Feedback Enhanced Therapy…Off and Running

The iPads have arrived…and with it, our official launch of feedback enhanced therapy. They are so much fun to use, and learning how to use them has been a breeze:

I got a call from Dr. Eric Kuelker, a psychologist with Mental Health Pros, last fall. He called to tell me about a the largest mental health portal on the web. In addition to allowing clients full access to written information, video and audio seminars, mental health inventories, and the like, it also allows clients access to a secure and private electronic journal for them to organize their thoughts prior to a session. This journal can be for a client’s own use, or the client can allow the therapist to see it prior to the session to allow the session to be focused on the target at the launch of a session.

The most significant factor of Mental Health Pros is that it allows therapists to check in with clients to see how they are doing, and how they are perceiving therapy. Our new iPads allow the therapist and client to use less than a minute at the beginning and end of each session to do a “check”. The research speaks to the incredible ability of this to allow the therapist to adjust and tweak the approach to maximize the effectiveness of therapy for each client.

No two people are alike.

Duh.

But we as therapists haven’t always acted on that knowledge!

If you have more than one child, you know that what works for one child, and is generally recognized to be an effective strategy for parenting, may not work for the other child. One infant may want to be held upright, another held tight on his belly, or loosely on her back. One student benefits from written instructions, another by talking themselves throught it; one by repetition, another by creative problem solving. One employee benefits from watching others for a while, another learns best by jumping right in and learning by experience.

Different strategies have varying degrees of effectiveness because we’re all different.

And because we’re all different, what works for each person in counselling is also different.

Therapists have long recognized this, and seek to work with each client, adjusting their approach. However, historically, we’ve done this haphazardly, by working to “read” our clients’ preferences without overt discussion, and sometimes in the intense work of counselling, it can be overlooked.

At Bergen and Associates, we take research seriously, and the evidence is solid. We need to take a look at how clients are perceiving the effectiveness of therapy, and how well the therapist is working with them. The evidence is clear, has been replicated in repeated double blind studies (the “gold standard” for research):

• Improvement in a person’s functioning is greater when close attention is paid to how well the client feels the therapy is progressing. This was measured by therapists dividing their caseloads in half…one half were asked for verbal feedback as per usual, and one half completed the objective outcomes. The clients that provided objective feedback had on average, double the amount of positive change, than those who did not.
• When therapists use outcome measures with couples, they report a greater sense of happiness in their marriage than when it is not used. This sense of greater marital satisfaction continues to hold 8 months after therapy has ended.
• Researchers looked at the separation rate of couples…what difference did objectively measuring feedback make? When therapists got regular objective feedback from each spouse during therapy versus the control group who did not get this feedback, it was significantly different. The number of couples who had separated in the six months after therapy was cut in half when they were in the group who were able to increase the effectiveness of therapy with objective feedback.

Dr. Kuelker didn’t have to convince me on the importance of getting a good working alliance with my clients. I teach students at the University of Manitoba, and I spend time each year with them, showing the evidence that says that this is the single most important factor to a successful outcome. What I was a little skeptical about was how much difference such brief objective measures could make to the outcome of therapy. I needed to see for myself…and so I tried this system out for myself.

I have been using this system for the last 10 months or so. I have become convinced that this has made me a better therapist, allowed me to work more effectively with each client, and has allowed clients that I work with to be able to move more effectively into their future. It creates possibilities for more effective conversations. It allows clients to let me know how we can make adjustments so that sessions work better. It aknowledges that clients have an important role in helping establish the rhythm and style of the session. It recognizes that each individual and couple will have a slightly different preferred way of doing therapy–and it allows the client to help shape what that looks like.

I am aware that clients invest significant resources and are willing to risk becoming very vulnerable with us–we have a HUGE obligation to provide the very best experience and outcome possible for each client.

I take this seriously, and we are now set up to have each new client be enrolled in the Mental Health Pros system, with all of its advantages.

All of the therapists are now using this system with new clients. It’s a new era for Bergen and Associates. The recent release of the iPad is great timing for us (well, except the loooong wait for these little delights to arrive–they were on serious back order–but they finally came last week)…it facilitates the completion of the tools on a system that is easy for all clients to use. Mental Health Pros is a secure site that holds the information for us, and graphs the results so instantly both client and therapist (and referring physician if the client wishes) can see what difference the therapy is making in a person’s life. If something isn’t working, and we can see that, we can very quickly make decisions about how best to proceed.

Of course, if a client prefers to do therapy without this resource, this will certainly be respected. Our goal is to provide you with the best experience possible…and your input and wishes shape this experience “from the ground up”–if you are not comfortable with this, then please let us know.I

I’m excited about this enhanced ability to work even more effectively with clients.

Not long ago, I was finishing up with a client* that I worked with for a few months. We used the formal objective feedback measures, adjusting and tweaking as we went along.