I am finally set up in my new office for video so I made a video for clients about PCOMS and measuring outcomes at the encouragement of Geoffry White (see how he uses the video on his website: http://mylapsychologist.com/). It is just a simple way to orient clients to the process. Feel free to use it on your website:

Multicultural proficency and social justice are integral to the Heart and Soul of Change Project and we see the use of the ORS and SRS as ways of building cultural proficiency and operationalizing social justice. Our resident social justice expert, Dr. Jacqueline Sparks, is conducing a webinar on this topic on February 24th at noon Central Time. Here is the description:

Multicultural Proficiency, Social Justice, and Partnering with Clients: Transforming Relationships of Power though CDOI
Mental health disciplines recognize the role of clients’ culture in the provision of effective and socially just services, and diversity training is prominent in most agencies and professional programs. Despite this, there is little evidence that this emphasis has led to more effective or socially just clinical work. This webinar suggests that mental health theories, policies, paperwork, and procedures continue to reproduce relationships of power that diminish client self-determination, the heart of socially just mental health practice. CDOI redefines whose voice counts and ensures that clients who differ from their counselors and represent non-dominant social groups can direct services that best fit their preferences.
This webinar will:
1. Examine the effects of inequity built into everyday mental health practices
2. Discuss emerging research in social justice in mental health
3. Present a new framework for socially just practice in mental health
4. Discuss tools for assessing social justice in participants’ own or agency practice and for devising strategies for instituting CDOI at all levels to create more equitable and effective therapeutic partnerships.

You must be a CDOI member to participant (click below)

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Consider the reach of CDOI/PCOMS: PCOMS and/or CDOI are recognized by two states (Arizona and Colorado) as an evidence based treatment and PCOMS is currently under review by SAMHSA for national evidence based treatment designation. PCOMS has been implemented by hundreds of organizations, public and private, by thousands of behavioral healthcare professionals in all 50 states and 20 countries serving over 100,000 clients a year. I think it is safe to say that CDOI and PCOMS are becoming a part of the vernacular of providing mental health and substance abuse services.

The Norwegian-American research team (Jesse Owen, Morten Anker, Jacqueline Sparks and Barry Duncan) has scored again, our fourth article based on the massive Norway Couple Feedback Study. Our article, “Initial Relationship Goal and Couple Therapy Outcomes at Post and Six Month Follow Up” has been accepted for publication in the Journal of Family Psychology. This study shows the benefits of knowing what couples want to accomplish in therapy at the outset as well as how couple therapy can help folks regardless of their goals of wanting to improve the relationship or get out of it. It is based on the scale developed by Morten Anker as well as his experience with couples wanting a variety of different things from therapy. Most if not all research in couple therapy deals with couples who desire to improve their relationship but that only covers a portion of the couples we see in real life. This study addresses that reality. It confirms the common sense notion that couples wanting to improve their relationship get better outcomes and are more likely to be together at follow up than couples in which one or both individuals are seeking clarification regarding the viability of the relationship. Moreover, it also demonstrates that couple therapy can benefit clients regardless of their initial goal. We conclude that therapist awareness of each individual’s relationship goal prior to couple therapy could enhance outcomes and treatment tailored according to initial goals could set the stage for positive outcomes however defined.

Jesse Owen, who is now a Project Leader, is doing a webinar via the member site on January 27 about these issues (Become a CDOI Member to participate):

The Couple Therapy that Nobody Talks About: Ambivalence, Commitment, and Change
This webinar discusses couple therapy in which at least one partner is ambivalent about the viability of the relationship. Commitment is vital for couples to successfully develop a secure emotional base and maintain a healthy relationship. When commitment wavers it affects nearly all aspects of the relationship, such as communication, couple identity, willingness to sacrifice, as well as respect, trust, and safety. Treating couples with wavering commitment is rarely discussed in either the theoretical or empirical literature. This webinar covers: (a) cutting-edge research on the importance of assessing couples’ initial relationship goals as a facet of the working alliance; (b) a theoretical framework to understand couples’ commitment; and (c) treatment guidelines for treating couples when at least one partner desires to clarify the viability relationship.

Two other items of interest: A brief video about On Becoming a Better Therapist that I did at APA: http://www.apa.org/pubs/books/interviews/4317217-duncan.aspx

And an interview I did with an old friend from graduate school who hosts a radio show:
http://www.clientdirectedoutcomeinformed.com/media/mp3/Wake_Up_Call_2011-11-20.mp3

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The Partners for Change Outcome Management System (PCOMS), otherwise known as CDOI, has jumped the first hurdle and is officially under review by NREPP (SAMHSA’s National Registry of Evidence-based Programs and Practices), and will soon be so designated on the NREPP website. This doesn’t guarantee that it will make the approved list but it looks very good given the research we have done, especially the RCTs (all three RCTs are available on the website). This will be, of course, quite a boon to the use of the ORS and SRS in everyday clinical practice and from my perspective quite a boost for involving clients as full partners in decisions that affect their care.

Speaking of research, there are several research projects that are in process: an RCT with returning veterans with PTSD related problems and substance abuse concerns is in the writing phase; an RCT with children with behavioral problems in the schools is in its second year of data collection; a comparison trial of residential treatment services with and without CDOI for clients with the “SMI” moniker is underway; an RCT with prescribers of psychotropic meds is in the planning stages; and a component study addressing why the feedback intervention works is also in the planning stages. I’ll keep you informed of the progress.

Along the lines of Sami Timimi’s “No More Psychiatric Labels” campaign to abolish diagnostic systems like ICD and DSM (Check it out at http://www.criticalpsychiatry.net/?p=527  Support the campaign at http://www.causes.com/causes/615071-no-more-psychiatric-labels/about), another project is underway that calls attention to the many pitfalls of the psychiatric diagnosis. I just signed their petition. Check it out: “Open Letter to the DSM-5″
http://www.ipetitions.com/petition/dsm5/?utm_medium=email&utm_source=system&utm_campaign=Send%2Bto%2BFriend

I really think this is an important cause, extremely well articulated, and I’d like to encourage you to add your signature, too. It’s free and takes just a few seconds of your time.

And, I want to call your attention to the Training of Trainers Conference in West Palm Beach, Florida from January 30 to February 3, 2012. There are still a few spots left so don’t miss out on this intense CDOI/PCOMS immersion as well as the fun and sun. I am convinced that the difference between successful and unsuccessful agency implementation boils down to having someone on site that knows the ins and outs of not only CDOI, but also the nuts and bolts of making it happen on an organizational level. Hope to see you there.

Finally, join me for this month’s webinar on ensuring data integrity and therapist understanding on November 23rd at 1PM Central. Join the member site to watch.

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I just returned a few weeks ago from Europe which included training in The Netherlands, Switzerland, and Belgium which I did for Korzybski International. They run an extensive multiyear post graduate training program in Solution Focused Cognitive Therapy, which in Europe is called the Bruges Model as well as many other useful therapeutic ideas and practices. This was my second trip for them and the more I get to know them the more I have come to like what they are doing. This trip cemented my involvement in their training program and now CDOI and PCOMS will be a fixed feature of their training. There is now a formal affiliation between the Korzybski Institute and the Heart and Soul of Change Project. This is important because it will help spread the word to many who would have otherwise never heard of CDOI or PCOMS because of language differences. While many Europeans speak English, many do not as well. French speaking folks, for example, have had little exposure to the ideas (the first edition of Heroic Client was translated but it did not include the ORS/SRS) but no longer. There is a translation of the Heart and Soul of Change in the works and I am hopeful that On Becoming a Better Therapist will be next. And, I will be conducting training in France next year which hopefully inspire interest as well.

I am pleased to announce that Luc Isebaert will join The Heart and Soul of Change Project as a Project Leader. I don’t know if you have seen the Dos Equis commercials about the “most interesting man in the world” but since meeting Luc, I beg to differ. Luc is truly a renaissance man, and a walking encyclopedia of art, music, wine, beer (his family ran a brewery and if you know anything about Belgium, you know that beer is a national treasure), history, and of course psychotherapy. Luc is also a gourmet chef and I had an amazing dinner at his home and his partner Sophie (a concert pianist who played for us over a glass of incredible Riesling wine on a piano that Franz Liszt played at the Paris World Fair in 1878). Luc and I share a common heritage in Ericksonian and systemic thinking (hence the name, Korzybski Institute) as well as many perspectives of therapy and training therapists. He co-founded the Korzybski Institute in 1982. His previous position was Chief of the Dept of Psychiatry and Psychosomatics at St John’s Hospital in Bruges. Luc was taken by CDOI’s attention to the common factors as well as the importance of monitoring outcomes.

On a more content related note, Jesse Owen just turned me on to a great alliance article: Crits-Christoph, P., Connolly Gibbons, M, , Hamilton, J., Ring-Kurtz, S., Gallop, R. (2011). The dependability of alliance assessments: The alliance-outcome correlation is larger than you think. Journal of Consulting and Clinical Psychology, 79, 267-278. Once again, a very sophisticated study validates the focus of CDOI and PCOMS. 

This study found that session 3 alliance ratings accounted for 4.7% of the variance but the average of sessions 3-9 explained a whopping 14.7% of outcome variance. This study suggests that a single session view of the relationship between the alliance and outcome very likely underestimates its impact on ultimate treatment outcome. Bottom line: Don’t underestimate the power of the alliance! In addition they recommended ongoing alliance assessment with alliance measures that don’t put too much burden on clients but that are reliable and valid. Do you know of any?

Don’t forget the upcoming webinar on supervision (Supervision Matters: Tapping into Therapist Aspirations to Get Better) coming up this Thursday, June 30 at noon Central. Join the CDOI member site to catch this one and many others.

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As I have said before, the reason that we are called the Heart and Soul of Change Project is because we are committed to both creating and disseminating research from naturalistic sites that operationalize our mission to privilege the client’s voice and enter true partnerships with those we serve. That is our ongoing project. Besides the ones I mentioned in the “Bob Bohankse Land” blog, there is another project well underway in one site and beginning in another and a completed one that just made the light of day in the Journal of Family Psychotherapy. The first randomized clinical trial of feedback ever done with children and adolescents in the schools (or anywhere else) has been underway for some time in Mary Haynes Land, otherwise known as Maine and Community Health and Counseling Services. This project has been a collaborative effort of Mary Haynes (who is also a Project Leader of the HSCP) and Liam Shaw, a supervisor of the Skowhegan office (and several dedicated therapists) with the ongoing support of Executive Director Dale Hamilton. Another site has just signed on, thanks to the leadership of Bob Bohanske and the support of the President of Southwest Behavioral Health, Jeff Jorde. Also part of the Phoenix team are Vice President Ed McClelland and Clinical Supervisor Alysson Zatarga, who will really be the ones making it happen. This study could really make a difference in how services are delivered in the schools, ensuring that kids and adolescents have a voice in decisions about their care. This study is an collaborative of Barry, Project Leader and UCA Professor John Murphy, and Art Gillaspy, Associate Professor at UCA. Considering the impact the Norway Couple Feedback Trial had on how couple services are delivered in Norway, this study could change the way services are provided in the schools.

And the completed and published project: Anker, M., Sparks, J., Duncan, B., & Stapnes, A. (2011). Footprints of couple therapy: Client reflections at follow up using a mixed method design in routine care. Journal of Family Psychotherapy, 22, 22-45. In this study, we explored client experiences of couple therapy using their written responses to questions at 6-month follow-up. We did a qualitative thematic analysis and a number of themes emerged along with client evaluations of those themes. We analyzed these with respect to the overall sample, gender, and the feedback/no-feedback groups in the original Norway Feedback Trial (Anker, Duncan, & Sparks, 2009). There were two general domains—relationship and tasks, that neatly fit Bordin’s definition of the alliance. Respondents were generally satisfied with the relationship domain, but there were more dissatisfied responses in the tasks domain. Basically, clients indicated that they liked therapists who were friendly, warm, and able to be neutral. There were more negative assessments of therapists not giving enough concrete suggestions, not challenging when appropriate, or not structuring the session. These findings did not differ significantly by gender and supported other the findings from similar studies. What was interesting had to do with the category “service delivery.” This category had the most statements in the tasks domain and there were more negative than positive. Clients were not happy with how the scheduling of therapy happened, the frequency of meetings, and lack of therapist follow-through on contacting clients between sessions and being flexible about scheduling. This was very interesting as this element of our work is rarely discussed in the literature, or training for that matter. But it is an important aspect of the alliance. Even more interesting, this was the one category that differed between the feedback and no-feedback groups, with no-feedback clients more dissatisfied with service delivery. We weren’t exactly sure what this meant, but speculated that therapists routinely getting and responding to feedback somehow were more attentive to their clients in these areas. We also asked couples what they thought of the feedback process. Over 60% of clients found it useful while less than 30% didn’t find it helpful. But the client’s goal for the relationship was important here. Of those clients who indicated that his or her goal was to improve the relationship, over 80% found the feedback process helpful.

Here is the article:

Finally, don’t forget this month’s webinar: Tuesday, May 31 at Noon Central: George Braucht and Neil Kaltenecker present: “Stand by Me: Recovery-Oriented, Person-Directed & Outcome Informed Peer Services”

This webinar highlights an application of CDOI skills and tools that blend the alcohol and other drug use recovery-oriented (RO) systems of care model with person (instead of client)-directed (PD) and outcome-informed (OI) peer-delivered services. As empirically demonstrated, transforming acute care models and techniques into CDOI services achieves improved efficiencies and outcomes that can contribute significantly to reaching the enhanced service goals fostered by the Parity and Affordable Healthcare laws. A key takeaway of this webinar is an example of how to integrate into existing services the experience, strength and hope of ROPDOI-trained people in long-term recovery along with the pervasive, culturally-diverse community resources for initiating and sustaining recovery. Building on Georgia’s seminal work on mental health peer specialists, the webinar focuses on the service delivery tools used by peer recovery coaches who have completed the Certified Addiction Recovery Empowerment Specialist (CARES) Academy. This webinar is suitable for behavioral, healthcare and social service providers and administrators; recovery community members; and others who are seeking or in long-term recovery. Participants who have not already seen Dr. Bob Bohanske’s webinar Operationalizing recovery: The Consensus Statement in Action are encouraged to view it before this webinar.

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I usually don’t write on this blog about the places I visit to do training because I don’t really want the blog to be a twitter accounting of my travels to exotic and not so exotic places. But I have to talk about my travels this week to Bob Bohankse land, otherwise known as Phoenix, Arizona. I conducted a two-day training: one day was an overview of CDOI for the new folks and the second day covered the clinical nuances of getting the max out of the measures and the four steps of CDOI supervision for the seasoned staff members and supervisors. But I went a day early and stayed an extra day so Bob and I could work on and prioritize the many projects (that is the reason that we are called the Heart and Soul of Change Project because we are committed to doing things to both create and disseminate research from naturalistic sites that operationalize our mission to privilege the client’s voice) that would advance the state of knowledge about CDOI and PCOMS and therefore further help to spread the word. Although there are several, two in particular deserve special mention. First is an article to discuss the incredible data that Bob’s agency, Southwest Behavioral Health has collected. Bob has data on over 6000 clients and the results are nothing short of phenomenal, both for kids and adults. As a teaser, here is a piece of the data offering a comparison to services delivered without CDOI and PCOMS:

Children with CDOI: Achieved reliable change on average (including caretakers) and 47% achieved all goals (v. 32%) in 128 less days.
Adults with CDOI: Achieved reliable change on average and 33% achieved all goals (v. 19%) in 138 less days.

The article also proposes that that CDOI and PCOMS not only offer a way to improve outcomes while increasing productivity and saving money, it also operationalizes the vision of “recovery” as described by the SAMSHA and the Consensus Statement of Recovery. Bob will be presenting a webinar about Operationalizing Recovery and his data on April 22. Sign up for the members site now!

The second project is joint project of Southwest Behavioral Health, the Erikson Foundation, and the Heart and Soul of Change Project, and it is redo of the “Impossible” Case Project I did way back in the early to middle 90’s that culminated in the book Psychotherapy with “Impossible” Clients. This was an inspiring project that really changed the way that I did psychotherapy. I am very proud of that project and what we found but I really didn’t know what I was doing, research wise. There were no quantitative findings and no systematic assessment of outcome or of the chart review process. Further, although I conducted interviews with all the clients at termination, it was not a systematic qualitative inquiry and therefore didn’t mine all the golden data that was there. But this project will. It will repeat the study of clients who have had multiple treatment failures and pursue their experience and perceptions of why those failures occurred as well as why the current round produced a different outcome (hopefully). The project will include Bob, me, and Jacqueline Sparks (our qualitative consultant), as well as Lynette Small and Heath Kilgore (Southwest Behavioral folks).

A special issue of the Journal of Clinical Psychology: In Session (February, 2011) addressed a topic near and dear to the hearts of CDOI therapists: Adapting Psychotherapy to the Individual Patient (sic). Here are some highlights.

Preferences: In this meta-analysis, we summarize results from 35 studies that have examined the preference effect with adult clients. Overall, clients who were matched to their preferred therapy conditions were less likely to drop out of therapy prematurely (OR=.59, p<.001) and showed greater improvements in treatment outcomes (d=.31, p<.001). Type of preference (role, therapist, or treatment type) was not found to moderate the preference effect. These results underscore the centrality of incorporating patient preferences when making treatment decisions. Swift, J.K., Callahan, J.L. & Vollmer, B.M. Preferences. Journal of Clinical Psychology: In Session, 67, 155–165.

Matching client preferences or privileging client ideas is what CDOI is all about in general, and what exploring the client’s theory is about specifically–the client’s view of the problem and how it may be best addressed including the role of therapist and the choice of any given explanation of and remedy to the problem.

Expectations: Patients’ expectations have long been considered a contributory factor to successful psychotherapy. Expectations come in different guises, with outcome expectations centered on prognostic beliefs about the consequences of engaging in treatment. Our research review includes a comprehensive meta-analysis (N =8,016 patients across 46 independent samples) of the association between pretherapy or early-therapy outcome expectations and posttreatment outcomes. The overall weighted effect size was d=.24, p<.001, indicating a small but significant positive effect of outcome expectations on adaptive treatment outcomes. Constantino, M.J., Arnkoff, D.B., Glass, C.R., Ametrano, R.M., & Smith, J.Z. (2011). Expectations. Journal of Clinical Psychology: In Session 67, 184–192.

Enhancing client expectations for success is part and parcel to CDOI clinical work. Monitoring outcome and conveying that the therapy is about change builds on expectancy effects as does matching client preferences about intervention. The alliance, expectancy, and model/technique are interdependent and overlapping. Technique is the alliance in action, carrying an explanation for the client’s difficulties and a remedy for them—an expression of the therapist’s belief that it could be helpful in hopes of engendering the same response in the client. Indeed, you cannot have an alliance without a treatment, an agreement between the client and therapist about how therapy will address the client’s goals. Similarly, you cannot have a positive expectation for change without a credible way for both the client and therapist to understand how change can happen. Soliciting systematic feedback is a living, ongoing process that engages clients in the collaborative monitoring of outcome, heightens hope for improvement, fits client preferences, maximizes therapist-client fit and client participation, and is itself a core feature of therapeutic change

Culture: We present an original meta-analysis of 65 experimental and quasi-experimental studies involving 8,620 participants. The omnibus effect size of d = .46 indicates that treatments specifically adapted for clients of color were moderately more effective with that clientele than traditional treatments. The most effective treatments tended to be those with greater numbers of cultural adaptations. Mental health services targeted to a specific cultural group were several times more effective than those provided to clients from a variety of cultural backgrounds. We recommend a series of research-supported therapeutic practices that account for clients’ culture, with culture-specific treatments being more effective than generally culture-sensitive treatments.  Smith, T.B., Domenech Rodríguez, M., & Bernal, G. (2011). Culture. Journal of Clinical Psychology:In Session, 67, 166–175.

And of course, we believe that being outcome informed allows one to be more culturally sensitive. Privileging the client via practice based evidence levels the counseling process by inviting collaborative decision making, honoring client diversity with multiple language availability, valuing local cultural and contextual knowledge, and amplifying the voice of the disenfranchised.

Don’t forget the upcoming webinar: Become a CDOI Member!
Title: Barry Duncan – Therapeutic Work: It’s Not Just for Clients Anymore; Date: Monday, March 28, 2011;  Time: 12:00 PM – 1:00 PM CDT

Sometimes being a therapist feels like the worst job on earth: worse than tarring roofs in Miami in August, draining septic tanks, or being the new Star Trek crewmember who just beamed down to a hostile planet with Kirk, Bones, and Spock. Media depictions of therapists tend to cast us as crackpots and we are 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. Our culture just doesn’t seem to value what we do. While some still thrive in private practice, most of us make far less than we did during the so-called golden era of insurance reimbursement. And, for many in public behavioral health settings, continual cutbacks and the pervasive threat of layoff are a way of life. The typical therapist working in an agency faces many hardships—seemingly unattainable productivity requirements, insurmountable paperwork, and more and more intrusive funder oversight. And this does not even speak to the emotional downsides of the work, the sometimes overwhelming tragedy of the human condition that seems inured to our best efforts—the stories of suffering that are sometimes hard to shake.
Here are two very funny, jaded (but sadly true in parts) accounts of the downsides, one addressing becoming a clinical psychologist and the other about becoming an MSW.

But we don’t do this work because we thought we would acquire the lifestyles of the rich and famous or the adoring eyes of a grateful nation; and we knew at the outset that mixing it up in the morass of human misery would not be a walk in the park. It is amazing to think, especially in these hard economic times that smart, creative individuals make the necessary sacrifices to attain advanced degrees only to earn far less money than those with comparable education in other fields—and willingly face a constant pelting of the pitfalls of being human. Doing the required servitude without the promise of a rags to riches future only makes sense because being a psychotherapist is more of a calling than a job—a quest for meaningful activity and personal fulfillment as well as an altruistic desire to be useful to others. This says something quite good about us and our career choice, something characteristic and perhaps idiosyncratic about us.

But many of us are battle weary, even shell shocked, and in the face of media ridicule, cultural devaluation, and financial uncertainty may have all but forgotten why we enlisted in the therapy rank and file in the first place. How does a therapist on the front lines keep going?

The answer may surprise you. More on that next time. That’s what On Becoming a Better Therapist is all about.

Don’t forget to join the member site so you can check out the upcoming Webinar addressing case management by Dr. Mary Haynes. Here’s the blurb: This workshop explores the ground-breaking expansion of the use of feedback to case management services. Based on her eight years of experience in extending the use of outcome management to settings other than traditional therapy, Mary will address the unique benefits and challenges of incorporating client feedback in community-based work with adults.

The Heart and Soul of Change Project (HSCP) 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 client based outcome feedback, or what is called the Partners for Change Outcome Management System (PCOMS). Consequently we are not just interested in capitalizing on what others do; rather the HSCP team produces research and directly translates it to clinical practice in the real world. The Norway Feedback Trial and Alliance Study is a case in point–these studies led to national implementation of PCOMS in Norway. And the hits just keep coming. First, the third randomized clinical trial (RCT) demonstrating the dramatic improvement in outcomes provided by merely adding feedback to therapeutic mix via the ORS and SRS is now in print. This is the replication study of the Norway Feedback Trial and it is an uncanny replication. This study found almost identical findings: four times as many couples achieved clinically significant change and the effect size for feedback was .49. Congratulations to Jeff Reese, Project Leader of the HSCP, and his research team for helping put CDOI and PCOMS on the map. This study culminated in our submission to SAMSHA for evidenced based treatment status (more on that later as well as the important distinction between evidence based treatment and evidence based practice).
Here is the study:

We have three RCTs in progress: one with returning veterans, one with kids in the schools, and one study seeking to ferret out what really causes the feedback effect, or what is called a component study. Stay tuned.

Next in print is the “Footprints” article to appear next month the in Journal of Family Psychotherapy. This article looked at 6 month follow up data from the Norway Feedback Trial. As just a teaser of a study that reaffirms the importance of the alliance plus throws in a few curves, we found that clients in the non-feedback group were significantly more likely to complain about the therapy service delivery than feedback clients. More on this next month.

And a soon to be published (in the 2nd edition of the John Norcross book, Psychotherapy Relationships that Work) meta-analysis of PCOMS studies conducted by feedback pioneer Michael Lambert and K. Shimokawa found that those in feedback group had 3.5 higher odds of experiencing reliable change and less than half the odds of experiencing deterioration.

Finally, check out the next webinar by Dr. Mary Haynes: Creative Applications: CDOI in Case Managment
This workshop explores the ground-breaking expansion of the use of feedback to case management services. Based on her eight years of experience in extending the use of outcome management to settings other than traditional therapy, Mary will address the unique benefits and challenges of incorporating client feedback in community-based work with adults.

Join the member site now!

The first annual Heart and Soul of Change Project Training of Trainers Conference occurs next week in West Palm Beach. It looks like a talented group of participants and I am excited to be a part of it. Bob Bohanske and Jacqueline Sparks, Project Leaders, will be joining in toward the end of the week. As I have reflected about what I thought the six most important things that the TOT should cover and what people should understand, I came up with the following list:

• Dodo Verdict: Implications for Psychotherapy as well as the EBT v. EBP Controversy
• Common Factors: The Heart (the Client) and Soul (the Alliance) of Change
• Rationale for Practice Based Evidence and the Power of Feedback
• The Predictors of Ultimate Outcome (Early Change and the Alliance)
• The Clinical Nuances of Using the Measures and Making them Meaningful to the Work
• The Keys to Agency Implementation including Culture Building, Integration at All Levels, and especially, Supervision

There are more to be sure and client privilege is built in to each of the above. But this seems to capture the stuff that forms the foundation of an understanding of client directed, outcome informed clinical work.

Speaking of the EBT v, EBP controversy, I did a webinar last Friday for the CDOI Members (now over 300 and growing). Here is the description:
In this seventh of seven webinars corresponding to the seven chapters of On Becoming a Better Therapist, Barry discusses the fifth and final step to keep your development on the front burner and accelerate your growth as a therapist, the Treasure Chest. This collection of client comments about your work with them and your own articulations of the experiences that meant the most to your development help you to re-remember why you became a therapist while tracking your development as a therapist through narrative accounts of the clients who taught you the most. Barry will also discuss the controversial issues of the day–managed care, evidence based practice, psychiatric drugs, and the medical model–and encourage you to take a stand to protect the aspects of your identity as a therapist that you hold dear.

Why am I telling you this if you not a member? Because I messed up when I presented it the first time and didn’t record the video portion of the presentation. Chalk it up to old age or whatever. So I had to do it over for the members but the good news is that it left me with an audio recording that I can make available to anyone interested. So here it is.

And speaking of the book, here is a review that appeared in Psychotherapy in Australia, by experienced clinician Bill Robinson.