discusses examples of implementing PCOMS in behavioral health settings.
A figure illustrating what meta-analytic research suggests about the factors running across all therapies that account for change in psychotherapy. From On Becoming a Better Therapist, 2nd Edition by Barry Duncan published by APA (2014).
This article argues that client perspectives have been overlooked in psychotherapy integration efforts. It proposes conducting therapy within the context of the client's own theory of change, which privileges the client's voice as the source of wisdom and solution. The client should be seen as the heroic driver of the therapeutic process, not just as an object of assessment and intervention by the therapist. Research shows that client factors such as strengths, perceptions of the therapeutic relationship, and resources account for the majority of improvement in therapy. Therefore, integration approaches should focus on understanding and incorporating the client's own ideas about the problem and how change occurs.
What Is Client Directed Outcome InformedScott Miller
Client Directed Outcome Informed (CDOI) clinical work privileges the client's perspective and uses their feedback to guide treatment in a partnership between client and provider. Several mental health and substance abuse treatment organizations that have implemented CDOI report improved outcomes like higher retention rates and lower costs from reduced sessions and cancellations. Research shows involving clients in decisions about their treatment and focusing on whether treatment is working improves success rates by an average of 65%.
This is the validation study of the Group Session Rating Scale (GSRS). In a nutshell, this study found more than acceptable reliability and validity with not only an alliance measure but also with group climate and cohesiveness scales. The GSRS was also predictive of last session outcomes. An RCT comparing PCOMS to TAU in group therapy has been submitted.
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
PCOMS: A Viable Quality Improvement Strategy for Public Behavioral HealthBarry Duncan
This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.
Excellence in therapy: An Interview with Scott D. Miller, Ph.D.Scott Miller
1) The interviewee, Scott Miller, became involved in psychotherapy through a series of fortunate events and encounters with inspiring professors during his university studies.
2) Miller believes that diagnostic codes are not very useful or informative. He finds it more useful to understand each client's unique characteristics to tailor therapy to the individual.
3) Most therapists do good work, but therapists vastly overestimate their own effectiveness by around 65% on average. Outcomes have remained fairly stable over time despite efforts to improve. Feedback from clients is important for improving practice.
Slone, N. C., Reese, R. J., Mathews-Duvall, S., & Kodet, J. (2015). Evaluating the Efficacy of client feedback in group psychotherapy. Group Dynamics: Theory, Research, and Practice, 19, 122-136. doi:10.1037/gdn0000026
The Partners for Change Outcome Management System: Duncan & Reese, 2015Barry Duncan
Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O'Donnell, & Lambert, 2012). Systematic client feedback offers one solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only two have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence based Programs and Practices: The Outcome Questionnaire-45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of the Partners for Change Outcome Management System, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large scale data collection, to re-prioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.
Article by Dr Mary Haynes about her agency's journey to a recovery orientation via CDOI and PCOMS published in the SAMHSA Recovery to Practice Newsletter.
Deterioration in Psychotherapy: A Summary of Research by Jorgen FlorScott Miller
This study explored how 10 Norwegian psychologists think about patient deterioration in psychotherapy. The psychologists showed a lack of common terminology around deterioration and underestimated its occurrence. They received little education on deterioration and felt uncomfortable discussing it. The study highlights the lack of awareness around negative outcomes in education and practice. It aims to provide a better basis for quantitative research on how deterioration is interpreted.
The original validation of the CORS for kids and the ORS for adolescents. Allowed the benefits of client based outcome feedback to expand to youth and family and paved the way to the current RCT with kids in the schools.
Duncan & Sparks Ch 5 of Cooper & DrydenBarry Duncan
THIS CHAPTER DISCUSSES
•
Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•
PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
Although many of you may not be interested in the psychometric details of the ORS and SRS, it does bear importantly on whether there are seen as credible. Jeff Reese and I (Duncan & Reese, 2013) recently exchanged views with Halstead, Youn, and Armijo (2013), debating when a measure is too brief and when it is too long. Here is our paper. First regarding when a measure is too brief: There is no doubt that 45 items, 30 items, or even 19 items is psychometrically better than 4 items, and that the increased reliability and validity of longer measures likely result in better detection, prediction, and ultimate measurement of outcome. But how much better is the really the question. Are these differences clinically meaningful and do they offset the low compliance rates and resulting data integrity issues from missing data? These are the questions that require empirical investigation to determine how brief is too brief, although from my experience, the verdict has already been rendered. But when is a measure too long? The answer is simple: When clinicians won’t use it.
When children and teens present with behaviour and emotional problems the lure of a quick fix is
understandable and drugs present a ready-made solution. Therapists are often hesitant to talk about
medication and defer to medical professionals. In this paper DUNCAN, SPARKS, MURPHY and MILLER
highlight the explosion in the use of psychotropic medications for children and teens. This trend flies in the
face of the American Psychological Association’s recommendation of the use of psychosocial interventions
as the first intervention of choice with children and teens. The reliability and validity of psychiatric diagnoses is
questioned, in particular against a background of fluctuations in child development and social adaptations,
and a compelling critique is provided of the current research findings on the effectiveness of psychotropic
medications including antidepressants and ADHD medications. Therapists are urged to shed their timidity
and discuss openly the risks and benefits of medication with the knowledge that there is empirical support
for psychosocial interventions as a first line approach. Recommendations are offered to engage clients as
central partners in developing solutions—medical or non-medical—that fit each child and each situation.
Reality therapy focuses on addressing clients' present unsatisfying relationships and ineffective behaviors by teaching them choice theory. The therapist guides clients to evaluate their current behaviors, identify their needs and wants, and make plans to behave more effectively. Reality therapy uses the WDEP method - exploring the client's wants, the direction of their behaviors, having them self-evaluate, and creating plans for change. The goal is for clients to learn how to better meet their needs and develop more satisfying relationships.
Cognitive behavioral therapy (CBT) can help treat a wide range of mental health issues like depression, anxiety, sleep problems, and more. It involves identifying unhealthy thought and behavior patterns and replacing them with adaptive ones. Therapy typically involves short-term goal-oriented sessions where the therapist helps the client understand how their thoughts influence their feelings and behaviors. While the duration varies per client, CBT is generally a short-term therapy that can see benefits after just a few sessions.
Solution Focused Brief Therapy (SFBT) aims to be brief, typically 5-8 sessions of 45 minutes each. It focuses on solutions rather than problems, and the future rather than the past. Key principles include focusing on exceptions, times when the problem does not occur, and having clients define their goals. Therapists ask questions about strengths, resources, exceptions, and relationships. They use techniques like the miracle question, scaling questions, and exception seeking questions to help clients envision solutions.
Alexandra Katehakis, MFT, CSAT-S, CST-S, Founder and Clinical Director of Center for Healthy Sex presents a slideshow for the International Institute of Trauma and Addiction Professionals on getting the most out of supervision and addressing counter-transference.
Motivational Interviewing - Dr Igor Koutsenok MD, MSjames_harvey_phd
Session 1 "Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes"
Presented by Dr Igor Koutsenok MD, MS (University of California San Diego, Department of Psychiatry) on 05/06/2020 during the first session of an ISSUP virtual training on MI.
**PLEASE NOTE that video slides have been removed to reduce file size**
Presentation content and learning outcomes:
After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.
Learning outcomes:
Introduction: Motivation and behavioral change in addiction medicine
Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
Spirit of MI
Expressing empathy
Roadblocks to communication
Four Processes in MI
Full details: https://www.issup.net/about-issup/news/2020-05/motivational-interviewing-course
learning objectives 16 16.1 Who seeks therapy and what are the goa.docxcroysierkathey
learning objectives 16 16.1 Who seeks therapy and what are the goals of therapy? 16.2 How is the success of psychotherapy measured? 16.3 What are some of the factors that must be considered to provide optimal treatment? 16.4 What psychological approaches are used to treat abnormal behavior? 16.5 What roles do social values and culture play in psychotherapy? 16.6 What biological approaches to treating abnormal behavior are available? Most of us have experienced a time or situation when we were dramatically helped by talking things over with a relative or friend. Most therapists, like all good listeners, rely on receptiveness, warmth, and empathy and take a nonjudgmental approach to the problems their clients present. But there is more to therapy than just giving someone an opportunity to talk. Therapists also introduce into the relationship psychological interventions that are designed to promote new understandings, behaviors, or both on the client’s part. The fact that these interventions are deliberately planned and systematically guided by certain theoretical preconceptions is what distinguishes professional therapy from more informal helping relationships. An Overview of Treatment The belief that people with psychological problems can change—can learn more adaptive ways of perceiving, evaluating, and behaving—is the conviction underlying all psychotherapy. Achieving these changes is by no means easy. Sometimes a person’s view of the world and her or his self-concept are distorted because of pathological early relationships that have been reinforced by years of negative life experiences. In other instances, environmental factors such as an unsatisfying job, an unhappy relationship, or financial stresses must be the focus of attention in addition to psychotherapy. Because change can be hard, people sometimes find it easier to bear their present problems than to challenge themselves to chart a different life course. Therapy also takes time. Even a highly skilled and experienced therapist cannot undo a person’s entire past history and, within a short time, prepare him or her to cope adequately with difficult life situations. Therapy offers no magical transformations. Nevertheless, it holds promise even for the most severe mental disorders. Moreover, contrary to common opinion, psychotherapy can be less expensive in the long run than alternative modes of intervention (Dobson et al., 2008; Gabbard et al., 1997). Numerous therapeutic approaches exist, ranging from psychoanalysis to Zen meditation. However, the era of managed care has prompted new and increasingly stringent demands that the efficacy of treatments be empirically demonstrated. This chapter will explore some of the most widely accepted psychological and biological treatment approaches in use today. Although we recognize that different groups of mental health professionals often have their own preferences with respect to the use of the terms client and patient, in this chapter we use ...
6 Great Tips you can take Away from Couples Therapyzoeclews
If you find that navigating your relationship is not as easy as you think, perhaps it is a good idea to consult with a professional. A couples therapist could be your best bet when it comes to fixing certain problems with your partner and strengthening your relationship.
Diane purcille practice inquiry quiz and reflection questionsdianepurcille
This document provides an overview of a practice inquiry model for continuing medical education (CME) for family medicine physicians. It discusses using practice inquiry sessions to help physicians work through dilemmas with patients where they may feel stuck. It encourages reflection on real patient cases and leveraging the group's clinical experiences and evidence to clarify agreements and improve patient-physician relationships. Facilitators guide the discussion with questions to help participants think more deeply about issues. Outcomes of the sessions must be documented for CME compliance but can be documented in various ways such as notes or post-session questionnaires, not just photographs. The goal is to help physicians address challenges in their practice.
Supershrinks: An Interview with Scott Miller about What Clinicians can Learn ...Scott Miller
The document summarizes an interview between Dr. David Van Nuys and Dr. Scott Miller about what really works in therapy. Some key points:
1) Dr. Miller argues that while different therapeutic approaches work, there is little evidence that diagnostic categories predict treatment outcomes or what approach works best for a specific diagnosis.
2) Research shows that on average, clients who receive treatment improve more than 80% of untreated clients, but debates over diagnostic systems and treatment approaches obscure this fact.
3) The rise of managed care and evidence-based practices has intensified debates over diagnoses and approaches, even though these factors have little bearing on outcomes according to research.
4) Dr. Miller advocates shifting the
Motivational Interviewing is an approach that uses a guiding style to engage patients and elicit their own motivations for behavior change. It has been shown to be effective across healthcare settings. Key aspects include practicing an engaging rather than directing style, developing strategies to understand patient motivations, and refining listening skills to encourage change talk. The approach aims to promote patient autonomy and work with their strengths to find solutions, rather than just focusing on problems.
This document provides guidance on effective patient interviewing skills for physicians. It discusses the importance of professionalism, ethics, using a biopsychosocial model, and patient-centered care. The four core ethical principles are autonomy, beneficence, non-maleficence, and justice. Effective communication involves actively listening, establishing rapport, asking open-ended questions to understand the patient's perspective, and using closed-ended questions to obtain specific details. The goal is to collaborate with patients to understand their health issues and concerns in a holistic manner.
The document provides information about using motivational interviewing to help patients quit smoking. It discusses the key concepts of MI including expressing empathy, developing discrepancy, avoiding argumentation, and supporting self-efficacy. Treatment options that are discussed include pharmacotherapy, behavioral modification, and arranging follow-up to monitor progress.
1. Counselling involves a counsellor helping a client explore difficulties, see things from a different perspective, and facilitate positive change through a trusting relationship.
2. The document discusses goals of counselling such as enhancing coping skills, improving relationships, promoting decision-making, facilitating client potential, and facilitating behaviour change.
3. The counselling process typically involves initial disclosure, in-depth exploration, goal setting, intervention, and evaluation or termination. Effective counselling techniques and evaluating progress are emphasized.
1. Counselling involves a counsellor helping a client explore difficulties, see things from a different perspective, and facilitate positive change through a trusting relationship.
2. The document discusses goals of counselling such as enhancing coping skills, improving relationships, promoting decision-making, facilitating client potential, and facilitating behaviour change.
3. The counselling process typically involves initial disclosure, in-depth exploration, goal setting, intervention, and evaluation or termination. Effective counselling techniques and evaluating progress are emphasized.
How To Choose The Right Therapist For You? | Solh WellnessSolh Wellness
Find your ideal mental health therapist can be tricky. Explore what to look for while finding the right therapist and online therapy options at Solh Wellness.
William Glasser developed reality therapy, which focuses on helping clients make responsible choices to meet their basic needs and improve their lives. Glasser believed human behavior is driven by five basic needs: survival, love, power, freedom, and fun. Reality therapy techniques encourage clients to evaluate their current situation, make action plans, practice new behaviors, and improve relationships to close the gap between their desired life and reality. The goal is to help clients gain a sense of control by making choices that lead to more fulfilling and productive lives.
6 PEER RESPONSES DUE IN 6 HOURS.. EACH SET OF 2 HAS ITS OWN INSTRUCT.docxpriestmanmable
6 PEER RESPONSES DUE IN 6 HOURS.. EACH SET OF 2 HAS ITS OWN INSTRUCTIONS
Respond to at least two of your classmates
KORIE'S POST:
I am going to be using my current job as a scenario. I currently work with an orthopedic, neurologist, and Interventional pain management doctor. We do send our patients out if our doctors can not fully treat the patient to there full capacity.
I have a patient that had gotten into a horrible car accident that she and her husband were hospitalized for a month from. They were driving back to FL from TX and another car went to switch lanes and he saw the car and with a quick reaction he switched lanes and with that they got dragged 10 feet under a semi truck. They had lots of neck and back pains, but mostly PTSD really badly.
I go in and I get the history and vitals and go over a bunch of things with the patient before the Dr goes in. I will present the case to the Dr and then they go in to see the patient. Once, the Dr comes out he will tell me what the plan is with the patient so then I can get them set up with all orders. When I had presented this case with the Dr, I told them all that they will need to see a Physc due to the severity of the PTSD.
The Dr did come out of the room and did tell me that he is going to be sending the patients to see a Physc as even with his neurologist skills this PTSD is out of his hands. Our, office does not do deep PTSD as this patient does need to have. We also sent the patient to see a counselor as well to have someone else to speak to regarding this accident. Some people once they are in an accident they do get very freaked out and very gittery to drive again, some have such issues that they get panic attacks or black out when in the car just as a passenger.
We had to send this patient out as our office does not handle such cases as deep with PTSD as this case was.
BROOKE'S POST:
The organization I work for now has many different departments. While we all work in public health, we all do different things. We all serve the same population but we all target different individuals in that population. I currently work in the education department which means, I cannot help an individual that comes in and needs help in the health insurance department. What I can do is refer that person out to the person in charge of that. My current workplace may not fit into this scenario as much as mental health and/or health professionals.
Scenario:
Adult male comes in to the VA clinic for his weekly marriage counseling appoint with his clinical social worker. Husband and Wife have been attending weekly cognitive behavior therapy marriage counseling for the last 4 months with no notable change in marriage or attitudes in regards to marriage. The couple has 3 children, a mix of yours, mine, and ours. Wife moved out of the couples home with the children for the last 9 months. The first appointment the couple had was separate appointments for each. It is clear t.
Maria Cambiaso | How to Choose a Psychologist?Maria Cambiaso
Maria Cambiaso: At some time in our lives, each of us may feel overwhelmed and may need help dealing with our problems. So we need outside help from a trained, licensed professional in order to work through these problems.
The document provides an overview of motivational interviewing (MI), including its goals, principles, techniques, theoretical underpinnings, and research support. MI is a client-centered counseling approach used to enhance motivation for behavior change by helping clients resolve ambivalence. It involves developing discrepancy between current behavior and goals, expressing empathy, avoiding argumentation, rolling with resistance, and supporting self-efficacy. Key techniques include open-ended questions, reflective listening, affirming, summarizing, and eliciting change talk. Research shows MI is effective for improving treatment outcomes across various health behaviors when compared to traditional advice-giving approaches.
1. PO Box 6157, Jensen Beach, FL 34957; 772.204.2511; 561.239.3640; barrylduncan@comcast.net
Dr. Barry L. Duncan, Director____________________________________________________________________
Training and Implementation of the Partners for Change Outcome Management System
A GUIDE FOR SEEKING
MENTAL HEALTH SERVICES
If you decide to seek therapy, it should work for you and with you. For this to occur, however, you
must be an informed consumer, and perhaps be a little skeptical of mental health services. First, rest
assured that therapy works! In fact, fifty years of research have unequivocally demonstrated that those
in treatment are better off than 80 percent of the people in the no treatment comparison groups. So
seeking a therapist to assist you in your efforts can be exactly what you need to inspire the changes you
wish to make. But a key factor is finding a therapist that is a good fit—not all therapists are created
equal nor are therapist's approaches all a good enough match with your preferences or ideas or what is
called your theory of change.
Finding a Therapist
The best way to start is to call prospective therapists and interview them by phone. It doesn't really
matter what professional degree the person holds (social worker, counselor, psychologist, marital and
family therapist) or whether he or she has a masters or a doctorate, unless of course you have a real
preference or believe that such distinctions are important for you; it is much more critical that you find
a person you can work with—who is good fit for you. Get the nuts and bolts questions regarding fees,
insurance, and location out of the way with the receptionist or office manager, if there is one. Tell him
or her that you are interviewing prospective therapists and would like to schedule a ten-minute phone
call with the therapist or counselor. An unwillingness to give you ten minutes to ensure a good fit
should be all the information you need to cross this one off your list. Respect the therapist's time and
keep to the ten minutes. Ask these questions or others you think relevant.
1. What is your philosophy or orientation of therapy?
2. How do you think change happens?
3. What do you think of diagnoses?
4. How important do you consider collaboration and client participation?
5. How many sessions do you average per client?
6. Do you keep outcome data? Tell me about it. If they don't monitor progress: Do you mind if
I monitor my progress? How are you at taking feedback from clients about the direction of
therapy?
Listen for answers that reflect faith in client resources, strengths, and capabilities as the cornerstone of
any change. Listen also for an emphasis on having a good relationship and the importance of your
participation. Compare the answers with your own views of how change occurs. If the therapist
identifies with a particular orientation, reflect about whether it fits your theory of change. If it is
different but you still think it has some merit, try it out. Recall that change principally results from
your input and participation-you are the star of the therapeutic drama. Research shows that:
1. Change depends on your resources and abilities. Effective therapy utilizes your strengths to create
solution possibilities.
2. 2
2. Change depends on your perceptions of the therapist and the relationship formed in therapy.
Effective therapy is based on a strong alliance.
3. Change depends upon addressing what you want, and fitting your views of change and inspiring the
hope necessary for action. Effective therapy matches your theory of change.
Seven Tips for Therapy
The way out is through the door. Why is it that no one will use this exit?
Confucius
1. If you don't like your therapist, then find another one.
Don’t be shy. No therapist can be all things to all people. Trust your gut. If you get a bad feeling or
vibe from your therapist, don’t waste your time trying to figure it out. Just go see someone else. Just
slip out the back Jack, make a new plan Stan, no need to be coy Roy, just get yourself free!
2. If you think that your therapist doesn't like you, understand you, or appreciate your point of
view, then find another therapist.
It is essential that you believe that your therapist is on your side and that you don’t have to worry about
his or her evaluation of you. If you are worried about it, then this likely is not the therapist for you.
Discuss this problem with your therapist and carefully attend to his or her reaction. If he or she
doesn’t’ change, hit the road Jack! This is one of three key elements of the alliance. Problems here
usually result in no change.
3. If you don't agree with the goals of the therapist, or do not think they are your goals, then find
another therapist.
If your therapist is telling you that you can’t get there from here, then you probably won’t. Stick to
your guns about your goals. Recall that your goals represent all your motivations and desires and will
encourage you to work hard. Agreement on goals is the second aspect of a strong alliance, so if your
therapist does not accept your preferred port of destination, abandon ship.
4. If you do not agree with the opinions or suggestions of your therapist, or if you are asking for
something and not getting it, and your feedback does not alter his or her approach, then find
another therapist.
If you want to give the therapist’s approach a shot, then do it. But if you don’t, tell your therapist that
you disagree with the approach and give him/her a chance to adjust to your feedback. But leave if he or
she persists in an approach that does not seem relevant or does not fit for you. Agreement about the
approach represents the third piece of the alliance. Get off at the next stop before this train derails.
5. If you think your therapist sees your problem or situation as hopeless or unchangeable, or that
it will require years to change, then find another therapist.
Nothing is permanent, especially problems, and besides who needs a pessimistic therapist? Hope is
critical to the change process. Without it, this plane is going down; parachute out before it crashes.
6. If you don't get something positive going within three to six sessions, talk to your therapist. If
no progress persists, then find another therapist.
Recall that change, if it is going to happen, usually happens relatively quickly. This doesn’t mean that
you will be “cured” of all difficulties in 6 sessions, it only means that you will begin to notice some
inroad to your concerns, and you will know that you are on the right track. Remember George
Washington. Ironically, old George even requested the bloodletting to be done the third time—don’t
3. PO Box 6157, Jensen Beach, FL 34957; 772.204.2511; 561.239.3640; barrylduncan@comcast.net
make the same mistake when you have evidence (on the ORS) that you are not making any progress.
Just hop on the bus, Gus.
7. If the therapist (or your doctor) recommends psychiatric medication and you have not asked
for it, or have any doubt whatsoever, find another therapist (or doctor).
If anyone tells you that you have a chemical imbalance, discuss what that really means. If you believe
that medication is the right choice for you, then do it. Please keep in mind, that just like bloodletting in
George Washington’s day, treatments today are just prevailing wisdoms of this day and time. They are
driven by market pressures and economics. Drug companies spend far more money on advertising than
on research and development, about $10,000 per physician per year. It is hard for any doctor to resist
such a barrage of marketing—they just don’t have the time to research drug company claims about
their products. Drugs are the prevailing wisdom of the day. If that fits for you, like it does for many,
then go for it; if it doesn’t, please feel free to just say “no” to drugs. You don’t need to discuss
much…just drop off keys Lee and get yourself free.
The above excerpted from What’s Right With You by Barry Duncan
About the Partners for Change Outcome Management System (pcoms.com)
The Partners for Change Outcome Management System (PCOMS) boils down to this: partnering with
clients to identify those who aren't responding and addressing the lack of progress in a proactive way
that keeps clients engaged while new directions are collaboratively sought. PCOMS monitors client
perceptions of progress and the therapeutic alliance throughout the course of therapy via two reliable
and valid four-item scales. It involves real-time comparison of client views of outcome with an
expected treatment response which serves as a yardstick for gauging client progress and signaling
when change is not occurring as predicted. With this alert, clinicians, clients, and agencies have an
opportunity to shift focus, re-visit goals, or alter interventions before deterioration or dropout. Because
of the research conducted by Duncan and colleagues at the Heart and Soul of Change Project (which
now includes 5 randomized controlled trials, a cohort study, and the first ever, large-scale
benchmarking study in public behavioral health, all published in top tier journals), PCOMS is included
in SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP). Besides the
brevity of its measures and feasibility for everyday use in the demanding schedules of front-line
clinicians, PCOMS is distinguished by its routine involvement of clients in all aspects of service
delivery.
About the Heart and Soul of Change Project (heartandsoulofchange.com)
The Heart and Soul of Change Project (hereafter the Project) is a practice-driven, training and research
initiative that focuses on what works in therapy, and more importantly, how to deliver it on the front
lines via PCOMS). The Project is distinguished by its commitment to ongoing research and
dissemination to front line practitioners. And we are distinguished by our dedication to client privilege.
Here is our mission: We are on a quest to replace client-diminishing practices with client-directed
ones: services that are based on a relational model instead of a medical one, are more informed by
client-rated outcomes than expert opinion, best guesses, or wishful thinking, and are more guided by
client preferences, culture, and ideas than theory, model, and technique. We see PCOMS as a vehicle
for these changes and the operationalization of social justice.
4. 4
About the Director, Barry Duncan, Psy.D.
Barry L. Duncan, Psy.D., is a therapist, trainer, and researcher with over 17,000 hours of clinical
experience. Dr. Duncan co-developed the measures of PCOMS to give clients the voice they deserve
as well as provide clients, clinicians, administrators, and payers with feedback about the client's
response to services, thus enabling more effective care tailored to client preferences. He is the
developer of the clinical process of PCOMS. He has over one hundred publications, including 17
books addressing client feedback, consumer rights, and the power of relationship and the common
factors. Because of his self-help books (the latest is What’s Right With You), he has appeared on
"Oprah," and several other national TV programs. His latest book, On Becoming a Better Therapist:
Evidence Based Practice One Client at a Time (2nd ed., APA, 2014) describes PCOMS as a way to
improve client outcomes at individual therapist and agency levels as well as a research proven, viable
quality improvement strategy. The Project website, https://heartandsoulofchange.com, is a major
dissemination vehicle of Barry’s work with over 250 free downloads.
About Better Outcomes Now (betteroutcomesnow.com)
Better Outcomes Now (BON) is the web application of PCOMS, created by the developer of the
clinical process of PCOMS, Dr. Barry Duncan, and the organization that conducted the five
randomized controlled trials that led to its evidence based practice designation.