Necessary Conversations in Therapy (Effectiveness, Outcomes and Research))

I had the pleasure this evening of tuning into a teleconference call with Bill O'Hanlon. Bill interviewed Bob Bertilino on effectiveness (the research supporting it) in psychotherapy. A subject near and dear to my heart, and one which is very much on the minds of the therapists I work with.

Some great ideas, and CEU's to boot (alas, we all need them!), the call was chock full of exactly what I had been hoping for...info and research on the importance of being open to evaluating what we do and what works for our clients. (And what helps them stay long enough to get something out of our work, and to really discover what that might be!)

Admittedly, I am a bit research adverse, it seems like a different language to me, but I must confess that I found the discussion lively and to the point...we do want to be effective, and there is research to help us understand what is effective and what is not. I also have to admit that there seem to be many variables in our work, and lots of dynamics to figure in....but:

The bottom line: feedback from clients is essential. And so is the therapeutic relationship. And, my own take, feedback helps move the therapeutic relationship along. Bob's got a new book coming out on the topic and there are other good reads out there as well, and check out http://www.talkingcure.com/ for some more stuff on effectiveness.

The research, according to Bill and Bob, supports the value and effectiveness of therapy. (good news!) And interestingly enough, effectiveness is more about how we are in the room than what approach we use. Helping clients to be with us requires an openness to what their agenda is, how they perceive the treatment, and what they consider useful and important in their sessions.

Though the call offered up several good ideas, and a few (buy-able) tools to help therapists along in the evaluation process, there was not enough time to delve into all the reasons that therapists hedge the issue of feedback in sessions. (Hint to Bill for another call on the topic).

My thoughts: I think we tend to be a self conscious bunch (surprise surprise), hardworking and interested in good outcomes for our clients, and subject to the many feelings that abound in the treatment room, but many therapists are uncertain about how to introduce the topic of feedback to clients, and even more unclear about what to do with it. Some therapists wait for some kind of acting out or resistance to show up (lateness, not paying, not coming to a session, problems with fees), to address the issue of how the therapy is going for the client. Until some behavioral communication happens, a discussion of the therapy itself rarely happens.

Some therapists I know ask for feedback all the time. And they do it in object neutral language that creates a safe way for the client to talk about the therapy without thinking s/he will offend the therapist ("How are the sessions going?" "What are your thoughts about our work so far?" "Are you getting what you had hoped for from therapy?") . Others prefer to give written questionnaires, but the key is to have the conversation or do the evaluation early on and ongoing and in a way that fits nicely into the session.

It requires, I think, some bravery and commitment on the part of the therapist to really use feedback as a tool for information gathering and rapport building, or as we say in analytic circles, establishing a narcissistic transference. But we can use it to help us tailor our work. I would even say that we should study the effect that asking for and getting feedback has on the client and on the treatment.

And, as always, to help the client say everything to us, including everything about the therapy itself, to allow ourselves to be open to their experiences and to learn about them and what they need is not only key to building good therapeutic relationships and doing good workbut evaluating effectiveness and getting client feedback is (point made by Bill and Bob) an ethical responsibliity.

Lots of good things to study. A big thank you to Bill for the great call, (and for taking my question!) You can check out the call on Bill's site if you are interested. Well worth it!