It is always fun to post good news, to let folks know that CDOI continues to grow and is having an impact. One area that will lead to the expansion of CDOI practices is its inclusion in graduate training programs. This is a major strategic goal of the Heart and Soul of Change Project (HSCP) and we will reach out to professors and researchers to invite them to both conduct research and teach CDOI ideas and practices. The Norway Feedback Project will assist us in this endeavor because it brings academic credibility to the measures and is a nice calling card.
You might already know that Dr. Jacqueline Sparks, Project Leader at the HSCP, has implemented an outcome management protocol with students in her MFT program and clinic at the University of Rhode Island. Jackie’s program uses ASIST and can truly claim to not only train competent clinicians, but also effective ones. It also sets the course for new graduates on a lifelong journey of monitoring their effectiveness and their cumulative career development. Consider the benefits for these budding clinicians and for anyone who decides to monitor outcomes over the course of their career. Such a process allows a strategic trial and error application of new learning as well as the continual refinement of the tried and true mechanisms that we know enhance outcomes. In short, it enables you to take action about your effectiveness. It permits you to learn from your experience, not repeat it. (see below)
Now Jackie’s program is not the only one.
Jeff Reese, the researcher at University of Kentucky who conducted an independent RCT using the ORS and SRS that will soon appear in the prestigious journal Psychotherapy, brought me to UK last week to present to both students and faculty, and the community. After my visit with the Counseling Psychology department, standing on the strong shoulders of Jeff’s work, the program faculty unanimously decided to implement the ORS and SRS as an integral piece of their clinical training. Students will use the measures in their practicum training, and the faculty believes that it will not only strengthen their training, but will also operationalize their commitment to social justice. That’s what I am talking about!
The Heart and Soul of Change Project, like my new book, On Becoming A Better Therapist, suggests that you step up to the plate with two things: attaining systematic client feedback and taking your development as a therapist to heart. Integrating these two critical aspects, I believe, can open new vistas for therapists wishing to rapidly impact the quality of their work with clients. Attaining client feedback is a simple but clinically nuanced process of collaborating with clients, forming true partnerships, and enhancing the factors known to impact outcomes. It helps us know we are on track, enables us to empower change, and it provides an early warning system for clients at risk for drop out or other negative outcomes. Collecting client feedback also paves the way for your development as a therapist.
In a remarkable study, veteran researchers David Orlinsky and Helge Rønnestad (2005) took an in-depth look at therapists’ experience of their work and professional growth. Over a 15 year period, they collected richly detailed reports from nearly 5000 psychotherapists of all career levels, professions, and theoretical orientations from over a dozen countries. From their analyses of many specific aspects of therapeutic work, a mode of therapist participation was identified:
Healing Involvement reflects a mode of participation in which therapists experience themselves as personally committed and affirming to clients, engaging at a high level of basic empathic and communication skills, conscious of Flow-type feelings during sessions, having a sense of efficacy in general, and dealing constructively with difficulties if problems in treatment arose. Healing Involvement represents us at our best—the way we want to be with our clients. Think of it as being “in the zone” akin to how athletes describe their experience when their performance is optimal. Their extensive investigation identified three sources of Healing Involvement, a therapist’s experience of being in the zone: First is the therapist’s sense of cumulative career development—improvement in clinical skills, increasing mastery, and gradual surpassing of past limitations. Second, another important influence on Healing Involvement is the therapist’s sense of theoretical breadth. Orlinsky and Rønnestad suggest that understanding clients from a variety of conceptual contexts enhances therapist’s adaptive flexibility in responding to the challenges of clinical work. Indeed, broad spectrum integrative-eclectic practitioners were more likely to experience Healing Involvement. The third and by far most powerful influence on being in the zone is the therapist’s sense of currently experienced growth. Therapists like to think of themselves as developing now. Your ongoing experience of professional development is therefore critical to becoming a better therapist. In a sense we continually ask ourselves, “What have you done for me lately?” Therapists with the highest levels of current growth showed the highest levels of Healing Involvement. Orlinsky and Rønnestad suggest that the experience of current growth translates to positive work morale and energizes therapists to apply their skills on behalf of clients.
How does all this relate to client feedback? Tracking client responses to therapy provides an accessible route to being in the zone, addressing all three sources identified by Orlinsky and Rønnestad. First, collection of client feedback allows you to monitor your outcomes and plot your career development, so you will know about your effectiveness and whether you are improving. Moreover, charting your outcomes not only permits a more systematic process of planning and implementing strategies to improve your effectiveness, it also permits your evaluation of the strategies and whether or not your time might be better spent elsewhere. Second, tailoring your approach based on client feedback about benefit and the fit of the services will lead you to theoretical breadth as you expand your repertoire to serve more clients. Soliciting client feedback enhances your ability to be tuned to client preferences and encourages your flexibility to try out new ideas in search of what resonates with clients—opening you to a range of theoretical explanations and attending methods. Finally, securing client feedback seats you in the front of the class so you can readily see and hear the lessons of the day—to experience your currently experienced growth. Practice based evidence encourages your continual professional reflection with each client, thereby increasing your learning potential exponentially. Client feedback is the compass that provides direction out of the wilderness of negative outcomes and average therapy—taking the notion of clients as the best teachers of psychotherapy well beyond cliché, significantly accelerating your development as a therapist, and helping you become a better one.
Over the next several months, I’ll blog how you can accelerate your development as a therapist. Stay tuned.